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Overlooked complication of anticoagulant therapy: The intramural small bowel hematoma-A case report
Joana Marantes Pimenta1, Raluca Saramet1, João Pimenta de Castro1
1Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal.
Introduction:
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.
Presentation Of Case:
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.
Discussion:
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.
Conclusion:
Anticoagulant therapy is becoming a widespread prescription as the population ages, and intramural small bowel hematoma is one consequence in need of consideration.
Insights
Intramural small bowel hematoma, a rare complication of anticoagulant therapy, can cause abdominal pain. Conservative management is often effective for this condition, especially when diagnosed early via imaging.
Area of Science:
- Gastroenterology
- Internal Medicine
- Radiology
Background:
- Intramural small bowel hematoma is a rare complication of anticoagulant therapy.
- It is often overlooked in patients on anticoagulants.
- This case report aims to increase awareness and discuss management.
Purpose of the Study:
- To present a case of intramural small bowel hematoma in a patient on warfarin.
- To highlight the diagnostic features and conservative management of this condition.
Main Methods:
- Case report of an 81-year-old male with abdominal pain.
- Patient was on warfarin with an elevated INR (6.2).
- Diagnosis confirmed with abdominal ultrasound and CT scan.
Main Results:
- The patient presented with abdominal pain and an elevated INR.
- Imaging confirmed intramural small bowel hematoma.
- Conservative treatment with anticoagulant suspension and antidote was successful.
Conclusions:
- Abdominal complaints and elevated INR suggest intramural small bowel hematoma.
- CT scan is crucial for diagnosis, showing bowel thickening and luminal narrowing.
- Conservative management is preferred after excluding surgical complications.
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