Spontaneous Intramural Hematoma of the Small Bowel-A complication of Anticoagulant therapy

Spontaneous intramural small bowel hematoma is a rare complication of anticoagulant therapy. The authors report a case of small bowel intramural hematoma resulting from sodium Warfarin toxicity in a patient with prosthetic mitral valve. The patient presented with colicky abdominal pain, vomiting and melena. Typical findings on abdominal Sonography and MDCT with elevated INR value suggested the diagnosis. Patient was treated conservatively. The history of anticoagulant use with prolonged INR value in patients presenting with abdominal complaints should alert clinician and radiologist to look for this entity. The essence of prompt and accurate diagnosis of this condition lies in the conservative management to avoid an un-indicated surgery.