title: Intramural hematomas of the gastrointestinal system: a 5-year single center experience.
abstract: OBJECTIVE
  Although spontaneous intramural hematomas of the gastrointestinal tract are very rare, they may be observed with the use of oral anticoagulant, though less frequently in cases of hematological malignancy and other bleeding disorders. Cases diagnosed as spontaneous intramural hematoma have been assessed in our clinic.
  
  
  METHODS
  The cases, which were diagnosed as spontaneous intramural hematoma in the gastrointestinal tract (SIHGT) following anamnesis, physical examination, biochemical, radiological and endoscopic findings from July 2008 to July 2012, have been assessed retrospectively.
  
  
  RESULTS
  Seven out of 13 cases were women and the mean age was 65.1 years (34 to 82 years). The most frequent complaint on admission was abdominal pain. The most frequent location of SIHGT was the ileum (n = 8). Oral anticoagulant use was the most common cause of etiology (n = 12). In 10 cases, International normalized ratio values were higher than treatment range (2 to 3, where mechanical valve replacement was 2.5 to 3.5) and mean value was 7.6 (1.70 to 23.13). While 12 cases were discharged without problems with medical treatment, one case with acute myeloid leukemia died in the intensive care unit following cerebrovascular attack.
  
  
  CONCLUSIONS
  Spontaneus bleeding and hematomas that may arise in connection with bleeding diathesis may be fatal in cases with long-term oral anticoagulant treatment and insufficient follow-up. In management of these cases, it may be necessary to arrange conservative follow up and/or initialize low molecular weight heparin, and administer vitamin K as well as replace blood products and coagulation factors when indicated.
authors.affiliation: Department of General Surgery, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Kones
authors.forename: Ahmet Cem
authors.initials: AC
authors.lastname: Dural
authors.forename: Murat
authors.initials: M
authors.lastname: Gonenc
authors.forename: Mehmet
authors.initials: M
authors.lastname: Karabulut
authors.forename: Cevher
authors.initials: C
authors.lastname: Akarsu
authors.forename: Ilhan
authors.initials: I
authors.lastname: Gok
authors.forename: M Abdussamet
authors.initials: MA
authors.lastname: Bozkurt
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ilhan
authors.forename: Halil
authors.initials: H
authors.lastname: Alıs
keywords: Anticoagulants; Gastrointestinal tract; Hematoma; Hemorrhage; Tomography
references.citation: Arch Surg. 1964 Sep;89:527-35
references.pmid: 14167408
references.citation: Surg Today. 2006;36(6):563-5
references.pmid: 16715431
references.citation: Ulus Travma Acil Cerrahi Derg. 2010 Mar;16(2):165-9
references.pmid: 20517773
references.citation: Postgrad Med J. 1975 Feb;51(592):107-10
references.pmid: 1078728
references.citation: Br J Haematol. 2004 Jul;126(1):11-28
references.pmid: 15198728
references.citation: Wis Med J. 1994 May;93(5):212-4
references.pmid: 8053224
references.citation: AJR Am J Roentgenol. 2002 Dec;179(6):1389-94
references.pmid: 12438021
references.citation: Clin Radiol. 1997 May;52(5):378-80
references.pmid: 9171792
references.citation: Clinics (Sao Paulo). 2007 Dec;62(6):785-90
references.pmid: 18209923
references.citation: Am J Emerg Med. 2003 May;21(3):208-11
references.pmid: 12811714
references.citation: J Emerg Med. 2004 Oct;27(3):291-3
references.pmid: 15388219
references.citation: Eur J Emerg Med. 2007 Oct;14(5):272-3
references.pmid: 17823563
references.citation: Rev Clin Esp. 1995 Jul;195(7):463-7
references.pmid: 7667521
references.citation: Arq Gastroenterol. 2001 Jan-Mar;38(1):53-6
references.pmid: 11582964
references.citation: Haemophilia. 2008 Mar;14(2):383-4
references.pmid: 18179573
references.citation: Calif Med. 1966 Jun;104(6):449-53
references.pmid: 5963911
references.citation: J Clin Ultrasound. 1999 May;27(4):213-6
references.pmid: 10323195
references.citation: Arch Surg. 2002 Mar;137(3):306-10
references.pmid: 11888455