Intramural duodenal hematoma and hemoperitoneum in anticoagulant therapy following upper gastrointestinal endoscopy.
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.
Wang
Jaw-Yuan
JY
Department of Surgery, College of Medicine and Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
Ma
Cheng-Jen
CJ
Tsai
Hsiang-Lin
HL
Wu
Deng-Chyang
DC
Chen
Chiao-Yun
CY
Huang
Tsung-Jen
TJ
Hsieh
Jan-Sing
JS
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
D000925:Anticoagulants