title: Intramural duodenal hematoma and hemoperitoneum in anticoagulant therapy following upper gastrointestinal endoscopy.
abstract: OBJECTIVE
  To report the unusual occurrence of intramural duodenal hematoma in a case on anticoagulant therapy, presenting as a complication of gastrointestinal endoscopy.
  
  
  METHODS
  A 74-year-old female patient developed nausea, vomiting and abdominal pain, and subsequently hypovolemic shock, 2 days after fiberoptic upper gastrointestinal endoscopy. The patient's international normalized ratio value was 2.7. A computed tomographic scan of the abdomen demonstrated duodenal wall thickening with intramural hematoma, as well as hematoma in the pararenal space and pelvic cavity. The patient was treated by conservative treatment that included correction of clotting abnormalities, blood transfusion, nasogastric decompression, hydration, and parenteral nutrition support. She resumed oral intake after 10 days of support treatment, recovering uneventfully.
  
  
  CONCLUSIONS
  This case shows the possibility of development of an intramural duodenal hematoma in patients on anticoagulant therapy, without biopsies being taken.
authors.affiliation: Department of Surgery, College of Medicine and Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
authors.forename: Jaw-Yuan
authors.initials: JY
authors.lastname: Wang
authors.forename: Cheng-Jen
authors.initials: CJ
authors.lastname: Ma
authors.forename: Hsiang-Lin
authors.initials: HL
authors.lastname: Tsai
authors.forename: Deng-Chyang
authors.initials: DC
authors.lastname: Wu
authors.forename: Chiao-Yun
authors.initials: CY
authors.lastname: Chen
authors.forename: Tsung-Jen
authors.initials: TJ
authors.lastname: Huang
authors.forename: Jan-Sing
authors.initials: JS
authors.lastname: Hsieh
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology*; D006465:Hemoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants