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

Extensive small bowel intramural haematoma secondary to warfarin

“…It is a rare cause of small bowel obstruction [2, 3]. Over 90% of cases occur secondary to blunt abdominal trauma [2].…”

“…It is a rare cause of small bowel obstruction [2, 3]. Over 90% of cases occur secondary to blunt abdominal trauma [2]. The leading cause of non-traumatic ‘spontaneous’ intramural haematoma is supratherapeutic anticoagulation with warfarin [3].…”

“…haemophilia, von Willebrand's disease, idiopathic thrombocytopaenic purpura), haematological malignancies (e.g. leukaemia, lymphoma and myeloma), vasculitis, pancreatitis, chemotherapy, endoscopic biopsy or injection [2, 7, 8]. Spontaneous intramural haematoma involves the small bowel in 85% of cases (particularly the jejunum); however, rare cases of isolated oesophageal, gastric, colonic and rectal haematoma have also been described [2].…”

“…The majority of intramural haematomas are small and can be managed non-operatively [2]. The following case demonstrates an extensive warfarin-related small bowel intramural haematoma with secondary bowel obstruction that was effectively managed non-operatively.…”

Unusual complication of coumadin toxicity mimicking Crohn’s disease

“…Samie and Theilmann2 reported that haemorrhage originates in the submucosa. Haematoma leads to expansion in the intestinal wall and changes in the osmotic gradient.…”