warfarin and Abdominal-Pain

Topics: Abdominal Pain; Adult; Anticoagulants; Colectomy; Colitis, Ulcerative; Enoxaparin; Fibrinolysis; Humans; Ileostomy; Male; Mesenteric Ischemia; Postoperative Complications; Prognosis; Risk Factors; Thrombectomy; Thrombophilia; Tomography, X-Ray Computed; Warfarin

Budd-Chiari syndrome is a rare disorder characterised by hepatic venous outflow obstruction. It affects 1.4 per million people, and presentation depends upon the extent and rapidity of hepatic vein occlusion. An underlying myeloproliferative neoplasm is present in 50% of cases with other causes including infection and malignancy. Common symptoms are abdominal pain, hepatomegaly and ascites; however, up to 20% of cases are asymptomatic, indicating a chronic onset of hepatic venous obstruction and the formation of large hepatic vein collaterals. Doppler ultrasonography usually confirms diagnosis with cross-sectional imaging used for complex cases and to allow temporal comparison. Myeloproliferative neoplasms should be tested for even if a clear causative factor has been identified. Management focuses on anticoagulation with low-molecular-weight heparin and warfarin, with the new oral anticoagulants offering an exciting prospect for the future, but their current effectiveness in Budd-Chiari syndrome is unknown. A third of patients require further intervention in addition to anticoagulation, commonly due to deteriorating liver function or patients identified as having a poorer prognosis. Prognostic scoring systems help guide treatment, but management is complex and patients should be referred to a specialist liver centre. Recent studies have shown comparable procedure-related complications and long-term survival in patients who undergo transjugular intrahepatic portosystemic shunting and liver transplantation in Budd-Chiari syndrome compared with other liver disease aetiologies. Also, the optimal timing of these interventions and which patients benefit from liver transplantation instead of portosystemic shunting remains to be answered.

Topics: Abdominal Pain; Adult; Anticoagulants; Ascites; Budd-Chiari Syndrome; Heparin, Low-Molecular-Weight; Hepatomegaly; Humans; Liver Transplantation; Middle Aged; Portasystemic Shunt, Transjugular Intrahepatic; Prognosis; Ultrasonography, Doppler, Color; Warfarin

Splenic rupture is a life-threatening condition characterized by internal hemorrhage, often difficult to diagnose. Colonoscopy is a gold standard routine diagnostic test to investigate patients with gastrointestinal symptoms as well as to those on the screening program for colorectal cancer. Splenic injury is seldomly discussed during consent for colonoscopy, as opposed to colonic perforation, as its prevalence accounts for less than 0.1%. A 66-year-old Caucasian woman with no history of collagen disorder was electively admitted for routine colonoscopy for surveillance of adenoma. She was admitted following the procedure for re-dosing of warfarin, which was stopped prior to the colonoscopy. The patient was found collapsed on the ward the following day with clinical shock and anemia. Computed tomography demonstrated grade 4 splenic rupture. Immediate blood transfusion and splenectomy was required. Splenic rupture following routine colonoscopy is extremely rare. Awareness of it on this occasion saved the patient's life. Despite it being a rare association, the seriousness warrants inclusion in all information leaflets concerning colonoscopy and during its consent.

Topics: Abdominal Pain; Aged; Anticoagulants; Colonoscopy; Female; Humans; Splenic Rupture; Tomography, X-Ray Computed; Warfarin

Spontaneous intestinal hematoma is a rare complication of anticoagulant therapy. The authors reported three cases of intramural and submucosal small bowel hematoma resulting from warfarin administration. The first patient presented with abdominal pain, had intramural hematoma at jejunum, the most common site of intramural small bowel hematoma. Another patient who had submucosal duodenal hematoma presented with massive upper gastrointestinal bleeding, a rare manifestation of small bowel hematoma. The third patient presented with intramural ileal hematoma that caused abdominal pain and palpable mass after a short period of warfarin therapy. Typical findings on abdominal computerized tomography yielded the diagnosis. All patients rapidly improved after conservative treatment. The history of anticoagulant use with prolonged INR value in patients presented with abdominal pain should alert physicians to search for this entity. It is extremely important to recognize this syndrome in order to avoid an unnecessary operation since the outcome is usually excellent after conservative treatment.

Topics: Abdominal Pain; Aged; Anticoagulants; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; International Normalized Ratio; Male; Risk Factors; Thailand; Time Factors; Warfarin

Topics: Abdominal Pain; Aged; Anticoagulants; Diagnosis, Differential; Drug Interactions; Dyspnea; Female; Hematoma; Humans; Hypoprothrombinemias; International Normalized Ratio; Warfarin

Spontaneous intramural small-bowel hematoma (SISBH) is a rare complication of anticoagulation therapy. Presentation of SISBH can vary from mild abdominal pain to an acute abdomen.. A 70-year-old woman was brought to the emergency department because of severe abdominal pain for 1 day. She had a medical history of coronary artery disease and paroxysmal atrial fibrillation and was receiving anticoagulation therapy with warfarin for 3 years.. Computed tomography disclosed disproportional dilatation of the segmental small bowel and near-total obstruction of the intestinal lumen at the level of the jejunum, indicating an acute abdomen.. We performed laparoscopic exploration and found a segmental distal jejunum was tense, heavy, firm, and discolored with a blue hue. Histopathological examination of the resected jejunum revealed diffuse hemorrhage and necrosis at the mucosa and submucosal layers, indicating SISBH.. The patient had an uneventful recovery and was discharged in a relatively stable condition.. Warfarin-induced SISBH presenting as an acute abdomen is an emergency condition that needs early diagnosis and timely management. Surgical intervention may be indicated for intestinal obstruction, ischemia, perforation, peritonitis, and intra-abdominal hemorrhage.

Topics: Abdomen, Acute; Abdominal Pain; Aged; Anticoagulants; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Warfarin

Atrial fibrillation is one of the most common arrhythmias. The main thrombotic complication of arterial fibrillation is ischemic stroke, but it can also cause acute renal infarction from embolization. The low incidence and nonspecific clinical manifestations of acute renal infarction make it difficult to diagnose, often leading to either delayed diagnosis or misdiagnosis. Due to its rarity, more efficient treatment guidelines are helpful for the management of acute renal infarction related to the thromboembolic complication of arterial fibrillation.. We report a case of acute renal infarction due to underlying arterial fibrillation, where a novel interventional therapeutic method was used. A 66-year-old Chinese man with arterial fibrillation, not on anticoagulation due to the patient's preference, and coronary artery disease post-percutaneous coronary intervention to left anterior descending artery about 1 year ago, was currently on dual antiplatelet therapy. He suddenly developed intermittent and sharp left-sided abdominal pain and was found to have an acute left renal infarction on computed tomography scan. Angiogram showed acute occlusion of the left renal artery due to thromboembolism. For this patient, a combination method of local thrombus aspiration, angioplasty, and infusion of nitroglycerin and diltiazem were used, restoring blood flow to the left kidney. After recovery, the patient was discharged on aspirin, clopidogrel, and warfarin. At 6 months follow-up, there was no residual kidney dysfunction.. Acute renal infarction from thromboembolism is a rare but serious complication of arterial fibrillation. More efficient and different options for intervention methods will benefit the treatment of this disease. Here, we report a combination therapeutic method that has not been used in acute renal infarction associated with arterial fibrillation, and which restored renal perfusion and prevented long-term kidney injury.

Topics: Abdominal Pain; Aged; Anticoagulants; Aspirin; Atrial Fibrillation; Clopidogrel; Diltiazem; Humans; Infarction; Male; Nitroglycerin; Platelet Aggregation Inhibitors; Thromboembolism; Thrombosis; Warfarin

Topics: Abdominal Pain; Adult; Anemia, Hemolytic; Antibodies, Monoclonal, Humanized; Anticoagulants; Budd-Chiari Syndrome; Complement Inactivating Agents; Drug Therapy, Combination; Ferritins; Hemoglobin A; Hemoglobinuria, Paroxysmal; Hemolysis; Hepatomegaly; Humans; Male; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

History A 55-year-old woman without systemic underlying disease, such as diabetes mellitus, inflammatory bowel disease, autoimmune disease, or chronic kidney disease, presented with generalized dull abdominal pain of 1-week duration. She had ingested herbal medicine for physical conditioning for several years. Laboratory findings, including biochemistry, electrolyte levels, and complete blood count, were all within normal limits, except for elevated serum C-reactive protein level (7.719 mg/dL; normal range, <1 mg/dL). The patient underwent initial evaluation with conventional abdominal radiography. She underwent subsequent evaluation with noncontrast CT of the abdomen and colonoscopy.

Topics: Abdominal Pain; Anticoagulants; Colitis; Colon; Female; Humans; Intestinal Mucosa; Middle Aged; Radiography, Abdominal; Tomography, X-Ray Computed; Vascular Calcification; Warfarin

A 74-year-old woman receiving long-term anticoagulation with warfarin for chronic atrial fibrillation presented with severe acute abdominal pain, diarrhoea and vomiting. Initial laboratory workup revealed a deranged coagulation profile. Computed tomography of the abdomen and pelvis demonstrated spontaneous distal jejunal intramural haematoma with associated reactive ileus. No overt pneumatosis intestinalis, intraperitoneal free gas or haemoperitoneum was seen. Based on clinical and imaging findings, a diagnosis of over-anticoagulation complicated by small bowel intramural haematoma was made. The patient was managed non-operatively with analgesia, cessation of warfarin and reversal therapy with vitamin K. Warfarin therapy was recommenced upon resolution of symptoms and optimisation of coagulation status. The clinical presentation, radiological features and overall management of anticoagulation-induced bleeding are further discussed in this article.

Topics: Abdominal Pain; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Ileus; International Normalized Ratio; Intestinal Obstruction; Intestines; Male; Middle Aged; Risk Factors; Tomography, X-Ray Computed; Warfarin

Splenic infarction is a rare clinical condition seen in the emergency department and can mimic acute abdomen. Hematologic, vascular, and thromboembolic events are considered in the etiology. Treatment options vary between symptomatic treatment and splenectomy. Warfarin is a vitamin K antagonist used for the prevention and treatment of thromboembolic disorders. In overdose situations, there is a possibility of bleeding in every part of the body. Prothrombin complex concentrates, vitamin K, and fresh-frozen plasma are used in the treatment of warfarin overdose. We describe a case of splenic infarction coexistent with warfarin overdose treatment, which has never been published in literature. Prothrombin complex concentrate was administered to the patient because of warfarin overdose. A spleen infarction was detected in computerized tomography of the patient after the occurrence of abdominal pain, and there was no infarction three days before hospitalization. The patient was monitored with symptomatic treatment in the general surgery clinic and discharged without the need for operation. In the pathogenesis, it was thought that prothrombin complex concentrates might be caused by early thrombosis or by warfarin not affecting the existing clot. Emergency physicians should not forget spleen infarction in the differential diagnosis of abdominal pain.

