Warfarin-induced gastric intramural hematoma

Felix, R; Galvão, Breno Victor Tomaz; Góis, Aécio Flávio Teixeira de

doi:10.1590/1806-9282.60.01.005

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…The treatment may be cause-dependent. Hence, GIHs secondary to coagulopathy are generally managed conservatively with blood transfusion and anticoagulation reversal [ 1 , 29 ]. Oral intake is usually interrupted in patients with abdominal pain, acute bleeding and symptoms of gastric outlet oclusion [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…If there is active bleeding or a trend toward enlargement, transcatheter arterial embolization (TAE) may be indicated. However, it is only technically possible if contrast extravasation of the gastroparietal branch of the left gastric artery is identified [ 4 , 16 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…As exposed in the current review, 50.8% of the sample underwent surgical exploration. It is especially recommended in cases with unclear diagnosis, suspected complications, ongoing bleeding and failure of minimally invasive therapy [ 5 , 25 , 28 , 29 ]. The decision to operate emergently is largely driven by the clinical scenario [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Gastric intramural hematoma subsequent to thoracic aortic dissection: Case report and literature review

Borges¹,

Cury²,

Carvalho³

et al. 2018

Annals of Medicine and Surgery

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IntroductionIntramural hematomas of the gastrointestinal tract are uncommom, usually located in the esophagus or duodenum, with idiophatic or secondary causes. We present a very rare case of gastric intramural hematoma caused by an unpublished etiology, with literature review.Case presentationAn elderly woman suffered acute thoracic aorta dissection followed by gastric intramural hematoma, diagnosed through endoscopy and computed tomography angiography. The treatment included endovascular aortic repair and conservative management.DiscussionThe postulated mechanism for the bleeding in gastric intramural hematoma is shredding of terminal arteries at the point of penetration into the muscular layer with subsequent dissection of the muscularis propria from the submucosa. The most frequently cited risk factor is hemorrhagic diathesis/anticoagulant use and the main etiologies are trauma and post-interventional endoscopy. In the diagnosis work-up, computed tomography is the method of choice, usually associated with endoscopy. There is no standard of care for such rare condition. Thus, treatment may be cause-dependent, ranging from conservative to minimally invasive and/or surgery.ConclusionsGastric intramural hematoma is a rare disorder with many causes and we described a new etiology for it. The computed tomography is the diagnostic modality of choice, with the aid of other examinations. The treatment comprises conservative measures, minimally invasive approach or most commonly surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Gastric intramural hematoma subsequent to thoracic aortic dissection: Case report and literature review

Borges¹,

Cury²,

Carvalho³

et al. 2018

Annals of Medicine and Surgery

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“…In gastric intramural haematomas, a review of the literature suggests that the most common aetiology is coagulopathy, with or without contribution by peptic ulcer disease. This is most commonly related to use of anticoagulation [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , less commonly in patients with haemophilia [16] , [17] , [18] , [19] , and one case described a patient with thrombocytopenia from myelofibrosis [20] . Other causes include peptic ulcer disease [21] , [22] , [23] , vascular aneurysms [24] , [25] , [26] , [27] , fish bone ingestion [28] , [29] , as a complication of endoscopy [30] , [31] , [32] , [33] , [34] , [35] , [36] , spontaneous and idiopathic cases [37] , [38] , [39] , [40] , [41] , and other isolated cases related to amyloidosis [42] , [43] , [44] , pancreatitis [45] , Ehlers-Danlos syndrome [46] , splenic rupture [47] , and one case describing haematoma after splenectomy for idiopathic thrombocytopenic purpura [48] .…”

Section: Discussionmentioning

confidence: 99%

A belly of blood: A case report describing surgical intervention in a gastric intramural haematoma precipitated by therapeutic endoscopy in an anticoagulated patient

Tan

Keh

2016

International Journal of Surgery Case Reports

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Gastric intramural hematoma, “intramural dissection” or “false aneurysm”, is a rare and dangerous condition which may be more broadly classified as a spectrum of acute gastric mucosal injury. It is postulated that disruption of the mucosa and blood vessels within the submucosal layer results in dissection of the muscularis propria from the mucosa, with eventual clot formation. While a majority of cases resolve with conservative management, we describe a successfully managed case requiring surgical intervention. Progression of the haematoma was documented both endoscopically and surgically in an elderly anticoagulated patient who suffered a complication of therapeutic endoscopic intervention. A review of the literature is presented.

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“…Hematoma was diagnosed in that patient by endoscopic ultrasound and gastroscopy when she presented with coffee ground hematemesis 6 hours after the procedure. The most common contributing factor to GIH is a bleeding diathesis, including warfarin use [5] and hemophilia (Figure 3). Among all reported cases associated with warfarin use, only one case [6] needed transcatheter arterial embolization, while others were managed conservatively through coagulopathy reversal and blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Gastric Intramural Hematoma: A Rare Complication of Percutaneous Endoscopic Gastrostomy

et al. 2016

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Patient: Male, 73Final Diagnosis: Gastric intramural hematomaSymptoms: BleedingMedication: —Clinical Procedure: Percutaneous endoscopic gastrostomySpecialty: Gastroenterology and HepatologyObjective:Diagnostic/therapeutic accidentBackground:Intramural hematomas primarily present in the esophagus or duodenum. We report a case of intramural hematoma in the gastric wall (GIH) secondary to percutaneous endoscopic gastrostomy (PEG) tube placement in a setting of platelet dysfunction.Case Report:This case study reviews the hospitalization of a 73-year-old male with a history of chronic kidney disease who was admitted for coronary artery bypass graft surgery and mitral valve repair. During his complicated hospital course, he inadvertently required the placement of a PEG tube. His coagulation profile prior to this procedure was within normal limits. The patient had no history of coagulopathy and was taking aspirin 81 mg per day. PEG tube placement was withheld due to an expanding hematoma that was noted at the site of needle insertion in the gastric wall. A single dose of intravenous desmopressin (0.3 microgram/kilogram) was administered under the suspicion of uremic bleeding. No further gastrointestinal bleeding events were observed. A platelet function assay (PFA) and collagen/epinephrine closure time indicated platelet dysfunction. Three days later, we again attempted a PEG tube placement. His PFA prior to this procedure had normalized due to aspirin discontinuation and improvement of renal function. Esophagogastroduodenoscopy (EGD) showed an area of flat bluish gastric submucosal bruising at the site of the previous hematoma. The PEG tube was placed successfully at an adjacent site. Over the course of the following month, the patient underwent uneventful feeding through the PEG tube.Conclusions:To our knowledge, cases of GIH are rarely documented in literature. Multidisciplinary vigilance is required to maintain a high index of suspicion for this complication in patients with uremia or other coagulopathies to aid in prompt diagnosis.

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Warfarin-induced gastric intramural hematoma

Cited by 10 publications

References 9 publications

Gastric intramural hematoma subsequent to thoracic aortic dissection: Case report and literature review

Gastric intramural hematoma subsequent to thoracic aortic dissection: Case report and literature review

A belly of blood: A case report describing surgical intervention in a gastric intramural haematoma precipitated by therapeutic endoscopy in an anticoagulated patient

Intraoperative Gastric Intramural Hematoma: A Rare Complication of Percutaneous Endoscopic Gastrostomy

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