Abstract
Spontaneous sublingual hematoma and intramural small bowel hematoma are rare and serious complications of anticoagulant therapy. Though previously reported individually, there has been no previous report of the same two complications occurring in a single patient. A 71-year-old Caucasian man, who was on warfarin for atrial fibrillation, presented with difficulty in swallowing due to a sublingual hematoma. He was observed in our intensive care unit, his warfarin was held and he recovered with conservative management. He represented two months later with a two day history of abdominal pain and distension. An abdominopelvic computed tomography (CT) scan now showed small bowel obstruction due to intramural small bowel hematoma and haemorrhagic ascites. Again, this was treated expectantly with a good outcome. In conclusion, life threatening haemorrhagic complications of oral anticoagulant therapy can recur. Conservative treatment is successful in most cases, but an accurate diagnosis is mandatory to avoid unnecessary surgery. CT scan is the investigation of choice for the diagnosis of suspected haemorrhagic complications of over coagulation.
Highlights
Spontaneous sublingual hematoma and for tachycardia (101 bpm)
Warfarin was held and he was treated with intravenous vitamin K, 5 mg and hydrocortisone, 100 mg
How quickly of oral anticoagulation can occur in any organ,[2] but the genitourinary, gastrointestinal, skin and nose are most commonly affected
Summary
A 71 year-old Caucasian male presented to the emergency department with an eight hour. Conflict of interests: the authors report no potential conflict of interests.
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