Spontaneous Intramural Small Bowel Hematoma Induced by Anticoagulant Therapy: Case Series

Ince M and Ince L

Department of Surgery, 100. Yıl Private Hospital, Ankara, Turkey Abdurrahman Yurtaslan Oncology Hospital, Ankara, Turkey

^*Correspondance to: Mehmet İnce 

 PDF  Full Text DOI: 10.25107/2474-1647.3717

Abstract

Objective: Spontaneous Intramural Small-Bowel and Intraabdominal Hematoma (SIBSH) is a rare complication of oral anticoagulation therapy. Bleeding duo to anticoagulation therapy is generally treated conservatively by nasogastric decompression and total parenteral nutrition, surgical intervention is required in patients with active bleeding, acute abdominal pain, or intestinal obstruction. The aim of our study was to review the imaging findings and outcomes of seven patients. Material and Method: The medical records and imaging of seven patient were evaluated at our institution between 2020-2024 with the diagnosis of spontaneous and nontraumatic intramural small-bowel hematoma. Ages, gender, primer disease, primer complaint, INR, PTT, LOS, Hb, HTC, CT findings and treatment of patients were retrieved retrospectively from our database. Results: Seven patients (two female, mean age 69.9 years) were identified. All of the patients suffered from abdominal pain, two had additional symptoms. All of the patients had overdosage of warfarin sodium and had abnormal coagulation parameters. The mean duration of the patients’ anticoagulation was 45 months. Abdominal CT showed the exact pathology which is intramural hematoma in all patients. Five of the patients were treated, nonoperatively, and two patients underwent surgery due to necrosis and obstruction. All patients were well at mean 18.9-week follow-up. Conclusion: SIBSH is a rare complication of anticoagulant therapy, however it should be considered in the differential diagnosis of acute abdomen. Firstly, nonsurgical treatment should be the treatment, but surgery is indicated if complicated patients such as generalized peritonitis, necrosis or intestinal obstruction develops.

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Cite the article

Ince M, Ince L. Spontaneous Intramural Small Bowel Hematoma Induced by Anticoagulant Therapy: Case Series. Clin Surg. 2024; 9: 3717..