Open Access Peer-reviewed

Complicated Gastric Ulcer and Jejunal Hematoma with Concomitant Warfarin Use: Analytical and Biomedical Case Study Report

Ali A. Samaha1, 2, Hilana Hatoum3, 4, Shaimaa Matar4, Fouad Zaarour4, John J. Haddad5,

1Faculty of Public Health, Lebanese University, Zahle, Lebanon

2Department of Biomedical Sciences, Lebanese International University, Beirut, Lebanon

3Department of Gastroenterology, Sahel General Hospital, Beirut, Lebanon

4Faculty of Medicine, Lebanese University, Beirut, Lebanon

5Cellular and Molecular Physiology and Immunology Signaling Research Group, Biomedical Laboratory and Clinical Sciences Division, Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon

American Journal of Medical and Biological Research. 2013, 1(3), 58-63. DOI: 10.12691/ajmbr-1-3-2
Published online: August 25, 2017

Abstract

Intramural hematoma is commonly known as a hematoma that occurs in the wall of a structure, such as the bowel or bladder, usually resulting from trauma or, in rare situations, excessive anticoagulation. In particular, intramural gastrointestinal hematoma is part of a spectrum of gastrointestinal injuries. Vomiting and straining, endoscopic procedures, and bleeding disorders are essentially among the most common predisposing factors. However, it can also be an unusual complication of anticoagulation and/or thrombolysis therapy. The most common symptoms are retrosternal chest pain, dysphagia, and hematemesis. Intramural bowel wall hematoma is an often forgotten, rare clinical entity that may pose considerable diagnostic dilemma. Therefore, it is conspicuously imperative to diagnose this condition promptly and correctly in order to avoid unnecessary surgical intervention. In this rare presented case report, a 51-year-old woman having mitral valve prothesis and mild heart failure under warfarin wasadmitted to the renowned Sahel General Hospital in Beirut in November of 2006 with massive upper gastrointestinal bleeding that was subsequently controlled by endoscopic sclerotherapy and medical management. About 12 h later, the aforementioned patientsuffered a severe abdominal pain accompanied by a steep dropping in the hematocrit level. Moreover, an abdominal computed tomography scan showed thick jejunal hematoma of approximately 70 cm in length that was handled surgically. The patient had been incessantly observed for about 7 days,andsubsequently discharged with therapeutic international normalized ratio(INR).

Keywords:

CT, Hemorrhagic bowel syndrome, INR, jejunal hematoma, NSAIDs, warfarin
[1]  Kumar KP, Diaz EAI, Mascarenhas RM.A rare cause of acute abdomen due to spontaneous intramural haematoma of the jejunum in a patient on warfarin. J Clin Diag Res 2011; 5: 1291-2.
 
[2]  Jaskolka JD, Binkhamis S, Prabhudesai V, et al. Acute gastrointestinal hemorrhage: Radiologic diagnosis and management. Can Assoc Radiol J 2013; 64: 90-100.View Article  PubMed
 
[3]  Avent ML, Canaday BR, Sawyer WT. Warfarin-induced intramural hematoma of the small intestine. Clin Pharm 1992; 11: 632-5. PubMed
 
[4]  Kleinman PK, Brill PW, Winchester P. Resolving duodenal-jejunal hematoma in abused children. Radiol 1986; 160: 747-50.
 
[5]  Moody EE. Acute jejunal obstruction secondary to traumatic intramural hematoma. Pediatrics 1957; 19: 863-8. PubMed
 
[6]  Birla RP, Mahawar KK, Saw EYW, et al. Spontaneous intramural jejunal haematoma: A case report.Cases J 2008; 1: 389.View Article  PubMed
 
[7]  Oyasiji T, Yood S.Jejunal amyloidoma: A rare cause of gastrointestinal bleeding.Cases J 2009; 2: 9100.View Article  PubMed
 
[8]  Essenhigh DM, Chir M, Toland J. Duodeno-jejunal haematoma. Br J Radiol 1968; 41: 349-53.View Article  PubMed
 