Topics: Abdominal Pain; Aged; Anticoagulants; Blood Coagulation Factors; Coagulants; Conservative Treatment; Diagnosis, Differential; Drug Overdose; Female; Humans; International Normalized Ratio; Predictive Value of Tests; Splenic Infarction; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Topics: Abdominal Pain; Abscess; Adalimumab; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Anticoagulants; Behcet Syndrome; Budd-Chiari Syndrome; Female; Fever; Humans; Liver Abscess; Splenic Diseases; Suction; Tomography, X-Ray Computed; Treatment Outcome; Warfarin; Young Adult

In March and April 2018, more than 150 patients presented to hospitals in Illinois with coagulopathy and bleeding diathesis. Area physicians and public health organizations identified an association between coagulopathy and synthetic cannabinoid use. Preliminary tests of patient serum samples and drug samples revealed that brodifacoum, an anticoagulant, was the likely adulterant.. We reviewed physician-reported data from patients admitted to Saint Francis Medical Center in Peoria, Illinois, between March 28 and April 21, 2018, and included in a case series adult patients who met the criteria used to diagnose synthetic cannabinoid-associated coagulopathy. A confirmatory anticoagulant poisoning panel was ordered at the discretion of the treating physician.. A total of 34 patients were identified as having synthetic cannabinoid-associated coagulopathy during 45 hospitalizations. Confirmatory anticoagulant testing was performed in 15 of the 34 patients, and superwarfarin poisoning was confirmed in the 15 patients tested. Anticoagulant tests were positive for brodifacoum in 15 patients (100%), difenacoum in 5 (33%), bromadiolone in 2 (13%), and warfarin in 1 (7%). Common symptoms at presentation included gross hematuria in 19 patients (56%) and abdominal pain in 16 (47%). Computed tomography was performed to evaluate abdominal pain and revealed renal abnormalities in 12 patients. Vitamin K. Our data indicate that superwarfarin adulterants of synthetic cannabinoids can lead to clinically significant coagulopathy. In our series, in most of the cases in which the patient presented with bleeding diathesis, symptoms were controlled with the use of vitamin K

Topics: 4-Hydroxycoumarins; Abdominal Pain; Adult; Anticoagulants; Blood Coagulation Disorders; Blood Transfusion; Cannabinoids; Female; Hematuria; Hemorrhage; Humans; Illinois; International Normalized Ratio; Male; Middle Aged; Patient Readmission; Vitamin K; Warfarin

Coronary sinus thrombosis is a rare phenomenon. When identified, it most often is a complication of infective endocarditis or procedural intervention. We present an unusual and unreported case of spontaneous coronary sinus thrombosis as embolic sequela of an intra-abdominal infectious process.. We report a case of a 61-year-old white woman with a history of end-stage renal disease on hemodialysis, paroxysmal atrial fibrillation not on long-term systemic anticoagulation, and history of recurrent diverticulitis that presented with acute onset abdominal pain and nausea. Computed tomography of her abdomen and pelvis with intravenous contrast was negative for acute intra-abdominal pathology, but incidentally identified an oval-shaped filling defect at the ostium of the coronary sinus suspicious for thrombus or mass which was confirmed on subsequent transesophageal echocardiogram. In light of her concomitant transaminitis but otherwise negative workup, the mass was believed to be thromboembolic in nature, originating within the hepatic venous system as a manifestation of recurrent diverticulitis with associated pylephlebitis and ultimately lodging into the coronary sinus. With the newly detected thrombus and history of paroxysmal atrial fibrillation, she was started on warfarin for therapeutic systemic anticoagulation that resolved her clot by 3-month follow up.. Although coronary sinus thrombosis is rare, a high index of suspicion and close scrutiny of the venous system in patients with intra-abdominal infectious processes would prevent delay in management of this potentially serious complication. The discussion of this case highlights the anatomy of the cardiac venous system, the pathophysiology of thrombus formation, and the utility of transesophageal echocardiography in confirming a diagnosis and assessing treatment efficacy.

Topics: Abdominal Pain; Anticoagulants; Coronary Thrombosis; Diagnosis, Differential; Echocardiography, Transesophageal; Female; Humans; Incidental Findings; Middle Aged; Portal Vein; Thrombophlebitis; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Acute mesenteric ischemia poses a diagnostic challenge due to nonspecific clinical clues and lack of awareness owing to its rarity. Ischemia due to mesenteric venous thrombosis has a good prognosis compared to arterial cause and can be managed conservatively with early diagnosis. The portomesenteric venous system is an unusual site of thrombosis in patients with protein S deficiency, and its thrombosis is an uncommon cause of acute mesenteric ischemia.. We present a case of a 27-year-old Mongolian man who presented with acute abdominal pain increasing in severity, and refractory to repeated attempts at treatment with a misdiagnosis of acute peptic ulcer disease. Contrast-enhanced computed tomography of his abdomen detected complete occlusion of the superior mesenteric vein, an extension of acute thrombus into the portal vein, and ischemic mid-jejunal loops. Early diagnosis and immediate anticoagulation with continuous intravenous infusion of unfractionated heparin prevented subsequent consequences. On further workup, our patient was diagnosed with isolated protein S deficiency. We started lifelong thromboprophylaxis with warfarin to prevent recurrence and our patient was asymptomatic on the latest follow-up 5 months after discharge.. Despite accurate detection of acute mesenteric ischemia by contrast-enhanced computed tomography, high index of suspicion is indispensable for its early diagnosis. Early diagnosis and immediate anticoagulation will prevent subsequent complications and need for surgical intervention. Young patients without known risk factors presenting with venous thrombosis in atypical sites should be investigated for prothrombotic diseases.

Topics: Abdominal Pain; Adult; Anticoagulants; Humans; Male; Mesenteric Ischemia; Mesenteric Veins; Portal Vein; Protein S Deficiency; Thrombolytic Therapy; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin

Long-acting anticoagulant rodenticides, also called superwarfarins, are known for their greater potency, longer half-life and delayed onset of symptoms. Cases of superwarfarin poisoning can pose a diagnostic and clinical challenge due to a wide array of presentations and prolonged severe coagulopathy requiring months of high-dose oral vitamin K therapy. The most common presentation of long-acting anticoagulant rodenticide poisoning is mucocutaneous bleeding, with other common presentations including haematuria, gingival bleeding, epistaxis and gastrointestinal bleeding. We discuss a case of deliberate self-poisoning with long-acting anticoagulant rodenticides presenting with haematuria and coagulation values above measurable limits. This case is important as it required immediate and maintenance therapy in order to prevent profound bleeding, as well as the evaluation of the patient's psychosocial factors to ensure medical compliance and to prevent refractory complications or repeated self-harm.

