A Review on the Clinical Characteristics and Outcomes from Spontaneous Intestinal Intramural Hematoma

ABSTRACT

PURPOSE: Spontaneous intestinal intramural hematoma (SIMH) is a very rare complication of anticoagulation. Most reports on SIMH have been case reports and case series, not well-established clinical studies. Therefore, the aim of this study was to evaluate the clinical characteristics and outcomes from SIMH. METHODS: A retrospective review of the records of 48 patients with non-traumatic SIMH was performed at an urban academic tertiary hospital between January 2001 and December 2012. These patients were diagnosed with SIMH by computed tomography and confirmed by a radiology specialist. Their clinical characteristics and outcomes from SIMH were determined. RESULTS: Among all SIMH cases, the percentage of warfarin users was 70.8%. The median age at presentation was 66.5 years, whereas warfarin users were older (68.0 years) than non-users (55.0 years) (p<0.01). SIMH patients had abdominal pain (81.3%), nausea and vomiting (50.0%) and 62.5% of them had abdominal tenderness. The most frequently involved site was the small bowel (85.4%) and there was only one patient with bowel obstruction from SIMH. A total of 33(68.6%) patients were admitted for 9.3 days for conservative treatment, including transfusion. On the other hand, two patients had surgical intervention. There were no mortality cases from SIMH during the study period. CONCLUSION: SIMH is rare disease which can treated with supportive care. However, it can cause severe complications, such as bowel obstruction and perforation, requiring surgical intervention. Therefore, emergency physicians have to consider SIMH carefully, especially in patients treated with an anticoagulation agent.