Anticoagulant-induced intramural intestinal hematoma

doi:10.1016/S0735-6757(02)42258-9

The American Journal of Emergency Medicine

Volume 21, Issue 3, May 2003, Pages 208-211

https://doi.org/10.1016/S0735-6757(02)42258-9 Get rights and content

Abstract

Intramural hematoma of the intestine is a rare complication of anticoagulant therapy. We evaluated 7 nontrauma patients with intramural hematoma of the intestine diagnosed at our institution between May 1998 and June 2001. All of the patients were receiving long-term anticoagulant therapy for previous diseases. All 7 patients had abdominal pain, 6 had additional symptoms of nausea and vomiting, and 4 had melanotic stools at admission. Six of the patients had abnormal coagulation parameters. Both abdominal ultrasonography (US) and computerized tomography (CT) showed the exact pathology in all patients. Five of the 7 patients were treated, nonoperatively, and the other patients underwent surgery. All of the patients were followed with abdominal US and CT (mean 12 = months), with complete resolution of their intramural hematomas. Abdominal US and CT evaluation performed together will help the accuracy of diagnosis of intramural hematoma, but nonoperative therapy is the treatment of choice, with surgery indicated if generalized peritonitis or intestinal obstruction develops.

Section snippets

Methods

Between May 1998 and June 2001, a total of 7 cases of spontaneously occuring intestinal hematoma were diagnosed in our ED. The patients were 4 females and 3 males, with a mean age of 61 years (range 44-78 years). All of the patients suffered from abdominal pain, 6 had additional symptoms of nausea and vomiting, and 4 had melanotic stools (Table 1). At admission, the mean duration of the patients complaints was 3 days (range = 1–4 days). All of the 7 patients had overdosage of warfarin sodium;

Discussion

Intramural hematoma of the intestine is an uncommon complication of anticoagulant therapy. Partial or complete bowel obstruction resulting from intramural hematoma is a relatively unusual and poorly understood condition.5 The use of anticoagulants such as warfarin sodium is increasing in many branches of medicine. Anticoagulants enjoy widespread usage, and the incidence of intramural hematoma of the intestine in the setting of anticoagulation is relatively rare (Better, Montani, and Bachmann

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Brief reportAnticoagulant-induced intramural intestinal hematoma

Abstract

Section snippets

Methods

Discussion

Am J Surg

Radiol Clin North Am

Oral anticoagulant drugs

N Engl J Med

Unusual complication of warfarin coumadin sodium toxicity

Wis Med J

Anticoagulants, thrombolytic and antiplatelet drugs

Incidence of intramural digestive system hematoma in anticoagulation. Epidemiological study and clinical aspects of 59 cases observed in Switzerland

Schweiz Med Wochenschr

Brief report
Anticoagulant-induced intramural intestinal hematoma