Intestinal intramural hematoma: A rare complication of Anticoagulation Therapy

Abstract

Objective: Anticoagulant therapy is commonly used in the treatment of cardiac and thromboembolic diseases, with bleeding being the most common side effect, which increases in likelihood with prolonged usage. Intestinal intramural hematoma, although rare, is a potential complication of anticoagulant therapy.

Case: Herein, we present the case of a 49-year-old male patient who presented to our outpatient general surgery clinic with complaints of nausea, vomiting, and abdominal pain. Upon examination, electrocardiography (ECG) revealed sinus rhythm without any ischemic changes, and echocardiography findings were within normal limits. The patient reported the use of warfarin, and his International Normalized Ratio (INR) was found to be 14.7 (normal range: 0.8-1.1). A 10 mg (1 ampoule) intravenous (IV) infusion of vitamin K was administered, and the warfarin dosage was adjusted accordingly. Subsequent follow-up assessments showed normalization of the INR levels.

Conclusion: Intestinal intramural hematoma is an exceedingly rare condition that necessitates prompt diagnosis and intervention, as delayed recognition can lead to life-threatening complications. Clinicians should maintain a high index of suspicion for intestinal obstruction secondary to anticoagulant therapy in patients presenting to the emergency department with symptoms such as abdominal pain, nausea, and vomiting.