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Anticoagulation-induced spontaneous intramural small bowel haematomas
Adrian Zammit1, Deborah Grech Marguerat, Clifford Caruana
1Department of Surgery, Mater Dei Hospital, Malta, Msida, Malta. a.zammit.12@ucl.ac.uk
BMJ Case Reports
|June 6, 2013
Summary
Small intestinal intramural hematomas can occur spontaneously, particularly in patients with impaired clotting. This case highlights a warfarin overdose leading to such a hematoma and subsequent small bowel obstruction, successfully managed conservatively.
Area of Science:
- Gastroenterology
- Hematology
- Radiology
Background:
- Small intestinal intramural hematomas (SIH) are rare, often associated with coagulopathy.
- Anticoagulant medications, like warfarin, can increase the risk of spontaneous bleeding complications.
Observation:
- A 57-year-old male presented with abdominal pain due to an inadvertent warfarin overdose.
- Computed tomography (CT) revealed duodenal, distal ileal, and terminal ileal wall thickening with proximal small bowel dilation, suggesting obstruction.
Findings:
- The patient was managed conservatively with nasogastric intubation and intravenous fluids.
- Anticoagulation was reversed using fresh frozen plasma and vitamin K, leading to clinical improvement.
Implications:
- This case underscores the importance of recognizing coagulopathy as a precipitating factor for SIH.
- Conservative management combined with reversal of anticoagulation can be effective for warfarin-induced SIH with obstruction.
- Resolution of SIH and obstruction was confirmed on follow-up CT imaging.
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