Topics: Abdominal Pain; Anticoagulants; Antifibrinolytic Agents; Anxiety Disorders; Blood Coagulation; Blood Coagulation Disorders; Chronic Pain; Comorbidity; Delayed-Action Preparations; Gastrointestinal Hemorrhage; Hematuria; Humans; Male; Middle Aged; Referral and Consultation; Suicide, Attempted; Treatment Outcome; Vitamin K; Warfarin

Topics: Abdominal Pain; Aged; Anticoagulants; Atrial Fibrillation; Back Pain; Diagnosis, Differential; Embolization, Therapeutic; Emergency Service, Hospital; Female; Flank Pain; Humans; Infarction; Kidney; Risk Factors; Tachycardia; Thrombosis; Tomography, X-Ray Computed; Warfarin

Sepsis is a syndrome of life-threatening organ dysfunction caused by a dysregulated host response to infection. It can have devastating consequences, including bilateral adrenal hemorrhage, particularly in patients at high thrombotic risk, such as those with antiphospholipid syndrome and those on long-term anticoagulation.. A 49-year-old white woman re-presented to hospital with a history suggestive of sepsis. She had a medical background of primary antiphospholipid syndrome on lifelong warfarin. Ten days prior to this presentation, she had been hospitalized following Escherichia coli bacteremia, commenced on intravenous antibiotics, and discharged 2 days later with a prescribed 5-day course of oral amoxicillin. On readmission, she had ongoing fever, myalgia, malaise, and hypotension. Investigations revealed anemia with thrombocytopenia, hyponatremia, and acute-on-chronic kidney injury. Despite treatment for urosepsis, she became tachypneic, clammy, light-headed, drowsy, and hypothermic. Computed tomography revealed bilateral adrenal hemorrhage, and biochemical examination confirmed hypoadrenalism. Following discharge, she had persistent renal and hepatic injury lasting 3 months.. Early identification, intensive monitoring, and aggressive support may reduce the acquired thrombotic risk and avoid potentially life-threatening outcomes of sepsis.

Topics: Abdominal Pain; Adrenal Gland Diseases; Adrenal Glands; Adrenal Insufficiency; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiphospholipid Syndrome; Diarrhea; Escherichia coli; Female; Hemorrhage; Humans; Hydrocortisone; Middle Aged; Sepsis; Tomography, X-Ray Computed; Treatment Outcome; Vomiting; Warfarin

A 69-year-old man was admitted to hospital with abdominal pain. In the four years prior to his presentation, he had undergone repeated transarterial chemoembolizations and injections for hepatocellular carcinoma. He underwent his 8th transcatheter arterial therapy one month prior to admission. Abdominal X-rays and contrast-enhanced computed tomography showed large amounts of small intestinal gas and venous thrombosis from the portal vein to the superior mesenteric vein, respectively. The thrombosis was reduced after anticoagulation therapy (heparin, antithrombin III, danaparoid sodium and warfarin). This is the first case report of paralytic ileus due to superior mesenteric venous thrombosis after transcatheter arterial therapy for hepatocellular carcinoma with an arterioportal shunt.

Topics: Abdominal Pain; Aged; Anticoagulants; Carcinoma, Hepatocellular; Embolization, Therapeutic; Humans; Intestinal Pseudo-Obstruction; Liver Neoplasms; Male; Mesenteric Ischemia; Mesenteric Veins; Portal Vein; Radiography; Thrombophlebitis; Treatment Outcome; Venous Thrombosis; Warfarin

Spontaneous isolated superior mesenteric artery dissection is a rare disease that may cause bowel ischemia or aneurysm rupture and subsequent death. Thus, the establishment of a correct diagnosis in the early stage is quite important.. To describe the presentation of 3 patients diagnosed with spontaneous isolated supramesenteric artery dissection and briefly summarize the diagnostic procedure, treatment, and clinical course.. We experienced three cases of isolated mesenteric artery dissection in the past 5 years. A definitive diagnosis was obtained by abdominal spiral computed tomography in two cases and angiography in one case. All patients were provided anticoagulation therapy.. One patient died of bowel ischemia, 2 were discharged within 21 days without complications, and one was able to discontinue anticoagulation therapy 12 months after discharge. The remaining patient has continued warfarin, making it difficult to determine the end point of anticoagulation.

Topics: Abdominal Pain; Adult; Anticoagulants; Heparin; Humans; Male; Mesenteric Artery, Superior; Mesenteric Ischemia; Middle Aged; Rupture, Spontaneous; Tomography, Spiral Computed; Vascular Diseases; Warfarin

Topics: Abdominal Pain; Aged; Anemia; Anticoagulants; Erythrocyte Transfusion; Female; Hematoma; Humans; International Normalized Ratio; Muscular Diseases; Rectus Abdominis; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Mitral valve prolapse is not commonly on the list of differential diagnosis when a patient presents in the emergency department (ED) in severe distress, presenting with non-specific features such as abdominal pain, tachycardia and dyspnea. A healthy 55-year-old man without significant past medical history arrived in the ED with a unique presentation of a primary mitral valve prolapse with an atrial septal defect uncommon in cardiology literature. Early recognition of mitral valve prolapse in high-risk patients for severe mitral regurgitation or patients with underlying cardiovascular abnormalities such as an atrial septal defect is crucial to prevent morbid outcomes such as sudden cardiac death.

