Spontaneous mesenteric hematoma associated to warfarin with surgical resolution.

Abstract

Introduction: spontaneous mesenteric hematoma is rare. It has been described as a complication of prolonged anticoagulation, more often associated with warfarin. The standard diagnostic study is computed tomography. Therapeutics of this pathology is under discussion. It is known that the conservative treatment is carried out in stable hemodynamically patients with spontaneous mesenteric hematoma, leaving surgical treatment as an alternative for patients in shock. Our objective is present a case of an adult patient with spontaneous mesenteric hematoma in relation to the warfarin, surgically treated with good evolution. Clinical case: Patient of 67 years, female, with spontaneous mesenteric hematoma in relation to warfarin, with a history of replacement of the mitral biological valve with tricuspid plastic of more than 3 months, in daily controls due to mishandling of coagulation with oral anticoagulant; she consult for sudden abdominal pain, in the epigastric region, accompanied by gastric vomiting. Physical examination she presented abdominal defense and peritoneal reaction. Computed tomography of the abdomen and pelvis was requested, where mesenteric hematoma is reported. Because the patient presented signs of peritoneal irritation, emergency surgery was performed with segmental resection of the small intestine; with good postoperative evolution, being discharged on the fifth day. Pathological anatomy reports massive submucosal hemorrhage. Conclusion: in a patient with abdominal pain with signs of peritoneal irritation, alteration of International Normalized Ratio due to the use of warfarin, without a traumatic history, a spontaneous mesenteric hematoma should be suspected and surgical treatment should be considered.

Keywords

• hematoma
• mesenterio
• anticoagulantes
• warfarina
• procedimientos quirúrgicos operativos