warfarin and Ileus

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

In the case presented here, we have succeeded in describing the endoscopic findings of anticoagulant ileus and evaluated the degree of bleeding as well as ischemia through endoscopic observation. We have demonstrated that enteroscopy using the double-balloon method is a useful diagnostic tool in the evaluation of a patient suspected to have anticoagulant ileus.

Topics: Anticoagulants; Catheterization; Endoscopy, Gastrointestinal; Hematoma; Humans; Ileus; Jejunal Diseases; Male; Middle Aged; Warfarin