[Acute abdomen in patients under anticoagulant treatment]

Hemorrhagic complications induced by anticoagulants occur in about 10-20% of patients treated. The bleeding source is found in the gastrointestinal tract in 30%. A careful history and physical examination, in combination with radiologic evaluation, serve to localize the bleeding site and avoid unnecessary surgery. Because anticoagulated patients may have the clinical picture of acute abdomen, it is important to differentiate extra-, intra- and retroperitoneal complications. During the past ten years we have treated 16 patients with acute abdomen under anticoagulation therapy: extra-, intra- and retroperitoneal complications were found in three, nine and four cases respectively. Rectus sheath hematomas, intramural bowel hematomas and retroperitoneal hematomas primarily underwent conservative, symptomatic treatment. Only intraperitoneal hemorrhage and psoas hematomas with neurologic manifestations required early surgical treatment. After successful treatment the indication for anticoagulation therapy should be reevaluated.