Intramural Small Bowel Hematoma Research Articles

Warfarin-induced spontaneous intramural small bowel hematoma presenting as an acute abdomen: A case report

Rationale:Spontaneous intramural small-bowel hematoma (SISBH) is a rare complication of anticoagulation therapy. Presentation of SISBH can vary from mild abdominal pain to an acute abdomen.Patient concerns:A 70-year-old woman was brought to the emergency department because of severe abdominal pain for 1 day. She had a medical history of coronary artery disease and paroxysmal atrial fibrillation and was receiving anticoagulation therapy with warfarin for 3 years.Diagnosis:Computed tomography disclosed disproportional dilatation of the segmental small bowel and near-total obstruction of the intestinal lumen at the level of the jejunum, indicating an acute abdomen.Interventions:We performed laparoscopic exploration and found a segmental distal jejunum was tense, heavy, firm, and discolored with a blue hue. Histopathological examination of the resected jejunum revealed diffuse hemorrhage and necrosis at the mucosa and submucosal layers, indicating SISBH.Outcomes:The patient had an uneventful recovery and was discharged in a relatively stable condition.Lessons:Warfarin-induced SISBH presenting as an acute abdomen is an emergency condition that needs early diagnosis and timely management. Surgical intervention may be indicated for intestinal obstruction, ischemia, perforation, peritonitis, and intra-abdominal hemorrhage.

Spontaneous Intramural Small Bowel Hematoma in an Elderly Man with Multiple Myeloma.

Spontaneous Intramural Small Bowel Hematoma in an Elderly Man with Multiple Myeloma.

Spontaneous intramural small-bowel hematoma: a cause of acute abdomen in anticoagulated patients.

Spontaneous intramural small-bowel hematoma (SISBH) is an uncommon cause of acute abdominal pain in anticoagulated patients.

Recurrent Spontaneous Jejunal Hematomas Resulting in Bowel Obstruction

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.

Clinical features and outcomes in spontaneous intramural small bowel hematoma: Cohort study and literature review.

Background/AimsSpontaneous intramural small bowel hematoma (SISBH) is an extremely rare complication of anticoagulant or antiplatelet therapy. We assessed the clinical characteristics and outcomes of patients with SISBH according to the anatomical location of the hematoma. MethodsFrom January 2003 to February 2016, medical records for all patients hospitalized for SISBH at 2 tertiary referral hospitals were retrospectively reviewed. The primary outcome was requirement for surgery.ResultsA total of 37 patients were enrolled. The mean age was 74.1 years. Among them, 33 patients (89.2%) were taking anticoagulant and/or antiplatelet agents. Duodenal intramural hematoma was detected in 4 patients (10.8%), jejunal in 16 (43.2%), and ileal in 17 (45.9%). Compared to jejunal and ileal involvement, duodenal intramural hematoma was significantly associated with high Charlson comorbidity index and low levels of white blood cells, hemoglobin, and platelets in the blood. SISBH in the duodenum was related to thrombocytopenia in 3 patients following systemic chemotherapy for malignancy. All patients with SISBH showed clinical improvement with conservative therapy. Mean length of hospital stay was 9.35 days. Independent predictors of a hospital stay of more than 7 days were body weight less than 60 kg (odds ratio [OR], 12.213; 95% confidence interval [CI], 1.755–84.998; P=0.011) and a history of cerebrovascular accidents (OR, 6.667; 95% CI, 1.121–39.650; P=0.037).ConclusionsCompared to jejunal and ileal involvement, thrombocytopenia may result in spontaneous duodenal intramural hematoma among patients who are treated with systemic chemotherapy for malignancies. Patients with SISBH have excellent clinical outcomes with conservative therapy regardless of the anatomical location of the hematoma.

