Intramural Jejunal Hematoma Causing Intermittent Bowel Obstruction—A Rare Manifestation of Warfarin Toxicity

Abstract

Patients with thromboembolic disorders are commonly on anticoagulants; hence, they are susceptible to bleeding episodes such as ecchymosis, gingival, subconjunctival bleeding, and rarely can have intramural hematoma of small bowel causing patient to present with intestinal obstruction. It is a rare cause of mechanical bowel obstruction requiring a nonsurgical management.

Our patient was a 55-year-old male, a known case of thromboembolism on warfarin medication, presented with abdominal pain and vomiting. Patient's laboratory reports reflected anemia and deranged coagulation profile with prothrombin time and international normalized ratio, both being elevated. Intramural hematoma of jejunum was diagnosed by abdominal contrast-enhanced computed tomography. Conservative management was done, warfarin was stopped and vitamin K was administered. Patient received fresh frozen plasma and packed cell blood.

It is important to suspect warfarin toxicity in patients on the medication who come with such presentation to avoid surgical management, which could be catastrophic due to excessive bleeding. It is important for regular monitoring of coagulation profile of such patients and to reduce prescribing other medications that can interact with warfarin. It is worth noting that novel oral anticoagulants, such as dabigatran and rivaroxaban, are associated with fewer side effects and do not require close laboratory monitoring.

Keywords

warfarin toxicity - intramural jejunal hematoma - intestinal obstruction

Publikationsverlauf

Eingereicht: 29. Mai 2021

Angenommen: 27. Juni 2022

Artikel online veröffentlicht:
06. November 2022

• References

• 1 Khan HS, Naeem A, Ayyaz M. Hemoperitoneum due to warfarin toxicity presenting as intestinal obstruction. J Coll Physicians Surg Pak 2015; 25 (Suppl. 02) S93-S94
• 2 Baser H, Kollu K, Sultan Selim AkgulY, Baser S, Serhat AygunM, Ecirli S. A rarely encountered complication due to the use of warfarin: spontaneous intramural hematoma in jejunum: two case reports. J Med Cases 2013; 4 (08) 560-563
• 3 Lobo L, Koudki R, Prasad Hl K, Shetty B. Colon obstruction due to an anticoagulant induced intramural haematoma; a rare case report. J Clin Diagn Res 2013; 7 (04) 739-741
• 4 Abbas MA, Collins JM, Olden KW, Kelly KA. Spontaneous intramural small-bowel hematoma: clinical presentation and long-term outcome. Arch Surg 2002; 137 (03) 306-310
• 5 Abbas MA, Collins JM, Olden KW. Spontaneous intramural small-bowel hematoma: imaging findings and outcome. AJR Am J Roentgenol 2002; 179 (06) 1389-1394
• 6 Gupta AK, Ross GS. Interaction between terbinafine and warfarin. Dermatology 1998; 196 (02) 266-267
• 7 Mekaj YH, Mekaj AY, Duci SB, Miftari EI. New oral anticoagulants: their advantages and disadvantages compared with vitamin K antagonists in the prevention and treatment of patients with thromboembolic events. Ther Clin Risk Manag 2015; 11: 967-977