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Related Experiment Videos

[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
PubMed
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.

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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.

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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.