|
1
|
Chen B, Tian S, Ren X, Jiang C. Spontaneous intramural hematoma of the small intestine secondary to warfarin therapy: A rare case series. Asian J Surg 2022; 45:2133-2135. [PMID: 35599116 DOI: 10.1016/j.asjsur.2022.04.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Baoxiang Chen
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China; Clinical Center of Intestinal and Colorectal Diseases of Hubei Province (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China; Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China
| | - Shunhua Tian
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China; Clinical Center of Intestinal and Colorectal Diseases of Hubei Province (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China; Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China
| | - Xianghai Ren
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China; Clinical Center of Intestinal and Colorectal Diseases of Hubei Province (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China; Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China
| | - Congqing Jiang
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China; Clinical Center of Intestinal and Colorectal Diseases of Hubei Province (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China; Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan, 430071, China.
| |
Collapse
|
|
2
|
Gungorer B. Risk factors associated with warfarin overdose and complications related to warfarin overdose in the emergency department. Drug Chem Toxicol 2021; 45:1732-1738. [PMID: 33494629 DOI: 10.1080/01480545.2020.1868493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this study was to investigate risk factors of bleeding and mortality in patients with warfarin overdose (WOD). Totally, 783 patients were included, of which, 272 patients (34.7%) with an INR below 5,364 patients (46.5%) with an INR between 5-10, and 147 patients (18.8%) with an INR of 10 or above. Demographic, clinical, and laboratory findings of the patients were obtained from the Real Life Data Provision Center and Hospital Information Management System. Admittance in autumn (OR = 1.75; p = 0.012), INR = 5-10 (OR = 2.65; p < 0.001), INR ≥ 10 (OR = 9.06; p < 0.001), and antiplatelet use alongside warfarin (OR = 1.93; p < 0.001) were found to be independent risk factors for bleeding in this study. The age (OR= 1.03; p = 0.005), bleeding (OR = 1.69; p = 0.020), primary hypertension (OR = 1.72; p = 0.031), and INR ≥ 10 (OR = 2.02; p = 0.025) were found to be independent risk factors for mortality. The cutoff value for INR in predicting bleeding was found to be >6.35 with 74.2% sensitivity and 72.7% specificity. The significant risk factors were determined in WOD development. INR level, autumn, and antiplatelet use were independently associated with bleeding due to WOD. In addition, bleeding, hypertension and INR levels were independently related to in-hospital-mortality due to WOD.
Collapse
Affiliation(s)
- Bulent Gungorer
- Ministry of Health, Ankara City Hospital, Üniversiteler, Ankara, Turkey
| |
Collapse
|
|
3
|
Kang EA, Han SJ, Chun J, Lee HJ, Chung H, Im JP, Kim SG, Kim JS, Yoon H, Shin CM, Park YS, Kim N, Lee DH, Jung HC. Clinical features and outcomes in spontaneous intramural small bowel hematoma: Cohort study and literature review. Intest Res 2018; 17:135-143. [PMID: 30301344 PMCID: PMC6361017 DOI: 10.5217/ir.2018.00085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/10/2018] [Indexed: 02/06/2023] Open
Abstract
Background/Aims Spontaneous intramural small bowel hematoma (SISBH) is an extremely rare complication of anticoagulant or antiplatelet therapy. We assessed the clinical characteristics and outcomes of patients with SISBH according to the anatomical location of the hematoma. Methods From January 2003 to February 2016, medical records for all patients hospitalized for SISBH at 2 tertiary referral hospitals were retrospectively reviewed. The primary outcome was requirement for surgery. Results A total of 37 patients were enrolled. The mean age was 74.1 years. Among them, 33 patients (89.2%) were taking anticoagulant and/or antiplatelet agents. Duodenal intramural hematoma was detected in 4 patients (10.8%), jejunal in 16 (43.2%), and ileal in 17 (45.9%). Compared to jejunal and ileal involvement, duodenal intramural hematoma was significantly associated with high Charlson comorbidity index and low levels of white blood cells, hemoglobin, and platelets in the blood. SISBH in the duodenum was related to thrombocytopenia in 3 patients following systemic chemotherapy for malignancy. All patients with SISBH showed clinical improvement with conservative therapy. Mean length of hospital stay was 9.35 days. Independent predictors of a hospital stay of more than 7 days were body weight less than 60 kg (odds ratio [OR], 12.213; 95% confidence interval [CI], 1.755–84.998; P=0.011) and a history of cerebrovascular accidents (OR, 6.667; 95% CI, 1.121–39.650; P=0.037). Conclusions Compared to jejunal and ileal involvement, thrombocytopenia may result in spontaneous duodenal intramural hematoma among patients who are treated with systemic chemotherapy for malignancies. Patients with SISBH have excellent clinical outcomes with conservative therapy regardless of the anatomical location of the hematoma.