[9]  Hou SW, Chen CC, Chen KC. Sonographic diagnosis of spontaneous intramural small bowel haematoma in a case of warfarin overdose. J Clin Ultrasound 2008; 36: 374-6.View Article  PubMed
 
[10]  Uzun MA, Koksal N, Gunerhan Y. Intestinal obstruction due to spontaneous intramural haematoma of the small intestine during warfarin use: A report of two cases. Eur J Emerg Med 2007; 14: 272-3.View Article  PubMed
 
[11]  Abbas MA, Collins JM, Olden KW. Spontaneous intramural small-bowel haematoma: imaging findings and outcome. AJR Am J Roentgenol 2002; 179: 1389-94.View Article  PubMed
 
[12]  Tran F, Koo JH. Gastrointestinal: Spontaneous jejunal hematoma secondary to supratherapeutic anticoagulation.J Gastroenterol Hepatol 2012; 27: 1643.View Article  PubMed
 
[13]  Abrassart S, Stern R, Peter R.Unstable pelvic ring injury with hemodynamic instability: What seems the best procedure choice and sequence in the initial management? Orthop Traumatol Surg Res 2013; 99: 175-82.View Article  PubMed
 
[14]  Spinelli G, Damiano G, Palumbo VD, et al. Ileus following spontaneous jejunum intramural hematoma: Case report and review of the literature. Acta Clin Croat 2012; 51: 435-9. PubMed
 
[15]  Erkan G, Çalişkan A, Kaan Ataç G, et al. Spontaneous intramural jejuna hematoma: Two cases. Turk J Gastroenterol 2012; 23: 615-6. PubMed
 
[16]  Abdel Samie A, Sun R, Huber A, et al. Spontaneous intramural small-bowel hematoma secondary to anticoagulant therapy: A case series. Med Klin Intensivmed Notfmed 2013; 108: 144-8.View Article  PubMed
 
[17]  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.View Article  PubMed
 
[18]  Chen H, Bai YZ, Wang WL.Jejunal subserosal hematoma in an 11-year-old boy. J Gastrointest Surg 2011; 15: 2291-2.View Article  PubMed
 
[19]  Chong VH, Basir N, Yaakub AB.Acute pancreatitis complicated by jejuna hematoma in a patient on anti-coagulants and anti-platelets. JOP 2010; 11: 262-5. PubMed
 
[20]  Cheng J, Vemula N, Gendler S.Small bowel obstruction caused by intramural hemorrhage secondary to anticoagulant therapy. Acta Gastroenterol Belg 2008; 71: 342-4. PubMed
 
[21]  Chaiteerakij R, Treeprasertsuk S, Mahachai V, et al. Anticoagulant-induced intramural intestinal hematoma: report of three cases and literature review. J Med Assoc Thai 2008; 91: 1285-90. PubMed
 
[22]  Chen YW, Chen MH, Wang LM, et al. Spontaneous intramural intestinal haematoma. Intern Med J 2007; 37: 661-2.View Article  PubMed
 
[23]  Shinozaki S, Yamamoto H, Kita H,et al. Direct observation with double-balloon enteroscopy of an intestinal intramural hematoma resulting in anticoagulant ileus. Dig Dis Sci 2004; 49: 902-5.View Article  PubMed
 
[24]  Lobo L, Koudki R, Prasad HIK, et al.Colon obstruction due to an anticoagulant induced intramural haematoma; A Rare Case Report. J Clin Diagn Res 2013; 7: 739-41. PubMed
 
[25]  Cao DT, Reny JL, Lanthier N, et al.Intramural hematoma of the esophagus. Case Rep Gastroenterol 2012; 6: 510-7.View Article  PubMed
 
[26]  Hong M, Warum D, Karamanian A. Spontaneous intramural esophageal hematoma (IEH) secondary to anticoagulation and/or thrombolysis therapy in the setting of a pulmonary embolism: A case report. J Radiol Case Rep 2013; 7:1-10. PubMed
 
[27]  Pomara C, Bello S, D’Errico S, et al.Sudden death due to a dissecting intramural hematoma of the esophagus (DIHE) in a woman with severe neurofibromatosis-related scoliosis. Forensic Sci Int 2013; 228:e71-5.View Article  PubMed
 
[28]  Chen HL, Wu CC, Lin AC. Small bowel intramural hematoma secondary to abdominal massage. Am J Emerg Med 2013; 31:758.e3-4.
 
