Recurrent Spontaneous Jejunal Hematomas Resulting in Bowel Obstruction

Galia Pollock,Amiya Chakraborty,Christopher J Parr

doi:10.35248/2165-8048.19.9.306

Abstract

Spontaneous intramural small bowel hematomas are rare complications of anticoagulation therapy. We present a case of a 71-year-old male presenting to hospital twice with supratherapeutic international normalized ratio (INR) and bowel obstruction, resulting in the diagnosis of recurrent intramural small bowel hematoma. This case illustrates the importance of stringent INR monitoring in those anticoagulated with warfarin and also demonstrates the importance of remaining clinically suspicious for this complication in patients who present with abdominal pain or intestinal obstruction symptoms in the setting of a supratherapeutic INR.

Highlights

CASE REPORTSpontaneous small intestinal intramural hematomas are a rare complication of anticoagulation therapy, with the jejunum being the commonest affected region of the bowel
We present a case of recurrent intramural small bowel hematoma secondary to supratherapeutic international normalized ratio (INR)
The patient was clinically well on discharge. This case emphasizes the importance of considering intramural small bowel hematoma in patients with supratherapeutic INR presenting with abdominal pain or bowel obstruction symptoms

Summary

INTRODUCTION

Spontaneous small intestinal intramural hematomas are a rare complication of anticoagulation therapy, with the jejunum being the commonest affected region of the bowel. The remaining five patients had bleeding predilections including hemophilia, chemotherapy-induced liver failure, known liver cirrhosis, idiopathic thrombocytopenia purpura, and systemic lupus vasculitis None of these patients had recurrence of their small bowel hematoma at median follow up time of 35 months [3]. The patient received the diagnosis of an intramural small bowel hematoma. The patient returned to the emergency department with new-onset acute abdominal pain and emesis He was found to have recurrence of his intramural jejunal hematoma and small bowel obstruction on non-contrast abdominal CT, this time involving a 20 cm segment of the jejunum (Figure 3). Conservative management including cessation of warfarin and aspirin was pursued Following clinical resolution, he was discharged with arrangements for follow up abdominal CT three weeks postdischarge.

DISCUSSION

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CONCLUSION