Collapse
Affiliation(s)
- Eun Ae Kang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Jun Han
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunsoo Chung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Chae Jung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
|
4
|
Ribeiro H, Azevedo R, Pereira E, Banhudo A. Spontaneous intramural intestinal hemorrhage due to anticoagulation therapy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 110:123. [PMID: 29278001 DOI: 10.17235/reed.2017.5019/2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
An 84-years old woman, medicated with acenocumarol, was admitted to the Emergency Room with lower abdominal pain and nauseas and no history of trauma. She was medicated with acenocumarol and had a non-measurable international normalized ratio. The findings of the bowel ultrasound, ileocolonoscopy and biopsies specimens were suggestive of intramural bleeding of the ileum, ileocecal valve and cecum. Spontaneous intramural bleeding of the gastrointestinal wall associated with oral anticoagulation is rare.
Collapse
Affiliation(s)
- Helena Ribeiro
- Gastroenterology, Hospital Amato Lusitano, ULS de Castelo Branco, Portugal
| | - Richard Azevedo
- Gastroenterology, Hospital Amato Lusitano, ULS de Castelo Branco, Portugal
| | - Eduardo Pereira
- Gastroenterology, Hospital Amato Lusitano, ULS de Castelo Branco, Portugal
| | - António Banhudo
- Gastroenterology Department, Hospital Amato Lusitano, ULS de Castelo Branco, Portugal
| |
Collapse
|
|
5
|
Spontaneous intramural small-bowel hematoma due to a rare complication of warfarin therapy: Report of two cases. J Acute Med 2014. [DOI: 10.1016/j.jacme.2014.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
|
6
|
Eichele DD, Ross M, Tang P, Hutchins GF, Mailliard M. Spontaneous intramural duodenal hematoma in type 2B von Willebrand disease. World J Gastroenterol 2013; 19:7205-8. [PMID: 24222967 PMCID: PMC3819559 DOI: 10.3748/wjg.v19.i41.7205] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/21/2013] [Accepted: 08/12/2013] [Indexed: 02/06/2023] Open
Abstract
Intramural duodenal hematoma is a rare cause of a proximal gastrointestinal tract obstruction. Presentation of intramural duodenal hematoma most often occurs following blunt abdominal trauma in children, but spontaneous non-traumatic cases have been linked to anticoagulant therapy, pancreatitis, malignancy, vasculitis and endoscopy. We report an unusual case of spontaneous intramural duodenal hematoma presenting as an intestinal obstruction associated with acute pancreatitis in a patient with established von Willebrand disease, type 2B. The patient presented with abrupt onset of abdominal pain, nausea, and vomiting. Computed tomography imaging identified an intramural duodenal mass consistent with blood measuring 4.7 cm × 8.7 cm in the second portion of the duodenum abutting on the head of the pancreas. Serum lipase was 3828 units/L. Patient was managed conservatively with bowel rest, continuous nasogastric decompression, total parenteral nutrition, recombinant factor VIII (humateP) and transfusion. Symptoms resolved over the course of the hospitalization. This case highlights an important complication of an inherited coagulopathy.
Collapse
|
|
7
|
Yoldaş T, Erol V, Çalışkan C, Akgün E, Korkut M. Spontaneous intestinal intramural hematoma: What to do and not to do. Turk J Surg 2013; 29:72-5. [PMID: 25931850 DOI: 10.5152/ucd.2013.41] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/10/2013] [Indexed: 11/22/2022]
Abstract
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 current approaches in the diagnosis and treatment of intramural hematoma. MATERIAL AND METHODS Between February 2010-October 2012, 14 patients diagnosed with small intestinal intramural hematoma were retrospectively analyzed. Nine patients were followed due to clinical findings and 5 patients underwent operation with a histopathological diagnosis of intramural hematoma. 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 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 rare cause of small bowel obstruction due to intramural hematoma, which is encountered even more rarely. An intramural hematoma should be considered among differential diagnosis of patients who present with abdominal pain and symptoms of obstruction with a history of anticoagulant drug use and elevated International Normalized Ratio (INR) levels. Early diagnosis and medical follow-up can provide a good response to treatment in the majority of patients without requiring surgery.
