Clinics in diagnostic imaging (201)

Abstract

M e d i c a l E d u c a t i o n CASE PRESENTATION A 74-year-old woman who was receiving anticoagulation therapy with warfarin for a past medical history of chronic atrial fibrillation presented to the emergency department with severe acute abdominal pain associated with diarrhoea and vomiting. The patient denied any haematemesis or melaena. Clinical examination revealed mild tenderness over the periumbilical area without guarding. The patient was afebrile and her vital signs were as follows: heart rate of 97 beats per minute, blood pressure of 97/69 mmHg and oxygen saturation of 98% on room air. Initial laboratory workup revealed an international normalised ratio (INR) of > 10 (therapeutic range for oral anticoagulants: 2-3.5) and prolonged prothrombin time of > 100.0 (normal range 9.2-11.2) seconds. There was no acute drop in haemoglobin levels. In view of the persistent abdominal pain, contrast-enhanced computed tomography (CT) of the abdomen and pelvis (Fig. 1) was performed. What do the CT images show? What is the diagnosis? CMEArticle

Warfarin-induced spontaneous intramural small bowel hematoma presenting as an acute abdomen: A case report

“…Conservative treatment was commonly applied; surgical intervention may be reserved for severe conditions, such as intestinal obstruction, ischemia, perforation, peritonitis, and intra-abdominal hemorrhage. [3]…”