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. 2018:52:111-113.
doi: 10.1016/j.ijscr.2018.10.010. Epub 2018 Oct 12.

Warfarin induced mesenteric and intestinal hematoma requiring surgical resection to relieve small bowel obstruction: A case report

Khuram Khan  1 , Saqib Saeed  2 , Sara Alothman  2 , Farhana Iqbal  3 , Alexius Ramcharan  2 , Brian Donaldson  2
Affiliations

Warfarin induced mesenteric and intestinal hematoma requiring surgical resection to relieve small bowel obstruction: A case report

Khuram Khan et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: Mesenteric and Intramural Hematoma leading to small bowel obstruction is a rare, but a fatal complication of anticoagulant therapy.

Presentation of case: We present this unique case of 61 year old male with non traumatic mesenteric and intramural hematoma secondary to warfarin leading to small bowel obstruction requiring surgical resection.

Discussion: Although there have been few cases reported in literature about intramural small bowel hematoma, however, associated with small bowel obstruction secondary to warfarin therapy are less frequently seen. Diagnosis of intramural hematoma can be made with Computed Tomography (CT) of abdomen. The most effective treatment approach is conservative management after excluding any signs of small bowel obstructions, peritonitis and bowel necrosis.

Conclusion: Therefore, early diagnosis is vitally essential to avoid morbidity in patients with these symptoms. Physician should have a higher index of suspicion to recognize and diagnose this complication is essential for early treatment intervention to prevent morbidity.

Keywords: Abdominal pain; Anticoagulant therapy; Intramural hematoma; Mesenteric; Small bowel obstruction; Warfarin.

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Figures

Fig. 1
Fig. 1
Computed Tomography of abdomen axial view showing dilated small bowels (target sign) (red arrow).
Fig. 2
Fig. 2
CT abdomen axial another view showing dilated small bowels along with mesenteric swirling; target sign (yellow arrow).
Fig. 3
Fig. 3
Gross image showing dilated small bowels along with intramural and mesenteric hematoma (blue arrows).
Fig. 4
Fig. 4
Resected gross image showing intramural and mesenteric hematoma (blue arrow).
See this image and copyright information in PMC

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