Surgically treated rare intestinal bleeding due to submucosal hematoma in a patient on oral anticoagulant therapy: A case report

Abstract

Rationale: Bleeding in the gastrointestinal tract is a common complication of oral anticoagulant therapy (AT), and it usually appears as mucosal erosion or ulcer; however, intestinal submucosal hematoma (ISH) is an uncommon cause of hemorrhage.

Patient concerns: This report presents the case of a 70-year-old woman with acute hematochezia induced by AT. She underwent computed tomography and endoscopy.

Diagnoses: Colon submucosal hematoma.

Interventions: Conservative treatment had no effect, and the patient underwent emergency surgery.

Outcomes: Surgical resection showed hemorrhage and necrosis in the left colon, and the patient recovered 24 hours after surgery and continued AT.

Lessons: The present case indicates that the ISH should be kept in mind as a complication of AT. It can be managed conservatively in some stable patients, but emergency surgery may be needed in some serious situations.

Figure 1

(A, B) Coronary angiography shows severe stenosis of both left and right coronary arteries.

Figure 2

(A, B) Submucosal hematoma ruptured into the intestinal cavity, and the intestinal cavity was stenosed.

Figure 3

(A, B) Plain computed tomography showed hyperdense lesion in the intramural aspect of the sigmoid colon.

Figure 4

Macroscopically, the size of the lesion was 60 mm × 38 mm × 20 mm and the cut surface appeared solid and yellow with focally reddish patches.

Figure 5

(A, B) The mucosal membrane was replaced by numerous hemorrhagic and necrotic tissues, the submucosa was edematous, and the muscle layer was intact, showing bleeding in some muscles (hematoxylin and eosin staining, × 40).