Reactions 1680, p340 - 2 Dec 2017 Gastric intramural haematoma: 3 case reports In a retrospective review, three men aged 40 years, 62 years and 65 years were described, who developed gastric intramural haematoma during treatment with warfarin [routes, dosages and durations of treatments to reactions onsets not stated; not all indications and outcomes stated]. Case 1: A 40-year-old man, presented to an emergency department with complaints of abdominal pain and vomiting. The man had an extensive history of cardiac problems, and had been taking warfarin. His abdominal exam showed that his upper abdomen was tender and rigid. There were no palpable masses or bowel sounds. Minor bleeding from the gums was observed. He was admitted, and his laboratory workup revealed mild anaemia, leucocytosis and an INR of 17. An 18mm thickened hypoechoic gastric wall was observed on the abdominal ultrasound. An endoscopy was carried out, which showed sub-mucosal haemorrhage which involved the antrum and body of the stomach, extending upto the duodenum. There were no signs of active bleeding. A CT scan of the abdomen confirmed a haematoma. He was initiated on stat vitamin-K and fresh frozen plasma. He was admitted for 13 days for observation and correction of the coagulation deficits. His stomach thickness reduced after five days of admission. Another endoscopy 10 days later showed significant improvements of the mucosal appearance. Case 2: A 62-year-old man presented to the emergency centre with complaints of abdominal pain and constipation lasting for two days. He had a history of ischaemic heart disease and atrial fibrillation, and hence, he had been administering warfarin. His abdomen appeared distended with tenderness and hypoactive bowel sounds. Melena was observed upon rectal examinations. Abdominal ultrasound showed significant thickening of small bowel loops and a left renal cyst. An abdominal CT was conducted with intravenous contrast, which showed thickening of the proximal 20cm of jejunum with patent superior mesenteric artery and vein. His INR value was 10.5, whereas the rest of the laboratory tests were normal. A gastric intramural haematoma was suspected. He was treated with vitamin-K, and his pain improved and fresh frozen plasma. He was discharged after four days. His dose of oral anticoagulation was adjusted. Case 3: A 65-year-old man presented to the emergency centre with complains of abdominal pain. He had a history of ischaemic heart disease, and had been administering warfarin. He described his pain to be of a diffuse, dull and aching type with tenderness in the right iliac fossa. Examination showed tenderness on the right lower quadrant. His laboratory examinations showed high blood sugar levels and an INR 9. An abdominal ultrasound was inconclusive, however, a 10 cm thickened terminal ileal loop was observed on the CT. A gastric intramural haematoma was suspected. He was treated with vitamin-K, fresh frozen plasma and fluid resuscitation. By the second admission day, his symptoms resolved. Author comment: "Gastric mural hematomas are very rare complications of anticoagulant therapy and present mainly with upper abdominal pain and vomiting that may or may not be blood stained." Bekheit M, et al. Non-traumatic intramural hematomas in patients on anticoagulant therapy: Report of three cases and overview of the literature. African Journal for Emergency Medicine 4: e1-e4, No. 4, Dec 2014. Available from: URL: http:// doi.org/10.1016/j.afjem.2014.07.009 - Egypt 803285372 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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