Parietal hematoma of the small bowel due to anticoagulant overdose: A case report

Anticoagulant-induced spontaneous small bowel hematoma is a rare cause of acute mechanical bowel obstruction. We report the case of a 77-year-old patient with complete arrhythmia due to atrial fibrillation under acenocoumarol 4mg daily who was seen for right iliac fossa pain. The laboratory tests showed a prothrombin rate (PT) of 12%, an International Normalized Ratio (INR) of 6, and an aPTT (activated partial thromboplastin time) of 43 seconds. Abdominopelvic ultrasound showed an echogenic pelvic effusion. The diagnosis of the small hematoma was made by abdominopelvic CT scan, which showed a thickening of the small bowel wall reducing its caliber associated with a parietal hematoma . The evolution was unremarkable under supplementation therapy vitamin K.