Recurrent Spontaneous Jejunal Hematomas Resulting in Bowel Obstruction

Abstract

Spontaneous intramural small bowel hematomas are rare complications of anticoagulation therapy. We present a case of a 71-year-old male presenting to hospital twice with supratherapeutic international normalized ratio (INR) and bowel obstruction, resulting in the diagnosis of recurrent intramural small bowel hematoma. This case illustrates the importance of stringent INR monitoring in those anticoagulated with warfarin and also demonstrates the importance of remaining clinically suspicious for this complication in patients who present with abdominal pain or intestinal obstruction symptoms in the setting of a supratherapeutic INR.