Spontaneous Intramural Hematoma of the Jejunum Induced by Anticoagulant Therapy

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  • Hirosawa Takashi
    Department of Surgery, Tohoku University Graduate School of Medicine
  • Kudoh Katsuyoshi
    Department of Surgery, Tohoku University Graduate School of Medicine
  • Aoki Takeshi
    Department of Surgery, Tohoku University Graduate School of Medicine
  • Ohnuma Shinobu
    Department of Surgery, Tohoku University Graduate School of Medicine
  • Tanaka Naoki
    Department of Surgery, Tohoku University Graduate School of Medicine
  • Musha Hiroaki
    Department of Surgery, Tohoku University Graduate School of Medicine
  • Motoi Fuyuhiko
    Department of Surgery, Tohoku University Graduate School of Medicine
  • Kamei Takashi
    Department of Surgery, Tohoku University Graduate School of Medicine
  • Naitoh Takeshi
    Department of Surgery, Tohoku University Graduate School of Medicine
  • Unno Michiaki
    Department of Surgery, Tohoku University Graduate School of Medicine

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<p>A spontaneous, intramural, small-bowel hematoma requiring a surgery is a rare complication of anticoagulant therapy. We present a case of an 82-year-old man who developed abdominal pain in the setting of abnormal coagulation function related to warfarin therapy used as chronic prophylaxis against recurrent pulmonary embolism. Computed tomography (CT) showed wall thickening and luminal narrowing of the jejunum. Dilation of the small bowel proximal to the thickening was also present, indicative of small bowel obstruction. Initially, the patient was treated conservatively, but he later required laparotomy due to worsening of his general condition. A 50cm jejunal segment was resected in order to relieve the intestinal obstruction and to arrest the bleeding. For intramural, small-bowel hematoma, conservative medical management should be the first treatment of choice, but surgical intervention may be indicated if conservative treatment is not successful.</p>

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