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Zhu Y, Wang C, Xu C, Liu J. Case Report: Spontaneous Intramural Hematoma of the Colon Secondary to Low Molecular Weight Heparin Therapy. Front Pharmacol 2021; 12:598661. [PMID: 34054512 PMCID: PMC8160441 DOI: 10.3389/fphar.2021.598661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/21/2021] [Indexed: 01/02/2023] Open
Abstract
Background: Hematoma of the colon is a rare hemorrhagic complication that affects patients accepting low molecular weight heparin (LMWH) therapy. Only scarce cases of colon hematoma have been reported, usually in children or patients accepting warfarin therapy. Case summary: A 76-year-old Chinese man was diagnosed with atrial fibrillation and heart failure, with cardiac function NYHA grade III on March 21, 2018. This patient was given LMWH for anticoagulation therapy and developed a colon hematoma on the third day of hospitalization. Abdominal computed tomography (CT) showed the thickening of areas of the colon up to 110 mm × 78 mm in thickness, which was a symptom of colon hematoma. The patient underwent conservative treatment successfully. On March 27, the patient's abdominal pain was alleviated, and a CT scan showed that the intestinal hematoma was absorbed. Conclusions: The most frequent minor bleeding events of LMWH anticoagulation are hemorrhage and subcutaneous hematoma. This case demonstrated that bowel hematoma despite its low incidence should be considered as an ADR of LMWH therapy, especially among patients who present with gastrointestinal symptoms.
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Affiliation(s)
- Ye Zhu
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Chao Wang
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Chao Xu
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, OK, United States
| | - Jia Liu
- Clinical Medical College, Yangzhou University, Yangzhou, China
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Tan TSE, Cheong SCW, Tan TJ. Clinics in diagnostic imaging (201). Small bowel intramural haematoma induced by anticoagulation therapy with associated reactive ileus. Singapore Med J 2019; 60:566-573. [PMID: 31781781 DOI: 10.11622/smedj.2019147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 74-year-old woman receiving long-term anticoagulation with warfarin for chronic atrial fibrillation presented with severe acute abdominal pain, diarrhoea and vomiting. Initial laboratory workup revealed a deranged coagulation profile. Computed tomography of the abdomen and pelvis demonstrated spontaneous distal jejunal intramural haematoma with associated reactive ileus. No overt pneumatosis intestinalis, intraperitoneal free gas or haemoperitoneum was seen. Based on clinical and imaging findings, a diagnosis of over-anticoagulation complicated by small bowel intramural haematoma was made. The patient was managed non-operatively with analgesia, cessation of warfarin and reversal therapy with vitamin K. Warfarin therapy was recommenced upon resolution of symptoms and optimisation of coagulation status. The clinical presentation, radiological features and overall management of anticoagulation-induced bleeding are further discussed in this article.
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Affiliation(s)
| | | | - Tien Jin Tan
- Department of Radiology, Changi General Hospital, Singapore
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Kang EA, Han SJ, Chun J, Lee HJ, Chung H, Im JP, Kim SG, Kim JS, Yoon H, Shin CM, Park YS, Kim N, Lee DH, Jung HC. Clinical features and outcomes in spontaneous intramural small bowel hematoma: Cohort study and literature review. Intest Res 2018; 17:135-143. [PMID: 30301344 PMCID: PMC6361017 DOI: 10.5217/ir.2018.00085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/10/2018] [Indexed: 02/06/2023] Open
Abstract
Background/Aims Spontaneous 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. Methods From 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. Results A 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). Conclusions Compared 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.
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Affiliation(s)
- Eun Ae Kang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Jun Han
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunsoo Chung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Chae Jung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Intramural Bowel Hematoma Presenting as Small Bowel Obstruction in a Patient on Low-Molecular-Weight Heparin. Case Rep Pediatr 2018; 2018:8780121. [PMID: 30009073 PMCID: PMC6020481 DOI: 10.1155/2018/8780121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/23/2018] [Indexed: 11/17/2022] Open
Abstract
There is increasing use of low-molecular-weight heparin (LMWH) for treatment of pediatric thromboembolic disease as it has been shown to be safe and effective. It has several advantages over unfractionated heparin, such as reduced need for monitoring, easier route of administration, decreased risk of heparin-induced thrombocytopenia, and lack of drug-drug interactions. Nevertheless, LMWH still poses a bleeding risk as with any anticoagulant therapy. We present the case of a 4-year-old boy who was placed on LMWH for a catheter-related deep venous thrombosis in the setting of intractable seizures and subsequently developed a small bowel obstruction secondary to a suspected intussusception. He underwent exploratory laparotomy and was found to have an intramural bowel hematoma. Prior to this bleed, the patient had been monitored daily, and his anti-Xa levels were found to be in the therapeutic range. This case highlights the need for a high index of suspicion for spontaneous bleeding even in the setting of therapeutic anti-Xa levels.
