Abstract
Oral anticoagulants, such as warfarin, are widely used in many indications, such as pulmonary thromboembolism, deep vein thrombosis, prosthetic valves, and persistent atrial fibrillation. Although hemorrhage is a major complication of warfarin, spontaneous intestinal intramural hematoma is a very rare condition. Spontaneous intestinal intramural hematoma caused by oral anticoagulant therapy is not a life-threathening complication as the other hemorrhagic complications of warfarin use. However, this condition may mimic other reasons of acute abdomen. For this reason, emergency medicine physicans and general surgeons should keep in mind this condition among the differential diagnosis of acute abdomen. Herein, we present two surgically treated patients with spontaneous intestinal intramural hematoma.
Keywords:
Spontaneous intestinal intramural hematoma, warfarin, oral anticoagulant, acute abdomen
References
1Oake N, Jennings A, Forster AJ, Fergusson D, Doucette S, van Walraven C. Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: A systematic review and meta-analysis. CMAJ 2008; 179; 235-244. doi:10.1503/cmaj.080171
2Hirsh J. Oral anticoagulant drugs. N Engl J Med 1991; 324: 1865-1875.
3Palareti G, Leali N, Coccheri S, Poggi M, Manotti C, D'Angelo A, Pengo V, Erba N, Moia M, Ciavarella N, Devato G, Berrettini M, Musolesi S. Bleeding complications of oral anticoagulant treatment: An inception-cohort, prospective collaborative study (IS-COAT). Italian study on complications of anticoagulant therapy. Lancet 1996; 348: 423-428. doi:10.1016/ S0140-6736(96)01109-9
4Van Walraven C, Oake N, Wells PS, Forster AJ. Burden of potentially avoidable anticoagulant-associated hemorrhagic and thromboembolic events in the elderly. Chest 2007; 131: 1508-1515. doi:10.1378/chest.06-2628
5Eiland M, Han SY, Hicks GM. Intramural hemorrhage of small intestine. JAMA 1978; 239: 139-142. doi:10.1001/ jama.239.2.139
6Better S, Montani S, Bachman F. Incidence of intramural digestive system hematoma in anticoagulation. Epidemiological study and clinical aspects of 59 cases in Switzerland. Schweitz Med Wochenschr 1983; 113: 630-636.
7Abbas MA, Collins JM, Olden KW. Spontaneous intramural small bowel hematoma: Clinical presentation and long-term outcome. Arch Surg 2002; 137: 306-310. doi:10.1001/archsurg.137.3.306
8Polat C, Dervisoglu A, Güven H, Kaya E, Malazgirt Z, Danaci M, Ozkan K. Anticoagulant- induced intramural intestinal hematoma. Am J Emerg Med 2003; 21: 208-
9doi:10.1016/S0735-6757(02)42258-9
10Jimenes J. Abdominal pain in a patient using warfarin. Postgrad Med J 1999; 75: 747-748.
11Levine MN, Raskob G, Landefeld S, Kearon C. Hemorrhagic complications of anticoagulant treatment. Chest 2001; 119 (1 Suppl): 108S-121S. doi:10.1378/ chest.119.1_suppl.108S
12Jones WR, Haridin WJ, Davis JT, Hardy JD. Intramural hematoma of the duodenum: A review of the literature and case report. Ann Surg 1971; 173: 534-544. doi:10.1097/00000658-197104000-00009
