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[A false incisional hernia during coumarin anticoagulation]
H M Gabriel1, L M Falcão, A O Soares
1Serviço de Medicina I, Hospital de St. Maria, Faculdade de Medicina, Lisboa.
Acta Medica Portuguesa
|October 1, 1995
Summary
A giant pelvic hematoma was misdiagnosed as an incisional hernia in a patient on chronic anticoagulation. This case highlights diagnostic challenges and the risks of anticoagulation in patients with complex medical histories.
Area of Science:
- Clinical Case Report
- Surgical Diagnosis
- Anticoagulation Management
Background:
- A 56-year-old female patient with a history of rheumatic polyvalvular disease, atrial fibrillation, and prior brain embolism was on chronic coumarin anticoagulation.
- The patient presented with symptoms initially suggestive of an incisional hernia following a previous McBurney laparotomy.
Observation:
- Upon admission, the patient's International Normalized Ratio (INR) was significantly elevated at 6.6.
- A giant pelvic hematoma with abdominal wall infiltration was identified, distinct from the initial hernia diagnosis.
Findings:
- The case illustrates a diagnostic challenge where a pelvic hematoma was mistaken for an incisional hernia.
- The patient's high INR indicated a heightened risk of bleeding complications.
Implications:
- This report underscores the importance of considering uncommon diagnoses, especially in patients with specific risk factors like chronic anticoagulation.
- It prompts a discussion on the risk-benefit balance of long-term oral anticoagulation in patients with recurrent embolic events.