A Rarely Encountered Complication due to the Use of Warfarin: Spontaneous Intramural Hematoma in Jejunum: Two Case Reports

Abstract

Spontaneous intramural small bowel hematoma due to the overuse of warfarin is a rarely encountered complication. In most patients, hematoma may be ameliorated with conservative modalities, and surgery is rarely needed. We presented two cases here. The first, a 81-year-old male patient, was admitted to our clinic with the complaint of abdominal pain and on the use of warfarin (5 mg/day) due to cerebrovascular event, congestive heart failure and atrial fibrillation. The physical examination revealed tenderness on abdominal left upper and lower quadrants. Prothrombin time, activated partial thromboplastin time and international normalized ratio were too long to measure clotting. On abdominal computerized tomography of the patient presenting with intestinal wall thickness on ultrasonography, wall thickness suggesting intramural hematoma was seen. Warfarin was discontinued, and fresh frozen plasma, erythrocyte suspension and intravenous fluids were given. During the follow-up, prothrombin time and international normalized ratio decreased to 14.6 seconds and 1.3, respectively, and hematoma was found to reduced on abdominal US. The second case, a 76-year-old woman patient and on the use of warfarin (5 mg/day), was admitted to the clinic with the complaints of abdominal pain, nausea and vomiting. She indicated common tenderness on abdominal examination, and activated partial thromboplastin time, prothrombin time and international normalized ratio were measured as 51.4 seconds, 43.9 seconds, and 3.8, respectively. Direct abdominal graphy showed no pathological finding. Abdominal ultrasonography and computerized tomography revealed wall thickness consistent with intramural hematoma on jejunum. Warfarin was discontunued, and fresh frozen plasma and intravenous fluids were administered. Activated partial thromboplastin time, prothrombin time and international normalized ratio were respectively decresed to 33.7 seconds, 20.1 seconds, and 1.7. Spontaneous intramural small bowel hematoma is a serious complication, so early diagnosis and prompt medical treatment are important. Many patients may be treated with conservative modalities successfully. J Med Cases. 2013;4(8):560-563 doi: http://dx.doi.org/10.4021/jmc1377w