Topics: Abdominal Pain; Anticoagulants; Anxiety; Cardiotonic Agents; Continuous Positive Airway Pressure; Digoxin; Dopamine; Dyspnea; Electrocardiography; Emergencies; Heart Septal Defects, Atrial; Heart Valve Prosthesis Implantation; Humans; Male; Metoprolol; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Prolapse; Treatment Outcome; Warfarin

A 78-year-old man presented with abdominal pain, high International Normalised Ratio and rapidly falling haemoglobin. He had a background of Marfan syndrome and was on warfarin following mechanical aortic valve replacement. Abdominal CT imaging showed haemoperitoneum with a leaking aneurysm of the left gastric artery measuring 10 mm in diameter. The decision whether to reverse his anticoagulation provided a difficult clinical scenario given the risk of thrombosis associated with the mechanical aortic valve. The patient went on to have a successful percutaneous embolisation of the aneurysm using a metallic coil and Onyx. Left gastric artery aneurysms are rare and have a reported mortality of up to 70%. This is the first case of gastric artery aneurysm described in a patient with Marfan syndrome.

Topics: Abdominal Pain; Aged; Anticoagulants; Aortic Aneurysm, Abdominal; Aortic Dissection; Blood Vessel Prosthesis Implantation; Celiac Artery; Embolization, Therapeutic; Heart Valve Prosthesis; Humans; Male; Marfan Syndrome; Risk; Warfarin

Topics: Abdominal Pain; Anti-Bacterial Agents; Anticoagulants; Appendectomy; Appendicitis; Drainage; Escherichia coli Infections; Female; Heparin; Humans; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Radiography; Sclerosis; Venous Thrombosis; Warfarin

We describe here the case of 41 yrs old male patient, who was admitted to the emergency department complaining for abdominal pain lasting for two days. The patient self-reported a history of idiopathic deep vein thrombosis five yrs before the visit. A subcutaneous cordlike induration, tender and painful, was clearly palpable in the left lower abdominal quadrant. Routine blood tests did not reveal any substantial abnormality, except increased D-dimer concentration. Ultrasound evaluation of the abdominal wall revealed diffuse thrombosis of the left superficial inferior epigastric vein, involving several small tributaries branches, extended until 1.5 cm from the confluence with the common femoral vein, which was finally classified as an atypical case of Abdominal Mondor's disease. Complete thrombophilia screening was negative. The patient was discharged with warfarin therapy 48 hours from admission. At 30 days follow-up, the patient self-reported a nearly complete recovery.

Topics: Abdominal Pain; Humans; Thrombophlebitis; Venous Thrombosis; Warfarin

Hormone replacement therapy increases risk of deep venous thrombosis (DVT) mainly in the extremities and lungs. There are reports of mesenteric ischemia secondary to oral contraceptive pills but no reports on hormone replacement therapy and mesenteric thrombosis. The authors present a case of a 44-year-old obese (BMI 32) woman, on long-term hormone replacement therapy, presented with thrombosis of portal, splenic and superior mesenteric veins. She underwent surgical resection of ischemic bowel and planned re-look laparotomies with further resections and jejuno-ileal anastomosis at final laparotomy. Thorough haematological investigations were normal. The authors conclude that hormone replacement therapy in obese patients with no other risk factors can cause a catastrophic mesenteric thrombosis. Aggressive surgical resection with re-look laparotomies and further resections can be lifesaving.

Topics: Abdominal Pain; Adult; Anticoagulants; Body Mass Index; Female; Hormone Replacement Therapy; Humans; Laparotomy; Mesenteric Veins; Obesity; Portal Vein; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin

A 46-year-old female was found to have a saccular superior mesenteric vein (SMV) aneurysm on computed tomography (CT) scan during workup for abdominal pain. It measured 3.5 cm in diameter. The SMV aneurysm was successfully resected, and the SMV was repaired with femoral vein patch angioplasty. She was placed on coumadin for 3 months. At follow-up, the vein patch repair was patent and the patient was doing well with complete resolution of her abdominal pain.

Topics: Abdominal Pain; Aneurysm; Angioplasty; Anticoagulants; Drug Administration Schedule; Female; Femoral Vein; Humans; Mesenteric Veins; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler, Duplex; Vascular Surgical Procedures; Warfarin

Topics: Abdominal Pain; Adult; Anticoagulants; Aortic Valve; Heart Valve Prosthesis; Hematoma; Hemophilia A; Humans; Male; Muscular Diseases; Psoas Muscles; Tomography, X-Ray Computed; Warfarin

Topics: Abdominal Pain; Anticoagulants; Antiphospholipid Syndrome; Fatal Outcome; Female; Fever; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mesenteric Arteries; Mesenteric Veins; Postprandial Period; Vasculitis; Warfarin; Young Adult

Iliopsoas haematoma is a rare complication that occurs in patients receiving anticoagulant therapy. The clinical manifestation of iliopsoas haematoma is non-specific. It can mimic orthopaedic or neurological disorders, including paraesthesia or paresis of the thigh and leg due to compression of the nerve plexus. Among the many available diagnostic modalities, computed tomography is the most useful radiological method for diagnosis. Treatment approaches for iliopsoas haematoma include conservative therapy, surgical intervention, or transcatheter arterial embolisation. Conservative therapy consists of bed rest, restoration of circulating volume, and drug discontinuation for correcting underlying coagulopathy. Although a conservative approach is the first choice, transcatheter arterial embolisation and surgical intervention may be required in patients with hemodynamically unstable and active bleeding. The report described a case of iliopsoas haematoma due to anticoagulant therapy with paraesthesia in the left leg who was successfully treated by conservative approach.

