warfarin and Intestinal-Obstruction

Topics: Anticoagulants; Avitaminosis; Colon; Digestive System Abnormalities; Digestive System Surgical Procedures; Endocarditis, Bacterial; Enterococcus faecalis; Female; Heart Valve Prosthesis Implantation; Humans; Infant; International Normalized Ratio; Intestinal Atresia; Intestinal Obstruction; Mitral Valve Insufficiency; Nutrition Assessment; Parenteral Nutrition; Short Bowel Syndrome; Vitamins; 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

The patients on anticoagulation therapy especially warfarin can develop gastrointestinal bleed, gum bleeding, hematuria or ecchymosis. Rarely do such patients present with hemoperitoneum producing symptoms. Hemoperitoneum can produce shock, cause compression symptoms or may even be fatal. Such patients can be managed conservatively or may need surgical exploration for ongoing bleeding or decompression. We had a patient taking warfarin who presented with hemoperitoneum producing intestinal symptoms. The patient was managed conservatively with fluid and blood product replacement and stopping warfarin. The benefits of thromboprophylaxis and the risks of bleeding should be carefully evaluated and the dose of warfarin carefully adjusted.

Topics: Adult; Anticoagulants; Female; Hemoperitoneum; Humans; International Normalized Ratio; Intestinal Obstruction; Male; Treatment Outcome; Warfarin

Intramural hematomas of the colon are rare. Intramural hematomas of the gastrointestinal tract often result from blunt trauma, although they may also occur spontaneously in patients taking anticoagulants or those with blood dyscrasia. Affected patients present with abdominal pain and lower gastrointestinal bleeding, as well as occasional signs of intestinal obstruction. The diagnosis is made using colonoscopy and abdominal CT. Resection of the involved bowel segment is accepted as the standard therapy; however, experience with conservative treatment has also been reported. We herein report the case of a 62-year-old woman taking warfarin who was diagnosed with a colonic intramural hematoma and completely recovered with conservative management.

Topics: Anticoagulants; Colon; Colonoscopy; Female; Fluid Therapy; Hematoma; Humans; Intestinal Obstruction; Middle Aged; Thrombosis; Tomography, X-Ray Computed; Warfarin

Oral anticoagulant therapy with warfarin is commonly used to prevent thromboembolic event in patients at risk with atrial fibrillation [1]. Spontaneous intramural hematoma of small intestine is rare complication of anticoagulant therapy and occurs in patient who receives excessive warfarin that may result in potentially serious complications. Small bowel intramural hematoma secondary to warfarin therapy is a recognized complication [2]. In the present report, we report an unusual case of small bowel intramural hemorrhage secondary to anticoagulant therapy after abdominal massage. The emergency physicians should be aware that the potential spontaneous small bowel intramural hemorrhage in the patients has a high index of suspicion because most patients are treated nonoperatively with a good outcome.

Topics: Aged; Anticoagulants; Hematoma; Humans; Intestinal Obstruction; Jejunal Diseases; Male; Massage; Tomography, X-Ray Computed; Warfarin

Many commonly prescribed drugs can interact with warfarin and prolong bleeding time beyond therapeutic limits. We report a patient who developed a rectus sheath haematoma following inadvertent over anticoagulation. Despite conservative management, the patient went on to develop large bowel obstruction from the expanding haematoma and operative intervention became necessary.

Topics: Aged; Anticoagulants; Female; Hematoma; Humans; Intestinal Obstruction; Radiography; Rectus Abdominis; Sigmoid Diseases; 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

We present a rare case of small bowel obstruction in a patient on long-term anticoagulation. A 53-year woman presented with abdominal pain and vomiting. She was on warfarin following aortic and mitral valve surgery. A small bowel follow through revealed jejunal narrowing consistent with a stricture. This probably was the result of submucosal bleeding because of over warfarinazation. The warfarin was stopped and she started on heparin with complete resolution of symptoms. This rare complication of anticoagulation should be considered in patients on warfarin. Early diagnosis is crucial as most patients are treated conservatively with very few patients requiring surgery.

Topics: Female; Gastrointestinal Hemorrhage; Heparin; Humans; Intestinal Obstruction; Intestine, Small; Middle Aged; Treatment Outcome; Warfarin

Topics: Acute Disease; Aged; Anticoagulants; Colonic Diseases; Female; Hematoma; Humans; Intestinal Obstruction; Tomography, X-Ray Computed; Warfarin

The increased mortality of emergency vs. elective colonic surgery applies equally to the right and left colon. Recent interest has surrounded the application of expandable metal stenting in acute obstruction but has been confined to the left colon. We describe successful application of stenting in the right colon, allowing postponement of a particularly high-risk laparotomy.. A patient with acute bilateral iliofemoral thromboses simultaneously developed complete obstruction of the proximal transverse colon. After heparinization and under fluoroscopic control, a 10-cm-long, self-expanding Wall-stent (Schneider, Bulach, Switzerland), 22 mm in diameter, was manipulated across the obstruction.. Immediate decompression with symptomatic relief ensued. The stent prevented obstruction during a 10-week period of anticoagulation, and repeat duplex scanning showed resolution of iliac thrombus. An elective right hemicolectomy was then performed. Postoperative course was uncomplicated, and histopathology confirmed a Dukes B carcinoma.. This case, in which a potentially hazardous laparotomy was delayed until the operative risk improved, defines a new role for stenting in colonic obstruction and demonstrates an extension of its applicability to the right colon. Literature review found no other report of stent application in the right colon.

