Zammit Adrian, Marguerat Deborah Grech, Caruana Clifford
Department of Surgery, Mater Dei Hospital, Malta, Msida, Malta.
BMJ Case Rep. 2013 Jun 3;2013:bcr2013008831. doi: 10.1136/bcr-2013-008831.
Small intestinal intramural haematomas may develop spontaneously, especially in patients with deranged clotting function. We present a case of a 57-year-old man who developed abdominal pain in the setting of abnormal clotting function secondary to an inadvertent warfarin overdose. A CT scan showed thickening of parts of the distal ileum, terminal ileum and duodenum. Dilation of the small bowel proximal to the thickening was also reported, indicative of a degree of small bowel obstruction. The patient was treated conservatively with a nasogastric tube and intravenous fluids. His anticoagulation was fully reversed with fresh frozen plasma and vitamin K. The patient remained well 6 months following discharge, with well-controlled anticoagulation levels and resolution of the findings on CT.
小肠壁内血肿可能自发形成，尤其是在凝血功能紊乱的患者中。我们报告一例57岁男性患者，因意外过量服用华法林导致凝血功能异常而出现腹痛。CT扫描显示回肠末端、终末回肠和十二指肠部分增厚。还报告了增厚部位近端小肠扩张，提示存在一定程度的小肠梗阻。该患者接受了鼻胃管和静脉输液的保守治疗。通过新鲜冰冻血浆和维生素K使其抗凝作用完全逆转。患者出院后6个月情况良好，抗凝水平得到良好控制，CT检查结果也已消失。