Topics: Abdominal Pain; Aged; Anticoagulants; Female; Femoral Nerve; Hematoma; Humans; Paresis; Psoas Muscles; Rare Diseases; Tomography, X-Ray Computed; Treatment Outcome; Vitamin K; Warfarin

An extrahepatic arterioportal fistula (APF) involving the gastroduodenal artery and superior mesenteric vein is rare and mostly results from iatrogenic injuries. The clinical symptoms associated with APFs may include abdominal pain, gastrointestinal bleeding, ascites, nausea, vomiting, diarrhea, or even congestive heart failure. We present the case of a 70-year-old man who presented with chronic abdominal pain and gastrointestinal bleeding secondary to APF and portal vein thrombosis. The endovascular embolization of APF was accomplished successfully, and symptoms of portal hypertension resolved immediately after intervention. Unfortunately, the patient did not respond well to anticoagulation therapy with warfarin. Therefore, the patient underwent implantation of a transjugular intrahepatic portosystemic shunt, and the complications of portal hypertension resolved. In conclusion, the embolization of APF is technically feasible and effective and can be considered the first-choice therapy in selected patients.

Topics: Abdominal Pain; Aged; Aneurysm; Anticoagulants; Arteriovenous Fistula; Duodenum; Embolization, Therapeutic; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Male; Mesenteric Veins; Phlebography; Portal Vein; Portasystemic Shunt, Surgical; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin

Topics: Abdominal Pain; Acute Disease; Aged, 80 and over; Anticoagulants; Female; Hematoma; Humans; Male; Muscular Diseases; Rectus Abdominis; Treatment Outcome; Warfarin

Topics: Abdominal Pain; Aneurysm; Anticoagulants; Female; Humans; Middle Aged; Portal Vein; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures; Warfarin

Acute renal failure due to bilateral hematoma is a rare complication of anticoagulant warfarin therapy. A 43-year-old man presented with complaints of hematuria and abdominal pain. He had been receiving warfarin for six years, after placement of an aortic valve prosthesis. One week prior to admission, he sustained a urinary tract infection which was treated with third-generation cephalosporin and indomethacin. His serum creatinine level was 1.8 mg/dl with an INR of 15. Three days later, he developed anuria and was treated with hemodialysis. Renal ultrasonography disclosed moderate bilateral hydronephrosis. Computed tomography without contrast enhancement showed bilateral extensive hyperdense thickening of the renal and ureteral walls and high-attenuation areas. Conservative treatment was preferred and diuresis resumed spontaneously, lumbar pain disappeared, and serum creatinine level returned to normal. One month later, renal computed tomography was found normal.

Topics: Abdominal Pain; Acute Kidney Injury; Adult; Anticoagulants; Diagnosis, Differential; Emergency Treatment; Hematoma; Hematuria; Humans; Male; Radiography; Renal Dialysis; Warfarin

Spontaneous intestinal hematoma is a rare complication of anticoagulant therapy, and small bowel obstruction caused by intramural hematoma secondary to anticoagulant therapy is even rarer. The first symptom is usually abdominal pain, frequently accompanied by nausea and vomiting. A history of anticoagulant use with prolonged international normalized ratios in patients presenting with abdominal pain should alert physicians to search for this entity. Typical findings on abdominal computed tomography yield the diagnosis. Early diagnosis is crucial because most patients are treated non-operatively with a good outcome. Herein, we present the non-enhanced and enhanced computed tomography findings of two cases who were admitted to the emergency clinic with acute abdominal pain and diagnosed as spontaneous intramural ileal hematomas and partial small bowel obstruction secondary to intramural ileal hemorrhage.

Topics: Abdominal Pain; Aged; Anticoagulants; Hematoma; Humans; Ileal Diseases; Intestinal Obstruction; Male; Middle Aged; Warfarin

Topics: Abdominal Pain; Adolescent; Anticoagulants; Chest Pain; Competitive Behavior; Contraceptives, Oral; Enoxaparin; Female; Gymnastics; Humans; Pulmonary Embolism; Warfarin

Long-term use of warfarin can provide benefits in the treatment of many diseases, but adverse bleeding events are unpreventable because of a narrow therapeutic range.. The aim of this retrospective chart review with data abstraction was to investigate the clinical presentations of intestinal intramural hemorrhage in emergency department (ED) patients.. We reviewed the cases of 17 patients with acute abdominal pain in our ED. Medical records including demographic data and results of abdominal computed tomography were retrospectively reviewed and analyzed.. The mean ± SD age of the reviewed patients was 77.7 ± 8.5 years (range, 60-93 years). The mean ± SD duration from onset of symptoms to ED visit was 2.5 ± 1.3 days (range, 1-5 days). All patients had abdominal pain, and 64.7% had nausea/vomiting. A total of 64.7% of patients had peritoneal signs. The jejunum was most commonly involved (88.2% of all cases). The maximal mean ± SD wall thickening of the bowel was 14.1 ± 4.4 mm (range, 7.4-26.7 mm), and the estimated mean ± SD length was 35.6 ± 24.4 cm (range, 9-105 cm). The mean ± SD prothrombin time and activated partial thromboplastin time were prolonged to 86.5 ± 26.9 and 116.2 ± 43.1 seconds, respectively. All patients received medical treatment and survived. At the last follow-up (mean, 27.4 months), none of the patients had recurrence of intestinal intramural hemorrhage or intestinal obstruction.. Prolonged prothrombin time and drug history can indicate the possibility of intramural intestinal hemorrhage, and abdominal computed tomography may help to exclude surgical diseases and prevent unnecessary surgery.

