Brodifacoum poisoning presenting with hematemesis and esophageal hematoma

Brodifacoum, a potent long-acting anticoagulant rodenticide, causes severe coagulopathy by inhibiting vitamin K recycling, leading to life-threatening hemorrhage. We report a rare case of a large esophageal hematoma with upper gastrointestinal bleeding in the setting of brodifacoum poisoning.

A 73-year-old woman with depression presented with severe upper gastrointestinal bleeding with a large esophageal hematoma. Her coagulopathy was initially responsive to vitamin K1 but recurred after treatment discontinuation. Toxicology confirmed intentional long-acting anticoagulant rodenticide poisoning (serum brodifacoum concentration of 2,181 μg/L). Symptoms improved with intravenous vitamin K1, but she died by suicide after discharge.

Contrast-enhanced computed tomography showed esophageal nodules with contrast extravasation; esophagogastroduodenoscopy confirmed a longitudinal submucosal hematoma.

Most esophageal injuries in poisoning result from local events (such as caustics and bezoars) and complications of vomiting or lavage. These images highlight the systemic toxicity of anticoagulation. The management of brodifacoum poisoning is challenging due to its long elimination half-life (16-62 days), far exceeding that of warfarin (17-48 h).

An esophageal hematoma as a rare but severe complication of brodifacoum poisoning, emphasizing the need for early diagnosis, a full course of vitamin K1 therapy, and integrated psychological care.