Spontaneous intestinal intramural hematoma: What to do and not to do
Tayfun Yoldaş, Varlık Erol, Cemil Çalışkan, Erhan Akgün, Mustafa Korkut
Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
Keywords: Small bowel, intramural hematoma, anticoagulout treatment
Objective: Spontaneous intestinal intramural hematoma is a rare complication of anticoagulant treatment. In this study, we retrospectively evaluated 14 patients with the diagnosis of intramural hematoma of the small intestine who were followed-up and treated in our clinic, and we aimed to determine the diagnosis and treatment of intramural hematoma with current approaches.
Material and Methods: Between February 2007-October 2012 14 patients with a diagnosis of small intestinal intramural hematoma were retrospectively analyzed. Nine patients were followed due to clinical findings and 5 patients who had undergone operation of the small intestine and histopathologically diagnosed as intramural hematoma were evaluated in our department.
Results: Abdominal computed tomography demonstrated ileal and jejunal wall thickening in 10 patients, while findings were consistent with mesenteric vascular disease in four. Five patients were operated on due to mechanical bowel obstruction and acute abdomen. The other 9 patients were followed up with medical treatment and 8 of these patients were already using warfarin due to cardiac bypass and valve replacement.
Conclusion: Spontaneous intestinal intramural hematoma is a cause of small bowel obstruction due to intramural hematoma, which is encountered more rarely. Patients who presented with abdominal pain and symptoms of obstruction with a history of anticoagulant drug use and having elevated International Normalized Ratio (INR) levels, should be considered in the differential diagnosis of intramural hematoma and investigated. Early diagnosis and medical followup without surgery is very important because it can provide a good response to treatment in the majority of patients.
Concept - T.Y., V.E.; Design - T.Y., V.E.; Supervision - T.Y., V.E.; Funding - T.Y., V.E., C.Ç., M.K., E.A.; Data Collection and/or Processing - T.Y., V.E.; Analysis and/or Interpretation - T.Y., V.E., C.Ç., M.K., E.A.; Literature Review - T.Y., V.E.; Writer - T.Y., V.E.; Critical Review - C.Ç., M.K., E.A.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.