Imaging characteristics of nontraumatic spontaneous intramural hematoma of small bowel secondary to warfarin therapy

Objective To investigate the imaging characteristics of nontraumatic spontaneous intramural hematoma of small bowel secondary to warfarin therapy. Methods The retrospective and descriptive study was conducted. The clinical data of 12 patients with nontraumatic spontaneous intramural hematoma of small bowel secondary to warfarin therapy who were admitted to the First People′s Hospital of Wenling (11 patients) and Taizhou Hospital of Zhejiang Province (1 patient) between January 2010 and December 2016 were collected. Patients received plain and enhanced scans of computed tomography (CT). Patients stopped warfarin therapy, received intramuscular injection of vitamin K1 and fresh-frozen plasma transfusion. Observation indicators: (1) primary signs of CT: ① small bowel wall thickening; ② increased density of small bowel wall; (2) secondary signs of CT: intestine lumen stenosis, intestinal pneumatosis, perienteric changes and other concomitant signs; (3) treatment situations. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M (range). Results Twelve patients received total abdomen plain scans of CT, and 7 received total abdomen enhanced scans of CT. (1) Primary signs of CT: ① Small bowel wall thickening. CT of 12 patients showed solitary, homogeneously symmetric, consecutive and diffuse thickening of small bowel wall, including ileal involvement in 7 patients and jejunum involvement in 5 patients. Ascending part of duodenum of 3 patients involved the 2nd and 3rd groups small bowel. The average length of involved small bowel was 30.7 cm (range, 11.0-58.0 cm). There was no multifocal thickening or colonic involvement. Of 12 patients, 10 and 2 showed moderate thickening (thickness was 1.0-2.0 cm) and severe thickening (thickness > 2.0 cm), and the thickest small bowel wall was 2.5 cm. ② Increased density of small bowel wall. Twelve patients showed varying degrees of increased density of small bowel wall, with an average value of 49.7 HU (range, 36.0-63.4 HU). Of 12 patients, homogeneously increased whole layer density of small bowel wall were detected in 4 patients, higher submucous layer density of small bowel compared with serosal layer density in 4 patients, and all of the above characteristics in 4 patients. Enhanced scans of CT in 7 patients showed enhancement in small bowel mucosal layer and serosal layer, no obvious enhancement in the submucous layer of small bowel wall, clear layers, and a target sign when small bowel lumen was perpendicular to scan slice, including 5 patients with obvious enhancement in small bowel mucosal layer, spring-like change, and clear imaging in portal vein phase. (2) Secondary signs of CT: ① Intestine lumen stenosis: 12 patients had varying degrees of intestine lumen stenosis. Five patients were complicated with small bowel obstruction, showing a gas-liquid level. ② Intestinal pneumatosis: 2 of 12 patients showed patchy and mottled gas shadow. ③ Perienteric changes and other concomitant signs: 12 patients showed obviously increased fat density in surrounding area of involved small bowel and corresponding mesenteric area, and indistinct outside small bowel, including 8 with lots of lath-like high density shadow in surrounding area of small bowel and mesenteric area. The varying degrees of hemoperitoneum were seen in 12 patients. (3) Treatment situations: of 12 patients, 9 underwent correct treatments, 8 of them were improved, and 1 of them with persistently severe abdominal pain underwent urgent explorative laparotomy, showing hemorrhage and necrosis, and then underwent surgery; 3 didn′t undergo correct treatment, without improved or severe symptoms. Conclusion Patients undergoing anticoagulant therapy show acute abdominal pain with abnormal coagulation function, small bowel wall thickening and increased density by CT scans, hemoperitoneum complicated with intestine lumen stenosis, small bowel obstruction and hematocele in surrounding area of small bowel and mesenteric area, these are highly indicative of nontraumatic spontaneous intramural hematoma of small bowel secondary to warfarin therapy. Key words: Intramural hematoma of small bowel; Warfarin; Tomography, X-ray computed; Diagnosis; Jejunum

Spontaneous intramural small bowel hematoma in a patient with acute myeloid leukaemia receiving chemotherapy and nilotinib

Spontaneous intramural small bowel hematoma (SISBH) is a rare, acute abdominal condition, with increasing incidence in recent years. Excessive anticoagulation with vitamin K antagonists is the most common aetiology. We...

CT findings of Intramural Small Bowel Hematoma Secondary to use of Oral Anticoagulant Therapy

CT findings of Intramural Small Bowel Hematoma Secondary to use of Oral Anticoagulant Therapy

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

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.