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Weng SC, Hsu CH, Wang NL, Lin SP, Jiang CB. Recurrent spontaneous subserosal hematoma of ileum causing intestinal obstruction in a patient with menkes disease: A case report. Medicine (Baltimore) 2016; 95:e4842. [PMID: 27631241 PMCID: PMC5402584 DOI: 10.1097/md.0000000000004842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Menkes disease (MD) is a disorder of copper metabolism due to ATP7A gene mutation that leads to severe copper deficiency. Deformed blood vessels can be found in many parts of the body, and intracranial hematoma is generally reported. METHODS We report a Taiwanese boy with MD who had recurrent spontaneous subserosal hematoma of ileum presenting as intestinal obstruction, with the 2 episodes 23 months apart. The patient returned to the usual physical status after surgical removal of the hematoma. RESULTS The defective copper metabolism causes dysfunction of a plenty of copper-dependent enzymes, giving rise to unique kinky hair appearance, progressive neurodegeneration, and connective tissue abnormalities. To our knowledge, this is the first report on recurrent subserosal hemorrhage of intestine in MD. CONCLUSION Owing to the fragile structure of blood vessels, subserosal hematoma should be considered when patients with MD having intestinal obstruction.
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Affiliation(s)
- Shu-Chao Weng
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
| | | | - Nien-Lu Wang
- Department of Pediatric General Surgery and Urology
| | - Shuan-Pei Lin
- Department of Genetics and Metabolism, MacKay Children's Hospital, Taipei
- Department of Medicine, MacKay Medical College, New Taipei City
- Division of Biochemical Genetics, Department of Medical Research, MacKay Memorial Hospital
- Department of Early Childhood Care, National Taipei University of Nursing and Health Sciences
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
- MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
- Correspondence: Chuen-Bin Jiang, MacKay Children's Hospital, Taipei, Taiwan (e-mail: )
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Creasy H, Meleagros L. Excess anticoagulation as a cause of small-bowel obstruction: a report of two cases. J Surg Case Rep 2015; 2015:rjv041. [PMID: 25858268 PMCID: PMC4390781 DOI: 10.1093/jscr/rjv041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Luke Meleagros
- North Middlesex University Hospital NHS Trust, London, UK
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7
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Non-traumatic intramural hematomas in patients on anticoagulant therapy: Report of three cases and overview of the literature. Afr J Emerg Med 2014. [DOI: 10.1016/j.afjem.2014.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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8
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Bowel obstruction from intramural hematoma in two children treated with low molecular weight heparin: Case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Yoldaş T, Erol V, Çalışkan C, Akgün E, Korkut M. Spontaneous intestinal intramural hematoma: What to do and not to do. Turk J Surg 2013; 29:72-5. [PMID: 25931850 DOI: 10.5152/ucd.2013.41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/10/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Spontaneous intestinal intramural hematoma is a rare complication of anticoagulant treatment. In this study, we retrospectively evaluated 14 patients with the diagnosis of intramural hematoma of the small intestine who were followed-up and treated in our clinic, and we aimed to determine current approaches in the diagnosis and treatment of intramural hematoma. MATERIAL AND METHODS Between February 2010-October 2012, 14 patients diagnosed with small intestinal intramural hematoma were retrospectively analyzed. Nine patients were followed due to clinical findings and 5 patients underwent operation with a histopathological diagnosis of intramural hematoma. RESULTS Abdominal computed tomography demonstrated ileal and jejunal wall thickening in 10 patients, while findings were consistent with mesenteric vascular disease in four. Five patients were operated due to mechanical bowel obstruction and acute abdomen. The other 9 patients were followed up with medical treatment and 8 of these patients were already using warfarin due to cardiac bypass and valve replacement. CONCLUSION Spontaneous intestinal intramural hematoma is a rare cause of small bowel obstruction due to intramural hematoma, which is encountered even more rarely. An intramural hematoma should be considered among differential diagnosis of patients who present with abdominal pain and symptoms of obstruction with a history of anticoagulant drug use and elevated International Normalized Ratio (INR) levels. Early diagnosis and medical follow-up can provide a good response to treatment in the majority of patients without requiring surgery.
