Overlooked complication of anticoagulant therapy: The intramural small bowel hematoma—A case report

• Published in: International journal of surgery case reports 2017-01, Vol.39, p.305-308
• Main Authors: Pimenta, Joana Marantes, Saramet, Raluca, Pimenta de Castro, João, Pereira, Luís Gabriel
• Format: Article
• Language: English
• Subjects: Abdominal pain; Anticoagulant therapy; Case report; Intramural small bowel hematoma; Warfarin
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2017.08.054

•Intramural small bowel hematoma is a haemorrhagic complication of anticoagulant therapy.•Abdominal complaints and elevated INR value should prompt suspicion.•CT scan is the preferred imaging method.•Immediate suspension of anticoagulant drugs and antidote administration is required. Intramural small bowel hematoma is a rare, and often overlooked consequence of anticoagulant therapy. In this report we present such a case in order to bring forth awareness to this entity, and its management. We report a 81-year old male who presented with abdominal pain for 2days. He had been under anticoagulant therapy with warfarin for 9 years, presenting with an elevated INR of 6,2. Intramural small bowel hematoma was confirmed with abdominal ultrasound and CT scan. The patient was treated conservatively with anticoagulant suspension and administration of antidote, and was subsequently discharged after 6days. Abdominal complaints and an elevated INR value point to the possible diagnosis of intramural small bowel hematoma, however these abdominal symptoms can vary between a mild pain and an established acute abdomen. CT scan showing symmetric bowel thickening associated with some luminal narrowing confirms the diagnosis. In terms of management, there are not sufficient papers to support a standardized treatment; currently the most accepted approach seems to be conservative treatment after the exclusion of complications that would call for surgery. Anticoagulant therapy is becoming a widespread prescription as the population ages, and intramural small bowel hematoma is one consequence in need of consideration