Topics: Abdominal Pain; Aged; Aged, 80 and over; Anticoagulants; Emergency Service, Hospital; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Partial Thromboplastin Time; Prothrombin Time; Retrospective Studies; Statistics, Nonparametric; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Spontaneous rectus sheath hematoma (RSH) is an uncommon and frequently misdiagnosed cause of acute abdominal pain. The purpose of this study is to present our experiences in the diagnosis and treatment of spontaneous RSH.. This is a retrospective study of the medical histories of 15 patients admitted to our emergency surgery unit between January 2000 and July 2009 and diagnosed with spontaneous RSH (12 females, 3 males; mean age, 64.5 years; range, 20-79 years).. All cases presented with acute abdominal pain or abdominal wall mass, or both. Eleven of the cases (73%) had been receiving some form of anticoagulation therapy. The leading indications for anticoagulation and/or anti-platelet therapy were atrial fibrillation in 5 patients (33%) and mitral valve replacement in 3 patients (20%). Diagnosis was made by abdominal ultrasonography and/or computerized tomography in 14 patients (93%). Twelve (80%) of the 15 patients were discharged uneventfully after conservative management following a mean hospital stay of 8.8 days (range, 3-24 days). The mortality rate was 20%.. Spontaneous RSH must be suspected in patients with advanced age who are using anticoagulation medications and present with acute abdominal pain. Early diagnosis permits conservative management and avoids unnecessary surgical interventions.

Topics: Abdominal Pain; Adult; Aged; Anticoagulants; Female; Hematoma; Humans; Male; Middle Aged; Partial Thromboplastin Time; Radiography; Rectus Abdominis; Retrospective Studies; Treatment Outcome; Warfarin

A 60-year-old man presented to the accident and emergency department with a 4-day history of abdominal pain following blunt abdominal trauma. An initial CT scan showed thickened walls of the proximal jejunum and thromboses in the portal, splenic and superior mesenteric veins. He was given warfarin and the abdominal pain resolved. A repeat CT scan 1 week later revealed significant resolution of the mural thickening and the portal vein thrombosis. A subsequent thrombophilia screen was negative and he continued taking oral anticoagulants for a total of 6 months. A repeat CT scan 3 months after presentation revealed complete recanalisation the portal venous system.

Topics: Abdominal Injuries; Abdominal Pain; Anticoagulants; Follow-Up Studies; Humans; Male; Middle Aged; Portal System; Portal Vein; Rare Diseases; Risk Assessment; Severity of Illness Index; Splenic Vein; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin; Wounds, Nonpenetrating

We present an unusual case of a 31-year-old nulliparous woman who was in her normal state of health until 3 weeks before her Emergency Department visit, when she began to have generalized abdominal pain that got acutely worse over a few days. She had a soft abdomen, but complained of excruciating pain. Her computed tomography (CT) scan revealed thrombosis in the superior mesenteric, splenic, and portal veins. Her hematological work-up detected a protein S deficiency, which is associated with recurrent venous thrombosis. The finding of mesenteric venous thrombosis associated with protein S deficiency is rare. The most important factor in survival is early diagnosis and prompt treatment with anticoagulants. Properly treated, patients with mesenteric venous thrombosis should have a good long-term prognosis. Past medical or family history of thrombosis in combination with abdominal symptoms should increase the suspicion for the disease.

Topics: Abdominal Pain; Adult; Anticoagulants; Female; Humans; Mesenteric Vascular Occlusion; Mesenteric Veins; Portal Vein; Prognosis; Protein S Deficiency; Splenic Vein; Venous Thrombosis; Warfarin

This case report describes a young man presenting with iliac fossa pain secondary to iliac vein thrombus due to inferior vena cava aplasia. No other identifiable risk factor or cause for deep vein thrombosis was demonstrated.

Topics: Abdominal Pain; Angiography; Anticoagulants; Humans; Iliac Vein; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed; Vena Cava, Inferior; Venous Thrombosis; Warfarin; Young Adult

Rectus sheath haematoma (RSH) is an uncommon condition with a propensity for difficult and mistaken diagnosis. We describe a case where management was complicated by the patient's requirement for anticoagulation.

Topics: Abdominal Pain; Aged, 80 and over; Anticoagulants; Disease Progression; Emergency Service, Hospital; Fatal Outcome; Hematoma; Heparin; Humans; Male; Muscular Diseases; Pulmonary Embolism; Rectus Abdominis; Risk Assessment; Tomography, X-Ray Computed; Warfarin

Spontaneous dissection of visceral arteries is rare in the absence of concurrent dissection of the aorta, iatrogenic injury from instrumentation, or trauma. We describe a spontaneous dissection of the celiac artery that was identified by computed tomographic scan in an otherwise healthy man with acute onset abdominal pain and no identifiable causes of dissection. The patient was successfully managed medically. Although endovascular treatment or surgical intervention is the procedure of choice for complicated cases, medical management with close observation is an acceptable management strategy for stable, uncomplicated cases of spontaneous celiac artery dissection.

Topics: Abdominal Pain; Analgesics, Opioid; Anticoagulants; Aortic Dissection; Aspirin; Celiac Artery; Diagnosis, Differential; Drug Therapy, Combination; Enoxaparin; Humans; Male; Meperidine; Middle Aged; Platelet Aggregation Inhibitors; Splenic Artery; Splenic Infarction; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

A 53-year-old man presented to hospital 2 hours after the abrupt onset of left upper abdominal pain. He was treated with analgesics and discharged after 4 hours of observation, but presented to another hospital 2 hours later with severe left abdominal pain. His past medical history included ischemic dilated cardiomyopathy due to recurrent myocardial infarction.. Physical examination, electrocardiography, laboratory investigations, contrast-enhanced computed tomography, and transesophageal echocardiography.. Renal artery thromboembolism resulting from dilated cardiomyopathy, severely reduced cardiac function and an intracardiac thrombus.. Anticoagulation with unfractionated heparin followed by enoxaparin and warfarin.