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Affiliation(s)
- Tayfun Yoldaş
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Varlık Erol
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cemil Çalışkan
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Erhan Akgün
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Korkut
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
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Abdel Samie A, Theilmann L. Risk factors and management of anticoagulant-induced intramural hematoma of the gastrointestinal tract. Eur J Trauma Emerg Surg 2013; 39:191-4. [PMID: 26815079 DOI: 10.1007/s00068-013-0250-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 01/04/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Intramural intestinal hematoma is considered a rare complication of overanticoagulation in elderly patients. Nevertheless, this clinical entity is increasingly being reported in the literature, and its incidence is predicted to increase further as a result of the wide use of long-term anticoagulation in an aging population. However, data regarding the risk factors and optimal management of this unusual complication in patients on phenprocoumon/warfarin are scarce. PATIENTS AND METHODS We retrospectively analyzed the medical reports of patients with intramural gastrointestinal hematoma on anticoagulant therapy who were treated in our unit between January 2008 and July 2011. RESULTS Four consecutive patients were identified during the study period. The mean age of the patients was 80 years. All patients were on uninterrupted anticoagulation with phenprocoumon due to chronic atrial fibrillation. Hematoma was localized in the duodenum in one patient, in the jejunum in two patients, and in the rectum in one patient. Hematoma occurred spontaneously in three patients and following a trauma in one patient. Excessive anticoagulation with an INR of >6 was associated with the development of this complication in all spontaneous cases. A combination of computed tomography and sonography established the diagnosis in all four. Conservative therapy proved successful in two patients, and surgery was necessary in two cases. CONCLUSION Intramural hematoma of the gastrointestinal tract should be suspected in any patient with abdominal pain or intestinal obstruction under anticoagulant therapy. Emergency physicians and surgeons should be aware of this rare complication, as most such cases will resolve spontaneously under conservative measures without the need for surgery.
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Affiliation(s)
- Ahmed Abdel Samie
- Department of Gastroenterology, Pforzheim Hospital, Kanzlerstr. 2-6, 75175, Pforzheim, Germany.
| | - Lorenz Theilmann
- Department of Gastroenterology, Pforzheim Hospital, Kanzlerstr. 2-6, 75175, Pforzheim, Germany
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11
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Una causa inusual de obstrucción intestinal en niños: hematoma intestinal secundario a heparina de bajo peso molecular. An Pediatr (Barc) 2012; 77:427-8. [DOI: 10.1016/j.anpedi.2012.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 04/11/2012] [Accepted: 04/27/2012] [Indexed: 11/20/2022] Open
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Abdel Samie A, Sun R, Huber A, Höpfner W, Theilmann L. Spontaneous intramural small-bowel hematoma secondary to anticoagulant therapy: a case series. Med Klin Intensivmed Notfmed 2012; 108:144-8. [PMID: 23135686 DOI: 10.1007/s00063-012-0184-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 09/11/2012] [Accepted: 09/25/2012] [Indexed: 12/17/2022]
Abstract
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.
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13
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Abdel Samie A, Theilmann L. Detection and management of spontaneous intramural small bowel hematoma secondary to anticoagulant therapy. Expert Rev Gastroenterol Hepatol 2012; 6:553-8; quiz 559. [PMID: 23061706 DOI: 10.1586/egh.12.33] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- Ahmed Abdel Samie
- Department of Gastroenterology, Pforzheim Hospital, Pforzheim, Germany.
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14
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Shankarnaryanan S, Hardikar W. Unusual cause of neonatal rectal bleeding: colonic intramural haematoma. J Paediatr Child Health 2012; 48:E108-9. [PMID: 22417474 DOI: 10.1111/j.1440-1754.2010.01976.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bright rectal bleeding in a neonate is most commonly due to necrotising enterocolitis, gastrointestinal infection or cows milk protein intolerance. We present here an infant who developed PR bleeding after cardiac surgery. Bleeding persisted despite presumptive treatment for the most common causes. A colonic intramural haematoma was identified on colonoscopy most likely related to anticoagulation in the setting of cardiac surgery.
