Spontaneous intramural hematoma of the small bowel is a rare complication due to an oral anticoagulation therapy

Abstract

Spontaneous intramural hematoma of the small bowel is a rare complication in oral anticoagulation therapy. Computed tomography (CT) as the diagnostic method of choice allows early and accurate recognition of this condition. Unrecognised intramural hematoma of the small bowel may lead to unnecessary surgical intervention since most hematomas resolve spontaneously with conservative treatment. We report two cases of spontaneous intramural hematoma of the small bowel as a complication in oral anticoagulant therapy. The first patient presented with duodenal hematoma. Endoscopy together with CT led to early recognition of the haemorrhage. Conservative treatment was successful. The second patient presented with jejunal hematoma which was not recognised on CT, so surgical exploration was carried out. Resection of the affected segment of the jejunum was not necessary. A high index of clinical suspicion of this complication in oral anticoagulant therapy is, therefore, critical in patients with symptoms of small bowel obstruction.