Abstract
An 84-year-old man was admitted to our hospital with abdominal pain and melena. He had a history of cerebral infarction and ischemic heart disease and was receiving regular anticoagulant drug therapy with warfarin and aspirin. Laboratory data revealed a prothrombin time-international normalized ratio (PT-INR) of 16.11 and serum Hb of 7.3g/dL. Computed tomography (CT) demonstrated a hematoma involving the? circumferential thickness of the intestinal wall and intraabdominal fluid collection. At first, the patient was treated conservatively with vitamin K infusion, fresh frozen plasma, and red blood cell and platelet transfusions. However, the abdominal pain worsened and the anemia persisted. Therefore, emergency surgery was performed for an intramural intestinal hematoma caused by anticoagulant drug therapy with warfarin and aspirin. The peritoneal cavity contained fresh blood. The adjacent mesentery was thickened because of a hematoma. The small intestine was dilated with a purple line of demarcation, necessitating partial resection. The treatment of first choice for an intramural hematoma is conservative. However, surgery should be considered if the patients’ data, vital signs and condition show any signs of deterioration.