[29]  Silva JD, Veloso N, Godinho R, et al. Fatal acute pancreatitis following sclerosis of a bleeding duodenal ulcer complicated by an intramural duodenal hematoma. Rev Esp Enferm Dig 2012; 104:603-4.View Article  PubMed
 
[30]  Sun P, Tan SY, Liao GH. Gastric intramural hematoma accompanied by severe epigastric pain and hematemesis after endoscopic mucosal resection. World J Gastroenterol 2012; 18:7127-30.View Article  PubMed
 
[31]  McClain LE, Pullatt RC. Spontaneous intramural hematoma of the ileum associated with obstruction during low-molecular-weight heparin use. Am Surg 2013;79:E3-5. PubMed
 
[32]  Jeong ES, Kim MJ, Yoo SH, et al. Intramural hematoma of the esophagus after endoscopic pinch biopsy. Clin Endosc 2012; 45:417-20.View Article  PubMed
 
[33]  Ikegami R, Tsuchida K, Oda H.Acute myocardial infarction caused by spontaneous coronary intramural hematoma. J Invasive Cardiol 2012;24:692-3. PubMed
 
[34]  Chen CY, Yan YH.Duodenal dissection secondary to intramural haematoma after endoscopic therapy for a bleeding duodenal ulcer in a patient on long-term haemodialysis with liver cirrhosis. BMJ Case Rep 2012;2012.
 
[35]  Julià I, Tauron M, Muñoz-Guijosa C. Postpartum acute coronary syndrome due to intramural hematoma and coronary artery dissection. Thorac Cardiovasc Surg 2013; 61:85-7.View Article  PubMed
 
[36]  Droste J, Zadeh HZ, Arif M, et al. Acute aortic intramural hematoma presenting with painless recurrent syncope. Heart Surg Forum 2012; 15:E286-8.View Article  PubMed
 
[37]  Goyal H, Singla U, Agrawal RR. A rare cause of acute pancreatitis: Intramural duodenal hematoma. Case Rep Gastrointest Med 2012; 2012:275604.
 
[38]  Johnson TW, Smith D, Strange JW, et al.Spontaneous multivessel coronary intramural hematoma: An insight with OCT. JACC Cardiovasc Imaging 2012;5:1070-1.View Article  PubMed
 
[39]  Iyisoy A, Celik M, Celik T, et al.The role of intravascular ultrasound guidance in the treatment of intramural hematoma probably caused by spontaneous coronary artery dissection in a young woman with acute anterior myocardial infarction. Cardiol J 2012; 19:532-5. PubMed
 
[40]  Harris KM, Braverman AC, Eagle KA, et al.Acute aortic intramural hematoma: An analysis from the International Registry of Acute Aortic Dissection.Circulation 2012;126:S91-6.View Article  PubMed
 
[41]  Lee JY, Chung JS, Kim TH.Successful endoscopic decompression for intramural duodenal hematoma with gastric outlet obstruction complicating acute pancreatitis.Clin Endosc 2012;45:202-4.View Article  PubMed
 
[42]  Costelloe J, McCormack O, Reynolds JV. Dissecting intramural hematoma of the esophagus. Dis Esophagus 2013;26:346.View Article  PubMed
 
[43]  Sarici IS, Ozçinar B, Bekın A.Intramural small bowel hematoma secondary to use of oral anticoagulant therapy. Turk J Gastroenterol 2012;23:88-91. PubMed
 
[44]  Barbetakis N, Asteriou Ch, Kleontas A, et al. Spontaneous intramural esophageal hematoma. Hippokratia 2011;15:280. PubMed
 
[45]  Shankarnaryanan S, Hardikar W.Unusual cause of neonatal rectal bleeding: Colonic intramural haematoma. J Paediatr Child Health 2012; 48:E108-9.View Article  PubMed