title: Sonographic diagnosis of spontaneous intramural small bowel hematoma in a case of warfarin overdose.
abstract: A 38-year-old man who had been treated with warfarin since mitral valve replacement 10 years earlier presented with acute onset of epigastralgia and melena. Coagulation tests were abnormal with a prolonged prothrombin time of >60 seconds and a prolonged activated partial thromboplastin time of >120 seconds. Abdominal sonographic examination revealed duodenal intramural hematoma that was confirmed on CT. Warfarin therapy was stopped and the patient was treated conservatively with vitamin K and fresh frozen plasma. Recovery was uneventful, and the patient was re-warfarinized 2 weeks later. Duodenal hematoma can be readily diagnosed with bedside sonography.
authors.affiliation: Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Rd, Shi Lin District, Taipei 111, Taiwan, ROC.
authors.forename: Sheng-Wen
authors.initials: SW
authors.lastname: Hou
authors.forename: Chien-Chih
authors.initials: CC
authors.lastname: Chen
authors.forename: Kuo-Chih
authors.initials: KC
authors.lastname: Chen
authors.forename: Shih-Yu
authors.initials: SY
authors.lastname: Ko
authors.forename: Chung-Shun
authors.initials: CS
authors.lastname: Wong
authors.forename: Chee-Fah
authors.initials: CF
authors.lastname: Chong
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000506:poisoning*; D003937:Diagnosis, Differential; D062787:Drug Overdose; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000628:therapy; D006406:Hematoma / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D007421:Intestine, Small; D008297:Male; D014463:Ultrasonography; D014859:Warfarin / Q000506:poisoning*
chemical_list: D000925:Anticoagulants; D014859:Warfarin