Concurrent Spontaneous Sublingual and Intramural Small Bowel Hematoma due to Warfarin Use.

Gül Pamukçu Günaydın,Hatice Duygu Çiftçi Sivri,Yavuz Otal,Serkan Sivri,Ayhan Özhasenekler,Gülhan Kurtoğlu Çelik

doi:10.1155/2015/583869

Abstract

Introduction. We present a case of concurrent spontaneous sublingual and intramural small bowel hematoma due to warfarin anticoagulation. Case. A 71-year-old man presented to the emergency department complaining of a swollen, painful tongue. He was on warfarin therapy. Physical examination revealed sublingual hematoma. His international normalized ratio was 11.9. The computed tomography scan of the neck demonstrated sublingual hematoma. He was admitted to emergency department observation unit, monitored closely; anticoagulation was reversed with fresh frozen plasma and vitamin K. 26 hours after his arrival to the emergency department, his abdominal pain and melena started. His abdomen tomography demonstrated intestinal submucosal hemorrhage in the ileum. He was admitted to surgical floor, monitored closely, and discharged on day 4. Conclusion. Since the patient did not have airway compromise holding anticoagulant, reversing anticoagulation, close monitoring and observation were enough for management of both sublingual and spontaneous intramural small bowel hematoma.

Highlights

We present the case of concurrent spontaneous sublingual and intramural small bowel hematoma due to warfarin anticoagulation
Laboratory studies were significant for international normalized ratio (INR) of 11.9 (0.8–1.2), with a prothrombin time (PT) of 139.1 sec (8.8–14), and with partial thromboplastin time (PTT) of 108.7 sec (22–38). He said that his INR levels were not checked for over 6 months because he was living in a remote village that was 2 hours away from the nearest hospital that has the test
The incidence of hemorrhage is related to INR level [1]

Summary

Introduction

Sublingual hematoma is a rare and potentially life threatening complication of oral anticoagulation [1,2,3]. A 71-year-old man presented to the emergency department complaining of a swollen, painful tongue and difficulty to speak that began a few hours ago He did not have recent trauma, dental work, cough, or fever. Oral physical examination revealed 3 × 3 cm sized, red-purple, tense, and tender mass consistent with a sublingual hematoma (Figure 1). Laboratory studies were significant for international normalized ratio (INR) of 11.9 (0.8–1.2), with a prothrombin time (PT) of 139.1 sec (8.8–14), and with partial thromboplastin time (PTT) of 108.7 sec (22–38) He said that his INR levels were not checked for over 6 months because he was living in a remote village that was 2 hours away from the nearest hospital that has the test. He was started on oral diet on day 3 and discharged on day 4

Discussion