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15
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Birla RP, Mahawar KK, Saw EY, Tabaqchali MA, Woolfall P. Spontaneous intramural jejunal haematoma: a case report. CASES JOURNAL 2008; 1:389. [PMID: 19077259 PMCID: PMC2628898 DOI: 10.1186/1757-1626-1-389] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 12/12/2008] [Indexed: 11/13/2022]
Abstract
Background Spontaneous intramural intestinal haematoma is a rare complication of anticoagulation therapy. A misdiagnosis may lead to an unnecessary and even hazardous surgical intervention. Case presentation An 85 year old lady presented to us with acute abdomen. She was on Warfarin and was found to have grossly deranged clotting parameters. Computed Tomography Scan revealed a long loop of markedly thick-walled proximal jejunum. A diagnosis of spontaneous intramural jejunal haematoma was made. Conclusion She was successfully treated with conservative management with Vitamin K and blood products.
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Affiliation(s)
- Rashmi P Birla
- Department of General Surgery, University Hospital of North Tees, Hardwick Road, Stockton-on-Tees, Cleveland, UK.
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Submucosal hematoma presenting as small bowel obturator obstruction in a patient on low-molecular-weight heparin. J Pediatr Surg 2008; 43:1569-71. [PMID: 18675658 DOI: 10.1016/j.jpedsurg.2008.03.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 03/25/2008] [Accepted: 03/26/2008] [Indexed: 11/23/2022]
Abstract
Recent studies have shown the efficacy of low-molecular-weight heparin (LMWH) in the treatment of venous thromboembolic disease in children. Compared to unfractionated heparin and coumadin, LMWH has more predictable pharmacokinetics and a reported lower incidence of osteoporosis and heparin-induced thrombocytopenia in children. The overall incidence of severe hemorrhage on LMWH in children is low. To date, there is a single report of a small bowel obstruction in a child secondary to a hematoma while on LMWH. We report the second case of a child, on enoxaparin (Lovenox) therapy, who underwent bowel resection secondary to a completely obstructing small bowel wall hematoma.
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Izquierdo Renau M, Pereda Pérez A, Sangüesa Nebot C, Lluna J. [Post-biopsy intramural duodenal haematoma]. An Pediatr (Barc) 2008; 68:624-5. [PMID: 18559206 DOI: 10.1157/13123299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Sorbello MP, Utiyama EM, Parreira JG, Birolini D, Rasslan S. Spontaneous intramural small bowel hematoma induced by anticoagulant therapy: review and case report. Clinics (Sao Paulo) 2007; 62:785-90. [PMID: 18209923 DOI: 10.1590/s1807-59322007000600020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Martínez Cecilia D, Torres Tordera EM, Arjona Sánchez A, Artero Muñoz I, Rufián Peña S. [Spontaneous intramural small bowel hemorrhage: an event on the increase]. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:331-3. [PMID: 17662215 DOI: 10.1157/13107567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Spontaneous intramural intestinal hemorrhage is highly infrequent. The most common cause is overdose of oral anticoagulants. Clinical presentation usually consists of abdominal pain and intestinal obstruction. The diagnostic imaging technique of choice is computed tomography. Spontaneous intramural intestinal hemorrhage usually resolves spontaneously and consequently the treatment of choice is non-operative. Surgery is reserved for complicated processes or when the diagnosis is uncertain. We present two cases. The first was due to overanticoagulation by acenocoumarol, and the second was an exceptional complication in a hemophiliac patient.
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Martins Dos Santos M, Rodrigues R, Tafarel J, Nakao F, Ferrari A, Libera E. SPONTANEOUS COLONIC HEMATOMA: ENDOSCOPIC APPEARANCE. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.2007.00689.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Mainwaring CJ, Pleydell-Pearce J, Chana J, Evans J, Roy A, Lewis H. An unusual complication of ice skating and the emergence of a previously undiagnosed bleeding disorder. Haemophilia 2006; 12:551-4. [PMID: 16919089 DOI: 10.1111/j.1365-2516.2006.01309.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report the case of an 8-year-old boy with no prior abnormal bleeding history who presented with severe central abdominal pain following a freak accident at a local ice rink. Clinical examination confirmed a tender periumbilical mass. An ultrasound scan confirmed a large haemorrhagic fluid collection adjacent to the second part of his duodenum that was causing a subacute small-bowel obstruction. He was found to have a persistently prolonged prothrombin time between 17.3 and 18.1 s but normal liver function tests. There was no suggestion of dietary vitamin K deficiency. Further investigations confirmed factor VII deficiency with levels between 30.4 and 33.6 IU dL-1. His prothrombin time did not normalize with intravenous vitamin K. He was subsequently treated with three 30 microg kg-1 body weight doses of novoseven at 4-h interval and made an excellent recovery. The haematoma virtually resolved completely confirmed by a follow-up ultrasound scan 3 months after the initial event.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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