[Incidence of intramural digestive system hematoma in anticoagulation. Epidemiologic study and clinical aspects of 59 cases observed in Switzerland (1970-1975)].

Intramural hematoma of the small intestine is a relatively rare but serious complication of oral anticoagulant therapy. On the basis of a retrospective epidemiological survey the authors estimate its incidence at 1 case per 20 000 admissions to medical and surgical services or 1 case per 2500 anticoagulated patients per year. The classical trial of clinical symptoms comprises abdominal pain, small bowel obstruction and multiple hemorrhagic symptoms (hematuria, hematomas, ecchymoses, hematemesis and melaena). The most important etiologic factors appear to be overanticoagulation with vitamin K antagonists (the thromboplastin time is prolonged in over 70% of cases) or correct oral anticoagulation associated with additional impairment of hemostasis due to the administration of drugs inhibiting platelet function. Radiologic examination of the gastrointestinal tract reveals that the jejunum and the ileum are sites of predilection for intramural intestinal hematoma. The treatment of choice is conservative; surgery should be reserved for cases in which the diagnosis is doubtful and for patients who exhibit signs of bowel necrosis or peritonitis.