Spontaneous intestinal intramural hematoma: What to do and not to do

Abstract

Objective: Spontaneous intestinal intramural hematoma is a rare complication of anticoagulant treatment. In this study, we retrospectively evaluated 14 patients with the diagnosis of intramural hematoma of the small intestine who were followed-up and treated in our clinic, and we aimed to determine current approaches in the diagnosis and treatment of intramural hematoma. Material and Methods:Between February 2010-October 2012, 14 patients diagnosed with small intestinal intramural hematoma were retrospectively analyzed. Nine patients were followed due to clinical findings and 5 patients underwent operation with a histopathological diagnosis of intramural hematoma. Results:Abdominal computed tomography demonstrated ileal and jejunal wall thickening in 10 patients, while findings were consistent with mesenteric vascular disease in four. Five patients were operated due to mechanical bowel obstruction and acute abdomen. The other 9 patients were followed up with medical treatment and 8 of these patients were already using warfarin due to cardiac bypass and valve replacement. Conclusion:Spontaneous intestinal intramural hematoma is a rare cause of small bowel obstruction due to intramural hematoma, which is encountered even more rarely. An intramural hematoma should be considered among differential diagnosis of patients who present with abdominal pain and symptoms of obstruction with a history of anticoagulant drug use and elevated International Normalized Ratio (INR) levels. Early diagnosis and medical follow-up can provide a good response to treatment in the majority of patients without requiring surgery.

Spontaneous Intramural Hematoma of the Jejunum Induced by Anticoagulant Therapy

“…It is most likely that there is a rupture of the terminal artery that branches from the mesentery and penetrates into the muscular layer of the intestinal wall. Therefore, bleeding dissects the intestinal wall between the muscularis mucosa and muscular layers 12,13) . Pro- gression of symptoms is due to an intramural osmotic gradient caused by the liquefying hematoma, which causes thickening of the intestinal wall and decreasing the intestinal luminal dimeter by drawing fluid from the surrounding tissues 14) .…”

“…In the presence of signs of peritoneal irritation, hematoma complications like necrosis, perforation and hemoperitoneum should be suspected 12) .…”

“…Owing to the rarity of this entity, there is no standardized treatment. However, most reports have recommended conservative therapy as the mainstay of therapy, including bowel rest, nasogastric decompression, correction of electrolyte disturbances, immediate suspension of oral anticoagulants, correction of abnormal coag ulation pa rameters by administering vitamin K, fresh frozen plasma (FFP) and blood transfusion 3,12,15) . The resolution of a hematoma might start as early as 1 week after the onset and complete resolution usually occurs within 2 months 5) .…”

Warfarin Therapy Induced a Rare Complication: Spontaneous Intramural Hematoma of the Jejunum: Case Report

“…In the presence of signs of peritoneal irritation, hematoma complications like necrosis, perforation and hemoperitoneum should be suspected. 7 Diagnosis is often delayed due to forgetting it, and a definite diagnosis can only be made after urgent laparatomy or radiological imaging. 8 There was no complaints of nausea, vomiting or constipation, apart from abdominal pain in our case.…”

Abdome Agudo Oclusivo Por Hematoma De Intestino Delgado: Relato De Caso

“…Ela mostra espessamento da parede intestinal (imagem de pseudorim) e o nível de sua obstrução 2,5,7,9 , achado este presente na TC da paciente. O jejuno é o segmento mais acometido, seguido pelo duodeno e íleo.…”