Farhoud S, Stephani S M, Bromberg S H
Gastroenterologia Cirúrgica do Hospital do Servidor Público Estadual-Francisco Morato de Oliveira (HSPE-FMO).
Arq Gastroenterol. 2001 Jan-Mar;38(1):53-6. doi: 10.1590/s0004-28032001000100010.
Spontaneous intramural hemorrhage of the duodenum due to anticoagulant therapy is rare and the treatment is controversial.
To present the acquired knowledge with the treatment of these disease.
A 71-year-old women receiving for a 3 month period an anticoagulant therapy presented cervical bleeding of soft tissues and symptoms of acute pancreatitis and high small bowel obstruction. Early noninvasive diagnosis by computed tomographic scan was possible and conservative therapy proved successful in complete resolution of the pancreatitis and obstructive symptoms, with resumption of oral intake in the fourth day of treatment. The frequency of bleeding in high risk patients during warfarin therapy is reduced by less intense therapy, achieving a prothrombin time with an International Normalized Ratio of 2.0 to 3.0.
The use of conservative treatment was helpful and the patient was discharged asymptomatic, 10 days after admission.
It is suggested conservative treatment for intramural hematoma of the duodenum and recommended laparotomy only when complications occur.
抗凝治疗导致的十二指肠自发性壁内出血罕见，治疗存在争议。
介绍这些疾病治疗方面的现有知识。
一名71岁女性接受了3个月的抗凝治疗，出现颈部软组织出血、急性胰腺炎症状和高位小肠梗阻。通过计算机断层扫描早期进行无创诊断是可行的，保守治疗成功地完全缓解了胰腺炎和梗阻症状，在治疗的第四天恢复了口服摄入。在华法林治疗期间，通过强度较低的治疗降低高危患者的出血频率，使凝血酶原时间的国际标准化比值达到2.0至3.0。
保守治疗有效，患者入院10天后无症状出院。
建议对十二指肠壁内血肿采用保守治疗，仅在出现并发症时推荐剖腹手术。
