Arch Iran Med. 2019;22(11): 653-658.
PMID: 31823631
  Abstract View: 364
  PDF Download: 210

Original Article

A Rare Complication of Anticoagulant Therapy: Intramural Hematoma of the Small Bowel

Nihan Acar 1 ORCID logo, Turan Acar 1, Feyyaz Gungor 1 * ORCID logo, Erdinç Kamer 1, Sebnem Karasu 2, Serkan Karaisli 1, Osman Nuri Dilek 1

1 Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
2 Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey


Background: Non-traumatic intramural hematomas of the small bowel (IHSB) are rare conditions which occur due to anticoagulant therapy. In this study, we aimed to explain our clinical approach to non-traumatic IHSB due to anticoagulant overdose and to present the long-term outcomes of the cases who were hospitalized.

Methods: Sixteen patients with non-traumatic IHSB were included and their medical records were retrospectively reviewed.

Results: Our patients included ten women and six men, with a mean age of 77.5 ± 8.4 (range: 65–95) years. All patients had been using oral anticoagulants (OACs) due to various cardiovascular and cerebral comorbidities. Common complaints at the time of admission included abdominal pain, vomiting and weakness. Ten patients (62%) had anemia, fifteen (94%) had leukocytosis and all patients (100%) had high levels of C-reactive protein (CRP). Abdominal computed tomography (CT) established the final diagnosis of IHSB in all patients. Fourteen patients (87%) were followed up with conservative therapy. Since the clinical course did not improve in two patients (12%), surgery was mandated. The mean duration of hospitalization was 10.25 ± 3.6 days (range: 3–17 days). Mortality occurred in two patients (12%).

Conclusion: IHSB should be considered in patients presenting with abdominal complaints and increased levels on coagulation tests. The diagnosis should be confirmed by abdominal CT scan, if possible. Accurate and timely diagnosis allows patients to be successfully treated without need for surgery.

Keywords: Adverse effects, Anticoagulant, Intestines
Cite this article as: Acar N, Acar T, Gungor F, Kamer E, Karasu S, Karaisli S, et al. A rare complication of anticoagulant therapy: intramural hematoma of the small bowel. Arch Iran Med. 2019;22(11):653–658.
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Abstract View: 364

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PDF Download: 210

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Submitted: 23 Dec 2018
Accepted: 30 Jul 2019
ePublished: 01 Nov 2019
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