Intermittent absorption of warfarin caused by an unrecognized pharyngeal pouch

An 80 year old woman on long term warfarin presented with an acute haemarthrosis of her right knee. Further investigations revealed a large pharyngeal pouch and a history of tablet regurgitation was obtained. Surgical resection was necessary 12 months later to ensure predictable absorption of orally administered drugs. The varying presentation of pharyngeal pouches and the importance of this complication are discussed.