title: Coumarin-induced intramural hematoma of the duodenum: case report and review of the literature.
abstract: OBJECTIVE
  Intramural hematoma of the small intestine is a complication of anticoagulant treatment with an estimated incidence of 1 case per 2500 anticoagulated patients per year. Patients may present with signs of small bowel obstruction or, in case of a ruptured hematoma, with upper gastrointestinal tract hemorrhage and hypovolemic shock.
  
  
  METHODS
  Case report and review of the literature.
  
  
  RESULTS
  We present a case of a 73-year-old male who was referred for a protruding mass in the duodenum and subsequently developed hematemesis and melena caused by a ruptured hematoma of the duodenal wall.
  
  
  CONCLUSIONS
  Although intramural hematoma of the duodenum is a rare complication of anticoagulant therapy, early diagnosis with subsequent correction of coagulation parameters is of vital importance.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands. b.veldt@erasmusmc.nl
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Veldt
authors.forename: Jelle
authors.initials: J
authors.lastname: Haringsma
authors.forename: Klaas W
authors.initials: KW
authors.lastname: Florijn
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D003374:Coumarins / Q000009:adverse effects*; D004386:Duodenum / Q000187:drug effects* / Q000473:pathology; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D006396:Hematemesis / Q000139:chemically induced; D006406:Hematoma / Q000139:chemically induced* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008551:Melena / Q000139:chemically induced
chemical_list: D000925:Anticoagulants; D003374:Coumarins; C030123:coumarin