A Case of a Small Intestinal Hematoma Induced by an Anticoagulant Drug

Abstract

An 81-year old woman was transferred to our hospital with low blood pressure and continuous abdominal pain. She was receiving with Warfarin potassium regularly following a cerebral infarction. Laboratory data revealed a prothrombin time-international normalized ratio of 10.0, and abdominal computed tomography demonstrated segmental thickening of the jejunal wall and mesentery, and fluid collection which appeared to be bloody ascites. Although an anticoagulant drug induced intramural and mesenteric hematoma was suspected, the symptoms worsened, and the possibility of intestinal necrosis could not be ruled out. After vitamin K administration, emergency surgery was performed. The peritoneal cavity was found to contain bloody ascites, segmental thickening of the jejunal wall and mesentery was seen due to the hematoma and part of the jejunum was found to be necrosed. Partial resection of the jejunum was performed. The postoperative course was uneventful. Conservative treatment is the first-choice treatment for intramural hematoma. However, some cases exist which may be complicated by hemorrhagic necrosis or perforation, hence careful observation is needed and surgery should be considered before the condition of the patient deteriorates.