[Anticoagulant induced intramural duodenal hematoma presenting as duodenal obstruction]. / Syndrome occlusif et hémorragique révélant un hématome duodénal intramural iatrogène.

An intramural hematoma of the duodenum was first reported in an article in the Lancet in 1838. At least, 90% of cases are caused by blunt abdominal trauma, typically accidents involving bicycles or motor vehicles. Intramural duodenal hematoma is a rare complication of anticoagulant therapy. It occurs in patients who receive excessive anticoagulation with warfarin or who have some other risk factor for bleeding. CT characteristics include circumferential wall thickening, intramural hyperdensity, luminal narrowing, and intestinal obstruction. Early diagnosis is crucial because most patients are treated nonoperatively with a good outcome.

[Diaphragm-like strictures of the colon from diclofenac]. / Diaphragmes coliques sous diclofénac.

BACKGROUND: Diaphragm-like strictures of the colon induced by nonsteroidal antiinflammatory drugs (NSAID) constitute a recently described uncommon clinical entity. CASE REPORT: An 86-year-old man consulted for abdominal pain and constipation. The physical examination revealed bloody stools and anemia in a patient on long-standing diclofenac therapy. Colonoscopy demonstrated two diaphragm-like strictures of the left and transverse colon with ulceration of the apex. Clinical outcome was favorable after discontinuing the NSAID. DISCUSSION: We compared this observation with 26 other case reports in the literature. The etiological mechanism appears to be related to systemic and local toxicity. Severe stenotic stricture may require surgical management. Endoscopic pneumatic dilatation may be an alternative to surgery.