Reactions 1446 - 6 Apr 2013 S Warfarin Intraluminal haematoma leading to caecal obstruction in an elderly patient: case report A 74-year-old woman developed an intraluminal haematoma leading to caecal obstruction while receiving warfarin; she subsequently died. The woman presented with per-rectal bleeding and acute colicky abdominal pain. Examination revealed dark stool with altered blood and clots. She had been receiving long-term anticoagulation with warfarin [dosage, route and duration of treatment to reaction onset not stated] for a metallic mitral valve. Her INR was 4.4, and her haemoglobin level was 6.9 g/dL. It was thought that she had a diverticular bleed. Warfarin was withdrawn, and the woman received blood transfusions and heparin. A few days later, she developed increasing abdominal distension and discomfort. A CT scan showed a distended caecum, a possible obstructing lesion and a thickened caecal wall. She underwent right hemicolectomy, and a large intraluminal haematoma was identified as the cause of obstruction. She recovered very slowly in a high- dependency unit, after which she contracted severe pneumonia, and later died [cause of death not stated]. Author comment: "The pathophysiology of the intraluminal haematoma in this case was likely a result of underlying caecal mucosal ulceration and a high INR from warfarin therapy." Thomas R, et al. Colonic obstruction caused by intraluminal haematoma. BMJ Case Reports 2012: [2 pages], 9 Oct 2012. Available from: URL: http:// dx.doi.org/10.1136/bcr-2012-006801 - United Kingdom 803085234 1 Reactions 6 Apr 2013 No. 1446 0114-9954/10/1446-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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Reactions 1446 - 6 Apr 2013

SWarfarin

Intraluminal haematoma leading to caecalobstruction in an elderly patient: case report

A 74-year-old woman developed an intraluminalhaematoma leading to caecal obstruction while receivingwarfarin; she subsequently died.

The woman presented with per-rectal bleeding and acutecolicky abdominal pain. Examination revealed dark stool withaltered blood and clots. She had been receiving long-termanticoagulation with warfarin [dosage, route and duration oftreatment to reaction onset not stated] for a metallic mitralvalve. Her INR was 4.4, and her haemoglobin level was6.9 g/dL. It was thought that she had a diverticular bleed.

Warfarin was withdrawn, and the woman received bloodtransfusions and heparin. A few days later, she developedincreasing abdominal distension and discomfort. A CT scanshowed a distended caecum, a possible obstructing lesion anda thickened caecal wall. She underwent right hemicolectomy,and a large intraluminal haematoma was identified as thecause of obstruction. She recovered very slowly in a high-dependency unit, after which she contracted severepneumonia, and later died [cause of death not stated].

Author comment: "The pathophysiology of theintraluminal haematoma in this case was likely a result ofunderlying caecal mucosal ulceration and a high INR fromwarfarin therapy."Thomas R, et al. Colonic obstruction caused by intraluminal haematoma. BMJCase Reports 2012: [2 pages], 9 Oct 2012. Available from: URL: http://dx.doi.org/10.1136/bcr-2012-006801 - United Kingdom 803085234