Spontaneous intramural small-bowel hematoma due to a rare complication of warfarin therapy: Report of two cases

Spontaneous intramural small-bowel hematoma secondary to warfarin therapy has been reported in the literature, but this complication of anticoagulant therapy is still considered rare. Here we report two cases of spontaneous nontraumatic jejunal intramural hematoma treated in our institution. After emergent admission for acute abdomen, both cases were found to have a history of warfarin therapy for atrial fibrillation. Prothrombin time, activated partial thromboplastin time, and international normalized ratio were elevated in both cases. For Case 1, abdominal computed tomography revealed segmental mural thickening with precontrast hyperdensity and perienteric haziness affecting the distal jejunum. The patient underwent emergent laparotomy under the impression of mesentery occlusion with impending bowel ischemia due to her history of atrial fibrillation. Abdominal computed tomography for Case 2 revealed jejunal intramural hematoma and bloody ascites. The patient received conservative therapy with nil by mouth, fresh frozen plasma transfusion, and vitamin K1 supplementation, and no surgical intervention was done based on experience gained with the first case. Although a few other recent cases have been reported, the differences in our two cases were especially helpful in demonstrating that surgery can be avoided. We suggest that a history of anticoagulant use with prolonged international normalized ratio values in patients presenting with abdominal pain should alert physicians to consider spontaneous intramural small-bowel hematoma secondary to warfarin therapy. Recognizing this syndrome is important in order to avoid unnecessary surgery because excellent outcomes can be achieved with conservative treatment.

Acute Abdomen Secondary to a Warfarin-Related Intramural Small Bowel Hematoma: A Case Report and Review

Acute Abdomen Secondary to a Warfarin-Related Intramural Small Bowel Hematoma: A Case Report and Review

A Rarely Encountered Complication due to the Use of Warfarin: Spontaneous Intramural Hematoma in Jejunum: Two Case Reports

Spontaneous intramural small bowel hematoma due to the overuse of warfarin is a rarely encountered complication. In most patients, hematoma may be ameliorated with conservative modalities, and surgery is rarely needed. We presented two cases here. The first, a 81-year-old male patient, was admitted to our clinic with the complaint of abdominal pain and on the use of warfarin (5 mg/day) due to cerebrovascular event, congestive heart failure and atrial fibrillation. The physical examination revealed tenderness on abdominal left upper and lower quadrants. Prothrombin time, activated partial thromboplastin time and international normalized ratio were too long to measure clotting. On abdominal computerized tomography of the patient presenting with intestinal wall thickness on ultrasonography, wall thickness suggesting intramural hematoma was seen. Warfarin was discontinued, and fresh frozen plasma, erythrocyte suspension and intravenous fluids were given. During the follow-up, prothrombin time and international normalized ratio decreased to 14.6 seconds and 1.3, respectively, and hematoma was found to reduced on abdominal US. The second case, a 76-year-old woman patient and on the use of warfarin (5 mg/day), was admitted to the clinic with the complaints of abdominal pain, nausea and vomiting. She indicated common tenderness on abdominal examination, and activated partial thromboplastin time, prothrombin time and international normalized ratio were measured as 51.4 seconds, 43.9 seconds, and 3.8, respectively. Direct abdominal graphy showed no pathological finding. Abdominal ultrasonography and computerized tomography revealed wall thickness consistent with intramural hematoma on jejunum. Warfarin was discontunued, and fresh frozen plasma and intravenous fluids were administered. Activated partial thromboplastin time, prothrombin time and international normalized ratio were respectively decresed to 33.7 seconds, 20.1 seconds, and 1.7. Spontaneous intramural small bowel hematoma is a serious complication, so early diagnosis and prompt medical treatment are important. Many patients may be treated with conservative modalities successfully. J Med Cases. 2013;4(8):560-563 doi: http://dx.doi.org/10.4021/jmc1377w

A Rarely Encountered Complication due to the Use of Warfarin: Spontaneous Intramural Hematoma in Jejunum: Two Case Reports

