[Acute pancreatitis due to intramural hematoma of the duodenum by the use of anticoagulants].
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.


METHODS
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.


CONCLUSIONS
It is suggested conservative treatment for intramural hematoma of the duodenum and recommended laparotomy only when complications occur.
Farhoud
S
S
Gastroenterologia Cirúrgica do Hospital do Servidor Público Estadual-Francisco Morato de Oliveira (HSPE-FMO).
Stephani
S M
SM
Bromberg
S H
SH
D000208:Acute Disease; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D004378:Duodenal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D006406:Hematoma / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D010195:Pancreatitis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects
D000925:Anticoagulants