Warfarin Woes: A Rare Case of Hemoperitoneum with Intramural Small Bowel Hematoma.
Ali HassanZainab HabbashMahdi AljawadFaris AlnemerAli AlzayerAqil AlZaherPublished in: The American journal of case reports (2024)
BACKGROUND Small bowel hematoma is a rare yet clinically significant condition characterized by the accumulation of blood within the mucosa and submucosa layers of the small intestine wall. It can lead to complications such as bowel obstruction, ischemia, perforation, and even hemorrhagic shock. The etiology of intramural small bowel hematoma is diverse, encompassing factors such as anticoagulant therapy, coagulopathies, vascular disorders, trauma, and underlying systemic conditions. CASE REPORT We present the case of a 67-year-old man with a history of aortic valve replacement who presented with intense abdominal pain. Physical examination revealed generalized abdominal tenderness and black stools upon rectal examination. Laboratory tests indicated coagulopathy with a prolonged thrombin time. A computed tomography scan confirmed the presence of an intramural small bowel hematoma and hemoperitoneum. The patient's condition significantly improved within 48 h under conservative management, including nasogastric tube insertion, continuous monitoring of gastric aspirate, nil per os status, intravenous fluids, and analgesics. Warfarin was temporarily stopped, and fresh frozen plasma was administered for anticoagulation reversal. Heparin infusion was initiated once the INR became within the therapeutic level. CONCLUSIONS The occurrence of spontaneous intramural small bowel hematoma, although rare, demands rapid diagnosis and prompt, well-coordinated management. This case underscores the pivotal role of multidisciplinary collaboration in providing a comprehensive assessment and a tailored approach to treatment. While conservative measures, including careful monitoring and supportive care, have demonstrated favorable outcomes, the consideration of surgical intervention remains crucial, particularly in severe cases.
Keyphrases
- small bowel
- venous thromboembolism
- atrial fibrillation
- computed tomography
- case report
- aortic valve replacement
- rare case
- direct oral anticoagulants
- abdominal pain
- healthcare
- transcatheter aortic valve implantation
- randomized controlled trial
- aortic valve
- magnetic resonance imaging
- palliative care
- risk assessment
- low dose
- type diabetes
- stem cells
- mental health
- magnetic resonance
- single cell
- heart failure
- coronary artery disease
- metabolic syndrome
- smoking cessation
- early onset
- growth factor
- contrast enhanced
- adipose tissue
- oral anticoagulants
- weight loss
- trauma patients
- skeletal muscle
- ejection fraction
- glycemic control
- loop mediated isothermal amplification