Intramural hematomas of the gastrointestinal system: a 5-year single center experience

Abstract

PurposeAlthough spontaneous intramural hematomas of the gastrointestinal tract are very rare, they may be observed with the use of oral anticoagulant, though less frequently in cases of hematological malignancy and other bleeding disorders. Cases diagnosed as spontaneous intramural hematoma have been assessed in our clinic.MethodsThe cases, which were diagnosed as spontaneous intramural hematoma in the gastrointestinal tract (SIHGT) following anamnesis, physical examination, biochemical, radiological and endoscopic findings from July 2008 to July 2012, have been assessed retrospectively.ResultsSeven out of 13 cases were women and the mean age was 65.1 years (34 to 82 years). The most frequent complaint on admission was abdominal pain. The most frequent location of SIHGT was the ileum (n = 8). Oral anticoagulant use was the most common cause of etiology (n = 12). In 10 cases, International normalized ratio values were higher than treatment range (2 to 3, where mechanical valve replacement was 2.5 to 3.5) and mean value was 7.6 (1.70 to 23.13). While 12 cases were discharged without problems with medical treatment, one case with acute myeloid leukemia died in the intensive care unit following cerebrovascular attack.ConclusionSpontaneus bleeding and hematomas that may arise in connection with bleeding diathesis may be fatal in cases with long-term oral anticoagulant treatment and insufficient follow-up. In management of these cases, it may be necessary to arrange conservative follow up and/or initialize low molecular weight heparin, and administer vitamin K as well as replace blood products and coagulation factors when indicated.

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

“…It can arise in the submucosal or muscular layer of the organ [ 4 ]. The postulated mechanism for the bleeding is shredding of terminal arteries at the point of penetration in the muscular layer with subsequent dissection of the muscularis propria from the submucosa [ 5 , 6 ] and the most common contributing factor is hemorrhagic diathesis/anticoagulant use [ 7 ].…”

“…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 ].…”

“…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 ].…”

An Unusual Cause of Lower Gastrointestinal Bleeding

“…1,2 Conservative therapy with anticoagulation withdrawal represents the main approach, with surgery reserved for complicated or severe cases. 1,2 We report a case of spontaneous hematoma of the descending colon facilitated by chronic anticoagulation. Several cases of gastrointestinal hematoma associated with antiplatelet and anticoagulant agents have been reported previously.…”

“…1,2 Risk factors include bleeding diathesis and anticoagulation. 1,2 Endoscopic and imaging diagnosis involve the identification of a localized, well-defined, intramural mass. 1,2 Conservative therapy with anticoagulation withdrawal represents the main approach, with surgery reserved for complicated or severe cases.…”