Contained Juxtarenal Aortic Perforation in the Setting of Severe Warfarin-Associated Coagulopathy

Severe warfarin-associated coagulopathy is a known cause of major bleeding; however, its relationship with large-vessel structural complications remains poorly defined. Spontaneous rupture or perforation of a nonaneurysmal abdominal aorta is rare and may present atypically, particularly when hemorrhage is contained.

A 90-year-old woman on chronic warfarin therapy presented with abdominal pain and an unmeasurable international normalized ratio. Computed tomography demonstrated a contained juxtarenal aortic perforation with a retroperitoneal hematoma, whereas prior imaging weeks earlier showed no aneurysm. Anticoagulation was reversed and hemodynamic control was initiated. Because of high operative risk, she was transitioned to comfort-focused care.

This case highlights acute aortic perforation in the absence of prior aneurysmal disease. Although anticoagulation is unlikely to directly cause rupture, it may exacerbate hemorrhage following structural disruption, likely related to underlying atherosclerotic or ulcerative pathology.

Early imaging, prompt reversal, and hemodynamic control are essential, although outcomes remain poor without definitive intervention.