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

Abstract

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.

Small Bowel Obstruction

“…[11][12][13] Patients on anticoagulation or antiplatelet therapy, or with conditions such as hemophilia or thrombocytopenia, have also been described to have spontaneous hematomas. 10,[14][15][16] Even connective tissue disorders, such as Ehlers-Danlos syndrome, may increase the risk of spontaneous intramural hematomas. 15 Symptoms may range from abdominal pain to obstructive symptoms with PO (per oral) intolerance and nausea/vomiting.…”

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 (1).…”

Spontaneous duodenal haematoma in a patient taking rivaroxaban

“…Intramural small bowel haematomas (ISBHs), including IDH, are rare and usually traumatic in nature 1–3 . Spontaneous ISBH are much less common and predominantly occur in older individuals 1 . The associated mortality rate is reported between 6% and 15% 1,4 …”

“…Spontaneous ISBH are much less common and predominantly occur in older individuals 1 . The associated mortality rate is reported between 6% and 15% 1,4 …”