Topics: Acute Disease; Adenocarcinoma; Aged; Anticoagulants; Colonic Neoplasms; Contraindications; Elective Surgical Procedures; Humans; Intestinal Obstruction; Laparotomy; Male; Stents; Thrombophlebitis; Warfarin

Coumadin is a coumarin anticoagulant that induces a state similar to vitamin K deficiency and is routinely used for chronic oral anticoagulation. Intramural hematoma of the bowel is a rare complication of anticoagulant therapy. In this paper, we describe such a case of an anticoagulated patient who had complaints of abdominal pain and who had inadvertently been taking higher dose of coumadin. Although the diagnosis can usually be made by history and plain abdominal x-ray, we report here some radiographic signs that can be seen on a CT-scan of the abdomen and are relatively specific for this diagnosis. We stress the importance of recognizing the disorder because the management is conservative and surgery is reserved for cases in which no improvement is seen.

Topics: Drug Overdose; Female; Hematoma; Humans; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Middle Aged; Warfarin

Topics: Anticoagulants; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestinal Obstruction; Jejunal Diseases; Male; Middle Aged; Warfarin

Two hundred sixty cases of intestinal intramural hematoma and subsequent bowel obstruction have been reported in the world literature. These cases have been evaluated and seventeen additional cases are reported. Multiple etiologic factors are presented, with trauma and anticoagulant therapy being the most common. Barium x-ray examination is the single most reliable diagnostic study. The mode of therapy for intramural hematoma depends upon thorough evaluation of the patient. Patients on anticoagulant therapy are best treated by observation and cessation of anticoagulants. Should the patient fail to improve or become worse, then surgery may become necessary. When trauma is a factor, prompt operative intervention is indicated.

Topics: Abdominal Injuries; Adolescent; Adult; Child; Child, Preschool; Gastrointestinal Diseases; Hematoma; Heparin; Humans; Infant; Intestinal Obstruction; Middle Aged; Warfarin

Topics: Cecum; Colon; Diagnosis, Differential; Embolism; Gastrointestinal Hemorrhage; Hematoma; Humans; Ileum; Intestinal Mucosa; Intestinal Obstruction; Intestine, Small; Male; Mesentery; Middle Aged; Warfarin

Topics: Aged; Female; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Hematoma; Humans; Intestinal Obstruction; Postoperative Complications; Thrombosis; Warfarin

Topics: Abdominal Muscles; Aged; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestinal Obstruction; Male; Middle Aged; Myocardial Infarction; Radiography; Retroperitoneal Space; Warfarin

Topics: Acute Disease; Adult; Aged; Emergencies; Gastrointestinal Hemorrhage; Hematoma; Humans; Hypoprothrombinemias; Intestinal Obstruction; Male; Middle Aged; Phenindione; Radiography; Warfarin

Topics: Aged; Gastrointestinal Hemorrhage; Hematoma; Humans; Intestinal Obstruction; Intestine, Small; Laparotomy; Male; Necrosis; Postoperative Complications; Warfarin

Topics: Abdomen, Acute; Hemoperitoneum; Humans; Intestinal Obstruction; Jejunum; Male; Middle Aged; Warfarin

Topics: Adult; Autopsy; Coronary Disease; Female; Gastrointestinal Hemorrhage; Humans; Intestinal Mucosa; Intestinal Obstruction; Intestine, Small; Jejunum; Radiography; Warfarin

Topics: Abdomen, Acute; Barium Sulfate; Blood Pressure; Blood Transfusion; Cerebrovascular Disorders; Duodenum; Female; Hematemesis; Hematuria; Hemoperitoneum; Humans; Intestinal Obstruction; Jejunum; Laparotomy; Male; Melena; Middle Aged; Myocardial Infarction; Prothrombin Time; Radiography; Vitamin K 1; Warfarin

Topics: Dicumarol; Duodenal Diseases; Gastrointestinal Hemorrhage; Geriatrics; Hematuria; Hemorrhage; Hypoprothrombinemias; Ileum; Intestinal Obstruction; Intestine, Small; Jejunum; Pathology; Radiography; Surgical Procedures, Operative; Toxicology; Warfarin

Topics: Aged; Humans; Intestinal Obstruction; Intestine, Small; Male; Myocardial Infarction; Warfarin

Topics: Aged; Electrocardiography; Hemoperitoneum; Humans; Intestinal Obstruction; Male; Mesenteric Vascular Occlusion; Middle Aged; Myocardial Infarction; Vitamin K; Warfarin

Topics: Anticoagulants; Geriatrics; Hematoma; Humans; Intestinal Diseases; Intestinal Obstruction; Intestine, Small; Myocardial Infarction; Surgical Procedures, Operative; Toxicology; Warfarin