Spontaneous intramural small bowel hematoma due to the overuse of warfarin is a rarely encountered complication. In most patients, hematoma may be ameliorated with conservative modalities, and surgery is rarely needed. We presented two cases here. The first, a 81-year-old male patient, was admitted to our clinic with the complaint of abdominal pain and on the use of warfarin (5 mg/day) due to cerebrovascular event, congestive heart failure and atrial fibrillation. The physical examination revealed tenderness on abdominal left upper and lower quadrants. Prothrombin time, activated partial thromboplastin time and international normalized ratio were too long to measure clotting. On abdominal computerized tomography of the patient presenting with intestinal wall thickness on ultrasonography, wall thickness suggesting intramural hematoma was seen. Warfarin was discontinued, and fresh frozen plasma, erythrocyte suspension and intravenous fluids were given. During the follow-up, prothrombin time and international normalized ratio decreased to 14.6 seconds and 1.3, respectively, and hematoma was found to reduced on abdominal US. The second case, a 76-year-old woman patient and on the use of warfarin (5 mg/day), was admitted to the clinic with the complaints of abdominal pain, nausea and vomiting. She indicated common tenderness on abdominal examination, and activated partial thromboplastin time, prothrombin time and international normalized ratio were measured as 51.4 seconds, 43.9 seconds, and 3.8, respectively. Direct abdominal graphy showed no pathological finding. Abdominal ultrasonography and computerized tomography revealed wall thickness consistent with intramural hematoma on jejunum. Warfarin was discontunued, and fresh frozen plasma and intravenous fluids were administered. Activated partial thromboplastin time, prothrombin time and international normalized ratio were respectively decresed to 33.7 seconds, 20.1 seconds, and 1.7. Spontaneous intramural small bowel hematoma is a serious complication, so early diagnosis and prompt medical treatment are important. Many patients may be treated with conservative modalities successfully. J Med Cases. 2013;4(8):560-563 doi: http://dx.doi.org/10.4021/jmc1377w

Spontaneous intramural small-bowel hematoma secondary to anticoagulant therapy: a case series

Spontaneous small-bowel hematomas most commonly involve the jejunum, followed by the ileum and duodenum, and occur in patients who receive excessive anticoagulation with phenprocoumon/warfarin or who have additional risk factors for bleeding. We report three cases of intramural small-bowel hematoma, all complications of treatment with phenprocoumon, which nowadays is used extensively for therapeutic and prophylactic purposes. Diagnosis can be readily attained by sonography and confirmed using computed tomography. Early diagnosis is crucial because most patients can be treated successfully without surgery. Based on this experience and data from the literature, conservative treatment is recommended for intramural intestinal hematomas, when other complications needing laparotomy have been excluded.

Detection and management of spontaneous intramural small bowel hematoma secondary to anticoagulant therapy

Intestinal hematoma, once considered a rare complication of anticoagulation, has recently been increasingly reported. Spontaneous small bowel hematomas most commonly involve the jejunum, followed by the ileum and duodenum. They occur in patients who receive excessive anticoagulation with vitamin K antagonists or who have additional risk factors for bleeding. Diagnosis can be readily identified with sonography and confirmed with computed tomography. Early diagnosis is crucial as most patients can be treated successfully without surgery. Conservative treatment is recommended for intramural intestinal hematomas, when other associated complications needing laparotomy have been excluded.

Spontaneous sublingual and intramural small-bowel hematoma in a patient on oral anticoagulation

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.

Intramural small bowel hematoma secondary to use of oral anticoagulant therapy

Intramural small bowel hematoma secondary to use of oral anticoagulant therapy

Spontaneous Intramural Hematoma of the Small Bowel-A complication of Anticoagulant therapy

Spontaneous intramural small bowel hematoma is a rare complication of anticoagulant therapy. The authors report a case of small bowel intramural hematoma resulting from sodium Warfarin toxicity in a patient with prosthetic mitral valve. The patient presented with colicky abdominal pain, vomiting and melena. Typical findings on abdominal Sonography and MDCT with elevated INR value suggested the diagnosis. Patient was treated conservatively. The history of anticoagulant use with prolonged INR value in patients presenting with abdominal complaints should alert clinician and radiologist to look for this entity. The essence of prompt and accurate diagnosis of this condition lies in the conservative management to avoid an un-indicated surgery.

Nontraumatic Spontaneous Intramural Small-Bowel Hematoma Caused by Warfarin-Induced Overanticoagulation

Nontraumatic Spontaneous Intramural Small-Bowel Hematoma Caused by Warfarin-Induced Overanticoagulation

Sonographic diagnosis of spontaneous intramural small bowel hematoma in a case of warfarin overdose

A 38-year-old man who had been treated with warfarin since mitral valve replacement 10 years earlier presented with acute onset of epigastralgia and melena. Coagulation tests were abnormal with a prolonged prothrombin time of >60 seconds and a prolonged activated partial thromboplastin time of >120 seconds. Abdominal sonographic examination revealed duodenal intramural hematoma that was confirmed on CT. Warfarin therapy was stopped and the patient was treated conservatively with vitamin K and fresh frozen plasma. Recovery was uneventful, and the patient was re-warfarinized 2 weeks later. Duodenal hematoma can be readily diagnosed with bedside sonography.