S Farhoud1, S M Stephani, S H Bromberg. 1. Gastroenterologia Cirúrgica do Hospital do Servidor Público Estadual-Francisco Morato de Oliveira (HSPE-FMO).
Abstract
BACKGROUND: Spontaneous intramural hemorrhage of the duodenum due to anticoagulant therapy is rare and the treatment is controversial. OBJECTIVE: To present the acquired knowledge with the treatment of these disease. CASE REPORT: A 71-year-old women receiving for a 3 month period an anticoagulant therapy presented cervical bleeding of soft tissues and symptoms of acute pancreatitis and high small bowel obstruction. Early noninvasive diagnosis by computed tomographic scan was possible and conservative therapy proved successful in complete resolution of the pancreatitis and obstructive symptoms, with resumption of oral intake in the fourth day of treatment. The frequency of bleeding in high risk patients during warfarin therapy is reduced by less intense therapy, achieving a prothrombin time with an International Normalized Ratio of 2.0 to 3.0. RESULTS: The use of conservative treatment was helpful and the patient was discharged asymptomatic, 10 days after admission. CONCLUSION: It is suggested conservative treatment for intramural hematoma of the duodenum and recommended laparotomy only when complications occur.
BACKGROUND: Spontaneous intramural hemorrhage of the duodenum due to anticoagulant therapy is rare and the treatment is controversial. OBJECTIVE: To present the acquired knowledge with the treatment of these disease. CASE REPORT: A 71-year-old women receiving for a 3 month period an anticoagulant therapy presented cervical bleeding of soft tissues and symptoms of acute pancreatitis and high small bowel obstruction. Early noninvasive diagnosis by computed tomographic scan was possible and conservative therapy proved successful in complete resolution of the pancreatitis and obstructive symptoms, with resumption of oral intake in the fourth day of treatment. The frequency of bleeding in high risk patients during warfarin therapy is reduced by less intense therapy, achieving a prothrombin time with an International Normalized Ratio of 2.0 to 3.0. RESULTS: The use of conservative treatment was helpful and the patient was discharged asymptomatic, 10 days after admission. CONCLUSION: It is suggested conservative treatment for intramural hematoma of the duodenum and recommended laparotomy only when complications occur.
Authors: Osman Kones; Ahmet Cem Dural; Murat Gonenc; Mehmet Karabulut; Cevher Akarsu; Ilhan Gok; M Abdussamet Bozkurt; Mehmet Ilhan; Halil Alıs Journal: J Korean Surg Soc Date: 2013-07-25