Topics: Abdominal Pain; Acute Disease; Anticoagulants; Cardiomyopathy, Dilated; Coronary Thrombosis; Diagnosis, Differential; Echocardiography, Transesophageal; Enoxaparin; Humans; Infarction; Kidney Diseases; Male; Middle Aged; Renal Artery; Tomography, X-Ray Computed; Warfarin

Topics: Abdominal Muscles; Abdominal Pain; Abdominal Wall; Anticoagulants; Female; Hematoma; Humans; Lifting; Middle Aged; Warfarin

Topics: Abdominal Pain; Anticoagulants; Female; Hematoma; Humans; Ileal Diseases; Ileocecal Valve; Middle Aged; Warfarin

Topics: Abdominal Pain; Administration, Oral; Adult; Age Factors; Back Pain; Drug Therapy, Combination; Heparin; Humans; Infusions, Intravenous; Male; Mesenteric Veins; Venous Thrombosis; Warfarin

Intramural hematoma of the intestine is a rare complication of anticoagulant therapy. We evaluated 7 nontrauma patients with intramural hematoma of the intestine diagnosed at our institution between May 1998 and June 2001. All of the patients were receiving long-term anticoagulant therapy for previous diseases. All 7 patients had abdominal pain, 6 had additional symptoms of nausea and vomiting, and 4 had melanotic stools at admission. Six of the patients had abnormal coagulation parameters. Both abdominal ultrasonography (US) and computerized tomography (CT) showed the exact pathology in all patients. Five of the 7 patients were treated, nonoperatively, and the other patients underwent surgery. All of the patients were followed with abdominal US and CT (mean 12 = months), with complete resolution of their intramural hematomas. Abdominal US and CT evaluation performed together will help the accuracy of diagnosis of intramural hematoma, but nonoperative therapy is the treatment of choice, with surgery indicated if generalized peritonitis or intestinal obstruction develops.

Topics: Abdomen; Abdomen, Acute; Abdominal Pain; Adult; Aged; Anticoagulants; Diagnosis, Differential; Drug Overdose; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Middle Aged; Radiography, Abdominal; Treatment Outcome; Ultrasonography; Warfarin

Mesenteric vein thrombosis (MVT) is rare. Its diagnosis is usually difficult and delayed. Herein, we report 2 patients who developed MVT as a complication of an appendicular mass. One of them had appendectomy and developed fever 10 days postoperatively. The other was treated conservatively. An abdominal computerized tomography (CT) scan with intravenous contrast was helpful in diagnosing the superior MVT in both patients, which were not suspected. Intravenous contrast should be used when performing CT of an appendicular mass. Special interest should be directed at studying the superior mesenteric vein. Early diagnosis of our patients helped to start early medical treatment with anticoagulation.

Topics: Abdominal Pain; Adult; Anticoagulants; Appendectomy; Appendicitis; Enoxaparin; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Radiography, Abdominal; Treatment Outcome; Venous Thrombosis; Warfarin

Topics: Abdominal Pain; Angina, Unstable; Anticoagulants; Blood Coagulation Disorders; Fever of Unknown Origin; Humans; Male; Medical Errors; Middle Aged; Nausea; Partial Thromboplastin Time; Prothrombin Time; Renal Dialysis; Warfarin

Mesenteric venous thrombosis (MVT), an uncommon but important clinical entity, is one possible cause of ischemia or infarction of the small intestine. Diagnosis of this condition is sometimes difficult and treatment is often delayed because patients usually present with nonspecific abdominal symptoms. The hallmark is pain that is out of proportion to the physical findings. We report two cases of MVT, where the patients initially presented with vague abdominal symptoms. Diagnosis was made on the basis of computed tomography of the abdomen showing thrombus within the superior mesenteric vein. A search for a precipitating condition revealed no evidence of a hypercoagulable state, myeloproliferative disorder, or malignancy. These cases illustrate well the nonspecific clinical presentation of MVT. A high index of suspicion, recognition of known risk factors, or a previous history of venous thrombosis coupled with a history of nonspecific abdominal symptoms should alert clinicians to the possibility of MVT. Early diagnosis and prompt anticoagulation are the mainstay of therapy unless there are signs of peritonitis that necessitate surgical resection of the infarcted bowel.

Topics: Abdominal Pain; Aged; Anticoagulants; Diagnosis, Differential; Female; Fibrinolytic Agents; Heparin; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Postoperative Care; Time Factors; Tomography, X-Ray Computed; Venous Thrombosis; Warfarin

A child with macrocephaly-cutis marmorata developed severe abdominal pain thought to represent mesenteric angina. There were abnormalities of the aortic and mesenteric vasculature not previously reported in this condition. Angina therapy afforded amelioration of his symptoms. Mesenteric angina should be considered as a cause for abdominal pain in children with mesodermal anomalies.

Topics: Abdominal Pain; Abnormalities, Multiple; Adolescent; Angiography; Anorexia; Brain; Humans; Infant, Newborn; Infarction; Kidney; Male; Mesenteric Arteries; Mesoderm; Spleen; Venous Thrombosis; Warfarin

Topics: Abdominal Pain; Anticoagulants; Ecchymosis; Heart Valve Prosthesis; Hematoma; Hemorrhage; Humans; Male; Middle Aged; Retroperitoneal Space; Tomography, X-Ray Computed; Warfarin

Topics: Abdominal Pain; Adult; Anticoagulants; Hematoma; Humans; Intestine, Small; Male; Tomography, X-Ray Computed; Warfarin

Topics: Abdominal Pain; Anticoagulants; Hematoma; Humans; Jejunal Diseases; Male; Middle Aged; Warfarin

A 39-year-old woman presented with progressively severe, sharp abdominal pain of three days' duration. The pain originated in the right lower quadrant of the abdomen and radiated to the back and suprapubic area. It worsened on ambulation and was associated with nausea and loose stools.

Topics: Abdominal Pain; Adult; Anticoagulants; Diagnosis, Differential; Female; Hemorrhage; Humans; Ovarian Cysts; Ovarian Diseases; Thrombosis; Ultrasonography; Warfarin