CASE REPORT: Direct Observation with Double-Balloon Enteroscopy of an Intestinal Intramural Hematoma Resulting in Anticoagulant Ileus

Abstract

In the case presented here, we have succeeded in describing the endoscopic findings of anticoagulant ileus and evaluated the degree of bleeding as well as ischemia through endoscopic observation. We have demonstrated that enteroscopy using the double-balloon method is a useful diagnostic tool in the evaluation of a patient suspected to have anticoagulant ileus.

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

“…With the help of pull and push enteroscopy, deep small-bowel lesions can be visualized [19]. However, the role of endoscopy in the diagnosis of intramural hematoma is not well established, as almost all cases are diagnosed "noninvasively" with CT and US.…”

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

“…With the help of pull and push enteroscopy, deep small bowel lesions can be visualized [28]. However, the role of endoscopy in the diagnosis of intramural hematoma is not well established, as almost all cases are diagnosed 'noninvasively' with CT and ultrasound scans.…”

Enteroscopy

“…Indeed, Sunada et al 37 reported 17 cases of stenosis of the small intestine for which double-balloon endoscopy was used, and all the procedures were completed safely, including in three cases diagnosed as small intestinal tumors and four cases in which endoscopic balloon dilatation was performed. Shinozaki et al 38 also reported a case of rare intestinal stenosis caused by an overdose of anticoagulant (anticoagulant ileus) for which they were able to use double-balloon endoscopy to observe the characteristic endoscopic findings of intestinal hematomas surrounded by pigmentation (Fig. 5).…”

“…Selective contrast-enhanced X-ray examinations can be performed as well by occluding the intestine with a balloon to prevent reflux of the contrast medium. 38,40 Another advantage of the double-balloon endoscope is that it can be used for endoscopic treatment in the small intestine. Yamamoto et al 35 succeeded in performing hemostasis, polypectomy, endoscopic mucosal resection, balloon dilatation, and stent placement in the small intestine.…”

“…5a,b. Images of the jejunum of the anticoagulant ileus acquired by double-balloon endoscopy, previously published by Shinozaki et al 38 a Black pigmented area along the proximal border of the lesion; b erythematous and edematous jejunal mucosa; c radiograph of the jejunum-specific contrast study. The "stack of coins" appearance is due to thickened mucosal folds showed multiple perforations in the region of lymphoma infiltration in the small intestine, with some of the perforations located in an area that the endoscope had not reached.…”