Complicated Gastric Ulcer and Jejunal Hematoma with Concomitant Warfarin Use: Analytical and Biomedical Case Study Report

Ali A. Samaha^{1, 2}, Hilana Hatoum^{3, 4}, Shaimaa Matar⁴, Fouad Zaarour⁴ and John J. Haddad^5,

¹Faculty of Public Health, Lebanese University, Zahle, Lebanon

²Department of Biomedical Sciences, Lebanese International University, Beirut, Lebanon

³Department of Gastroenterology, Sahel General Hospital, Beirut, Lebanon

⁴Faculty of Medicine, Lebanese University, Beirut, Lebanon

⁵Cellular and Molecular Physiology and Immunology Signaling Research Group, Biomedical Laboratory and Clinical Sciences Division, Department of Medical Laboratory Technology, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon

Cite this paper:
Ali A. Samaha, Hilana Hatoum, Shaimaa Matar, Fouad Zaarour and John J. Haddad. Complicated Gastric Ulcer and Jejunal Hematoma with Concomitant Warfarin Use: Analytical and Biomedical Case Study Report. American Journal of Medical and Biological Research. 2013; 1(3):58-63. doi: 10.12691/ajmbr-1-3-2

Abstract

Intramural hematoma is commonly known as a hematoma that occurs in the wall of a structure, such as the bowel or bladder, usually resulting from trauma or, in rare situations, excessive anticoagulation. In particular, intramural gastrointestinal hematoma is part of a spectrum of gastrointestinal injuries. Vomiting and straining, endoscopic procedures, and bleeding disorders are essentially among the most common predisposing factors. However, it can also be an unusual complication of anticoagulation and/or thrombolysis therapy. The most common symptoms are retrosternal chest pain, dysphagia, and hematemesis. Intramural bowel wall hematoma is an often forgotten, rare clinical entity that may pose considerable diagnostic dilemma. Therefore, it is conspicuously imperative to diagnose this condition promptly and correctly in order to avoid unnecessary surgical intervention. In this rare presented case report, a 51-year-old woman having mitral valve prothesis and mild heart failure under warfarin wasadmitted to the renowned Sahel General Hospital in Beirut in November of 2006 with massive upper gastrointestinal bleeding that was subsequently controlled by endoscopic sclerotherapy and medical management. About 12 h later, the aforementioned patientsuffered a severe abdominal pain accompanied by a steep dropping in the hematocrit level. Moreover, an abdominal computed tomography scan showed thick jejunal hematoma of approximately 70 cm in length that was handled surgically. The patient had been incessantly observed for about 7 days,andsubsequently discharged with therapeutic international normalized ratio(INR).

Keywords:
CT Hemorrhagic bowel syndrome INR jejunal hematoma NSAIDs warfarin

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