Spontaneous intramural small bowel haematoma following the administration of a laxative: A rare complication of anticoagulant therapy

Abstract

Warfarin is a medicine widely used for prophylactic and therapeutic purposes. Spontaneous intramural small bowel haematoma is a rare complication induced by over-anticoagulation. We present the case of a 54-year-old male under treatment with warfarin who presented to the emergency department with acute abdominal pain, haematemesis and haemorrhagic diarrhoea after ingestion of a laxative in preparation for a colonoscopy. His laboratory tests revealed international normalized ratio (INR) of 6.16 and a haematocrit (Hct) of 34.04. Computed tomography of the abdomen revealed an intramural small bowel haematoma. After initial conservative therapy, the patient displayed clinical and laboratory deterioration and underwent an exploratory laparotomy. Resection of the ischaemic bowel segment and an end-to-end enteroenteric anastomosis was performed. Spontaneous intramural small bowel haematoma is a rare clinical entity. Its diagnosis demands a high index of suspicion. The therapy in most cases is conservative with a good outcome. To our knowledge, this is the first case of spontaneous intramural small bowel haematoma to be reported in a patient with over-anticoagulation and ingestion of a laxative.