Collapse
Affiliation(s)
- Tayfun Yoldaş
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Varlık Erol
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cemil Çalışkan
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Erhan Akgün
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Korkut
- Department of General Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| |
Collapse
|
|
8
|
Abdel Samie A, Theilmann L. Detection and management of spontaneous intramural small bowel hematoma secondary to anticoagulant therapy. Expert Rev Gastroenterol Hepatol 2012; 6:553-8; quiz 559. [PMID: 23061706 DOI: 10.1586/egh.12.33] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Intestinal hematoma, once considered a rare complication of anticoagulation, has recently been increasingly reported. Spontaneous small bowel hematomas most commonly involve the jejunum, followed by the ileum and duodenum. They occur in patients who receive excessive anticoagulation with vitamin K antagonists or who have additional risk factors for bleeding. Diagnosis can be readily identified with sonography and confirmed with computed tomography. Early diagnosis is crucial as most patients can be treated successfully without surgery. Conservative treatment is recommended for intramural intestinal hematomas, when other associated complications needing laparotomy have been excluded.
Collapse
Affiliation(s)
- Ahmed Abdel Samie
- Department of Gastroenterology, Pforzheim Hospital, Pforzheim, Germany.
| | | |
Collapse
|
|
9
|
Rupture of pseudoaneurysm of the pancreaticoduodenal arcade after acute aortic dissection in a patient on anticoagulant therapy. J Cardiol Cases 2011; 3:e103-e105. [PMID: 30532849 DOI: 10.1016/j.jccase.2010.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 11/23/2010] [Accepted: 12/10/2010] [Indexed: 11/23/2022] Open
Abstract
An 81-year-old woman on anticoagulant therapy after mechanical heart valve replacement was admitted because of acute aortic dissection. Anticoagulant therapy had to be continued with heparin even after admission. Gastrointestinal hemorrhage occurred suddenly and she developed hemorrhagic shock. Computed tomography findings suggested that the bleeding was due to rupture of a pseudoaneurysm of the pancreaticoduodenal arcade. After the site of bleeding was identified by angiography, hemorrhage was successfully controlled by embolization with coils. With the aging of the population, vascular complications of arteriosclerosis are likely to increase. This case report provides important insights that could be helpful for treating such patients.
Collapse
|
|
10
|
Antoniou D, Zarifi M, Gentimi F, Christopoulos-Geroulanos G. Sonographic diagnosis and monitoring of an intramural duodenal hematoma following upper endoscopic biopsy in a child. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:534-538. [PMID: 19757424 DOI: 10.1002/jcu.20629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Intramural duodenal hematoma is an uncommon complication of pediatric endoscopic biopsy that occurs mainly in children with bleeding disorders. We report the case of a 5-year-old girl who presented with signs of partial duodenal obstruction and acute pancreatitis due to duodenal hematoma following endoscopic biopsy. The lesion was diagnosed and monitored by sonography and resolved with conservative management.
Collapse
Affiliation(s)
- Dimitris Antoniou
- Department of Pediatric Surgery, Aghia Sophia Children's Hospital, Thivon & Papadiamantopoulou Street, 11527 Athens, Greece
| | | | | | | |
Collapse
|
|
11
|
Abdel Samie A, Sun R, Theilmann L. A rare cause of obstructive jaundice. Gastroenterology 2009; 137:40, 394. [PMID: 19501203 DOI: 10.1053/j.gastro.2008.12.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 12/02/2008] [Accepted: 12/18/2008] [Indexed: 12/02/2022]
Affiliation(s)
- Ahmed Abdel Samie
- Department of Internal Medicine and Gastroenterology, Pforzheim Hospital, Pforzheim, Germany
| | | | | |
Collapse
|