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Coumadin-induced gastrointestinal hemorrhage associated with an ileal duplication
D A Staunton1, A F Jacobson, D Thorning
1Nuclear Medicine Section, Department of Veterans Affairs Medical Center, Seattle, WA 98108.
Insights
A young man experienced gastrointestinal bleeding after starting coumadin. Doctors found an inflamed intestinal duplication caused the hemorrhage, highlighting this rare cause in patients on anticoagulation.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Medical Diagnostics
Background:
- Anticoagulation therapy, such as with warfarin (coumadin), is crucial for patients post-aortic valve replacement but carries a risk of gastrointestinal bleeding.
- Recurrent gastrointestinal hemorrhage can be challenging to diagnose and manage, especially in young patients.
Observation:
- A 31-year-old male presented with recurrent gastrointestinal bleeding following aortic valve replacement and initiation of warfarin therapy.
- Diagnostic imaging, including radionuclide bleeding scans and contrast angiography, localized the bleeding site to the distal ileum.
Findings:
- Surgical exploration revealed a 1.8-cm spherical duplication in the ileum.
- Histological examination identified an inflammatory ulceration near the opening of the duplication as the source of hemorrhage.
Implications:
- Alimentary tract duplications, though rare, should be considered in the differential diagnosis of anticoagulation-associated gastrointestinal hemorrhage in young individuals.
- This case underscores the importance of thorough investigation for underlying structural abnormalities in patients with unexplained bleeding during anticoagulant therapy.
Abstract:
A 31-year-old man had recurrent gastrointestinal hemorrhage after aortic valve replacement and initiation of anticoagulation therapy with coumadin. Radionuclide bleeding scan and subsequent contrast angiogram demonstrated a site of hemorrhage in the distal ileum, and at surgery a 1.8-cm spherical duplication was found. On histologic examination, the duplication was lined with normal ileal mucosa, and near the mouth of the duplication an inflammatory ulceration proved to be the site of hemorrhage. In a young patient with anticoagulation-associated gastrointestinal hemorrhage, alimentary tract duplication should be considered.