Images in Clinical Medicine

Spontaneous Duodenal Hematoma during Oral Anticoagulation

Pierre Hösli, M.D., and Marc Schapira, M.D.

N Engl J Med 2000; 343:474August 17, 2000

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Figure 1 A 62-year-old man presented with abdominal pain and nausea. On examination, his abdomen was distended and diffusely tender. He had been receiving oral anticoagulants for more than two years after an extensive inferoposterolateral myocardial infarction complicated by persistent cardiac dysfunction. On admission, the international normalized ratio was more than 8. A computed tomographic scan of the abdomen showed thickening of the duodenal wall (arrow), corresponding to the presence of an intramural hematoma. The hematoma extended to the right in the retroperitoneal space surrounding the ascending colon. Anticoagulant therapy was discontinued, and its actions were reversed by the transfusion of 4000 U of vitamin K–dependent coagulation factors (factor IX complex, Swiss Red Cross). The patient's condition improved rapidly.

Pierre Hösli, M.D.
Marc Schapira, M.D.
Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland