Giant Intramural Hematoma of the Colon in Acquired Factor VIII Inhibitor.

Abstract

Intramural hematoma of the colon is very rare, particularly when associated with the development of autoantibodies against factor VIII.We report a case of a 66-year-old man with abdominal pain, hematochezia and clots in the left colon, without any radiologic signs ofactive bleeding or bowel occlusion or analytical changes in routine coagulation screening, but with positive autoantibodies against factor VIII. The clinical instability prompted surgical exploration. An intramural hematoma of the left colon was found, and a left colectomywas performed. The patient was treated with hemoderivatives and corticosteroids with clinical improvement. The diagnosis of spontaneous intramural hematoma might be a challenge, particularly in the absence of clinical suspicion. An early recognition is essentialfor a positive outcome. This case highlights a rare cause of bleeding and intestinal obstruction, but also the difficulty and relevance ofestablishing a clinical diagnosis when diagnostic tests are not completely informative.