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Abdominal Pain and Vomiting in a Patient with Over-anticoagulation -- a Rare Case of Spontaneous Intramural Hematoma of the Jejunum

  • Dino Kasumović1
  • Matej Nedić1
  • Ana Gudelj-Gračanin1
  • Antonela Šarac1
  • Adrijana Perkunić2

1Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia

2Clinical Department of Diagnostic and Interventional Radiology, Clinical Hospital Dubrava, Zagreb, Croatia

DOI: 10.22514/sv.2020.16.0035 Vol.16,Issue 2,October 2020 pp.203-206

Published: 28 October 2020

*Corresponding Author(s): Dino Kasumović E-mail:


Anticoagulants, including vitamin K antagonists, are widely used for therapeutic and prophylactic purposes. Bleeding is the most important complication of anticoagulant therapy due to over-anticoagulation. Over-anticoagulation may present in unusual ways, such as spontaneous intramural hematoma of the small bowel. The classical clinical picture consists of abdominal pain, small bowel obstruction (that can present as vomiting) and hemorrhagic symptoms that can be related to the bowel or other parts of the body. Radiological examinations are essential for the diagnosis. Ultrasound can be helpful in the diagnostic process, but computed tomography is the procedure of choice. Conservative treatment is usually successful, including procedures that stop the over-anticoagulant consequences. A surgical approach is reserved for complications such as necrosis or perforation of the bowel. The diagnosis is definitively confirmed by the spontaneous resolution of the pathological findings on a follow-up computed tomography scan. We present a case of a 72-year-old woman who was diagnosed with this rare condition affecting the jejunum in the emergency department in our hospital.


Anticoagulants, Hematoma, Jejunum, Abdominal pain, Computed tomography

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Dino Kasumović,Matej Nedić,Ana Gudelj-Gračanin,Antonela Šarac,Adrijana Perkunić. Abdominal Pain and Vomiting in a Patient with Over-anticoagulation -- a Rare Case of Spontaneous Intramural Hematoma of the Jejunum. Signa Vitae. 2020. 16(2);203-206.


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