Submucosal hematoma presenting as small bowel obturator obstruction in a patient on low-molecular-weight heparin

Area of Science:

• Pediatric Hematology
• Gastroenterology
• Pharmacology

Background:

• Low-molecular-weight heparin (LMWH) is increasingly used for pediatric venous thromboembolic disease due to predictable pharmacokinetics and a lower risk of complications like osteoporosis and heparin-induced thrombocytopenia compared to unfractionated heparin and coumadin.
• Severe hemorrhage is a rare adverse event in children treated with LMWH.

Observation:

• A case report details a child treated with enoxaparin (a type of LMWH) who developed a completely obstructing small bowel wall hematoma.
• This is the second reported instance of a small bowel obstruction secondary to a hematoma in a child receiving LMWH therapy.

Findings:

• The patient required bowel resection due to the severity of the obstruction caused by the hematoma.
• This case highlights a rare but serious gastrointestinal complication associated with LMWH treatment in pediatric patients.

Implications:

• While LMWH is generally safe and effective in children, clinicians should be aware of the potential for rare gastrointestinal complications such as small bowel obstruction from hematoma.
• Further investigation may be warranted to understand the mechanisms and risk factors for this specific adverse event in pediatric populations.
• This finding emphasizes the importance of vigilant monitoring for gastrointestinal symptoms in children receiving LMWH therapy.