Spontánny intramurálny hematóm tenkého čreva je vzácnou komplikáciou perorálnej antikoagulačnej liečby. Počítačová tomografia (CT) je diagnostickou metódou voľby, ktorá umožňuje včasné a presné rozpoznanie tohto stavu. Nerozpoznaný intramurálny hematóm tenkého čreva vedie často k zbytočnej chirurgickej intervencii, pretože väčšina hematómov sa resorbuje pri konzervatívnej liečbe spontánne. Autori referujú o dvoch prípadoch spontánneho intramurálneho hematómu tenkého čreva, ktorý vznikol ako komplikácia perorálnej antikoagulačnej liečby. U prvého pacienta vznikol hematóm v duodene. Endoskopické vyšetrenie a CT viedli k rýchlemu rozpoznaniu krvácania. Konzervatívna liečba bola efektívna. Hematóm u druhého pacienta vznikol v jejune a nebol jednoznačne rozpoznaný pri CT. Diagnóza bola stanovená až pri laparotómii. Resekcia postihnutého segmentu čreva nebola nutná. U pacientov liečených antikoagulanciami je pre rozpoznanie intramurálneho hematómu tenkého čreva zásadnou vysoká miera podozrenia na uvedenú komplikáciu antikoagulačnej liečby.
Spontaneous intramural hematoma of the small bowel is a rare complication in oral anticoagulation therapy. Computed tomography (CT) as the diagnostic method of choice allows early and accurate recognition of this condition. Unrecognised intramural hematoma of the small bowel may lead to unnecessary surgical intervention since most hematomas resolve spontaneously with conservative treatment. We report two cases of spontaneous intramural hematoma of the small bowel as a complication in oral anticoagulant therapy. The first patient presented with duodenal hematoma. Endoscopy together with CT led to early recognition of the haemorrhage. Conservative treatment was successful. The second patient presented with jejunal hematoma which was not recognised on CT, so surgical exploration was carried out. Resection of the affected segment of the jejunum was not necessary. A high index of clinical suspicion of this complication in oral anticoagulant therapy is, therefore, critical in patients with symptoms of small bowel obstruction. Key words: duodenum – hematoma – hemorrhage – anticoagulants The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers. Submitted: 30. 5. 2012 Accepted: 1. 10. 2012
- MeSH
- Medical History Taking MeSH
- Anemia MeSH
- Anticoagulants adverse effects MeSH
- Biopsy MeSH
- Diagnostic Techniques and Procedures MeSH
- Diagnosis, Differential MeSH
- Duodenum MeSH
- Endoscopy, Digestive System MeSH
- Atrial Fibrillation MeSH
- Hematoma MeSH
- Jejunum MeSH
- Blood Cell Count MeSH
- Hemorrhage * therapy MeSH
- Leukocytosis MeSH
- Humans MeSH
- Tomography, X-Ray Computed MeSH
- Signs and Symptoms, Digestive MeSH
- Signs and Symptoms MeSH
- Prothrombin Time MeSH
- Radiography MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Body Temperature MeSH
- Intestine, Small * drug effects MeSH
- Vitamin K MeSH
- Treatment Outcome MeSH
- Warfarin adverse effects MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Crohn Disease drug therapy MeSH
- Diagnostic Techniques, Digestive System MeSH
- Financing, Organized MeSH
- Adrenal Cortex Hormones therapeutic use MeSH
- Inflammatory Bowel Diseases drug therapy complications MeSH
- Humans MeSH
- Young Adult MeSH
- Antibodies, Monoclonal therapeutic use MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Retreatment MeSH
- Disease Progression MeSH
- Tumor Necrosis Factor-alpha antagonists & inhibitors therapeutic use MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
