Clinics in diagnostic imaging (201). Small bowel intramural haematoma induced by anticoagulation therapy with associated reactive ileus.
A 74-year-old woman receiving long-term anticoagulation with warfarin for chronic atrial fibrillation presented with severe acute abdominal pain, diarrhoea and vomiting. Initial laboratory workup revealed a deranged coagulation profile. Computed tomography of the abdomen and pelvis demonstrated spontaneous distal jejunal intramural haematoma with associated reactive ileus. No overt pneumatosis intestinalis, intraperitoneal free gas or haemoperitoneum was seen. Based on clinical and imaging findings, a diagnosis of over-anticoagulation complicated by small bowel intramural haematoma was made. The patient was managed non-operatively with analgesia, cessation of warfarin and reversal therapy with vitamin K. Warfarin therapy was recommenced upon resolution of symptoms and optimisation of coagulation status. The clinical presentation, radiological features and overall management of anticoagulation-induced bleeding are further discussed in this article.
['Tan|Timothy Shao Ern|TSE|', 'Cheong|Sook Chuei Wendy|SCW|', 'Tan|Tien Jin|TJ|']
D015746:Abdominal Pain D000368:Aged D000369:Aged, 80 and over D000925:Anticoagulants D001281:Atrial Fibrillation D005260:Female D006471:Gastrointestinal Hemorrhage D006406:Hematoma D006801:Humans D045823:Ileus D019934:International Normalized Ratio D007415:Intestinal Obstruction D007422:Intestines D008297:Male D008875:Middle Aged D012307:Risk Factors D014057:Tomography, X-Ray Computed D014859:Warfarin
haematoma anticoagulants warfarin atrial fibrillation haemorrhage