Spontaneous descending colon hematoma due to a rare complication of warfarin therapy: A case report

Abstract

Intramural hematoma of the colon should be considered as a diagnosis in anticoagulated patients who present with prolonged INR and GI symptoms. In stable cases, conservative medical treatment can be sufficient to avoid unnecessary procedures.

A Case of Idiopathic Colonic Intramural Hematoma: Successful Expectant Management

“…As in our case, laboratory testing may reveal anemia and leukocytosis [ 3 , 9 ]. An elevated WBC count occurs due to hemorrhagic rupture of the bowel wall, which results in intramural and peritoneal distribution of gastrointestinal bacteria and subsequent infections.…”

“…It should be noted that leukocytosis may be connected to a medical condition associated with sepsis. Furthermore, leukocytosis with a mass shown on a radiologic image may make hematoma identification more difficult because intraperitoneal contamination cannot be ruled out in such a scenario [ 6 , 9 ].…”

“…The gold-standard radiologic method for diagnosis is a contrast-enhanced CT scan [ 9 ]. Although a CT scan supports accurate diagnosis in the vast majority of instances, differential diagnosis with other non-cancerous or cancerous gastrointestinal malignancies can be problematic, particularly in occluded or perforated cases [ 6 ].…”

Perspectives and Management Strategies for Acute Colonic Intramural Hematoma

“…A recent review of the literature demonstrates a shift in the management of colonic hematomas over the past 50 years where surgical management was the treatment of choice; 24 however, since 2010 there has been a recent trend towards more conservative management. 6 , 7 , 16 …”

“… 2 According to Zhu et al and Yavari et al, despite the rarity of bowel hematoma incidence, it should be considered as an adverse drug reaction of low molecular weight heparin or warfarin therapy, especially among cases presenting with gastrointestinal symptoms with or without prolonged INR. 6 , 7 Gastrointestinal hematomas are estimated to occur in only 1 in every 250,000 anti-coagulated patients; with small intestinal hematoma reported in 1/2500 anticoagulated patients per year and far fewer reported colonic hematoma cases. 8 , 9 Colonic trauma can occur in only 0.5–5% of those exposed to blunt abdominal injuries, 10 with a very uncommon incidence of colonic intramural hematoma.…”