Clinical characteristics of spontaneous intestinal intramural hematoma: a single-center experience / 대한내과학회지

ABSTRACT

BACKGROUND/AIMS: Spontaneous intestinal intramural hematoma is a rare complication occurring most commonly in patients receiving anticoagulant therapy. The present study aimed to analyze the clinical features and prognosis of this condition. METHODS: We retrospectively analyzed the medical records of 14 patients who were diagnosed with spontaneous intestinal intramural hematoma based on characteristic computed tomography findings and treated for this condition at Asan Medical Center from March 2001 to February 2009. RESULTS: The median age of patients was 67 years. All patients were receiving anticoagulant therapy. The most common presenting symptoms were abdominal pain (14 patients), nausea/vomiting (9 patients), and melena/hematochezia (8 patients). The median international normalized ratio (INR) was 7.7 (1.6- >15.1). The INR was above 3.5 in 13 patients (93%). Hematomas most commonly involved the jejunum (7 patients), followed by the ileum (4 patients). All patients rapidly recovered without short-term complications after medical treatment, including correction of coagulation abnormalities. Twelve patients resumed anticoagulant therapy after symptomatic resolution and correction of coagulation abnormalities, and no complications, including rebleeding, occurred during the mean 37.4 months of follow-up. CONCLUSIONS: Spontaneous intestinal intramural hematoma rapidly improved after medical treatment, and no complications occurred. It may be safe to carefully resume anticoagulant therapy in patients at high risk of thromboembolism.