J Korean Surg Soc.  2009 Dec;77(Suppl):S13-S16. 10.4174/jkss.2009.77.Suppl.S13.

Intramural and Intraluminal Hematoma of the Small Bowel as the Lead Point of Intussusception in an Adult Patient with Warfarinization

• Kwak JH
• Jang HJ
• Kim JH
• Ahn JH
• Eom DW
• Han MS

• KMID: 1464792
• DOI: http://doi.org/10.4174/jkss.2009.77.Suppl.S13

Abstract

We report a case in which an intramural and intraluminal hematoma of the jejunum served as the lead point of intussusception in a 77-year-old man with warfarinization. The patient presented with cramping abdominal pain and vomiting. Palpation of the abdomen revealed periumbilical tenderness. Abdominal computed tomography revealed a circular mass with a concentric ring, consistent with an intussuscepted jejunum. Because of warfarinization, which was due to atrial fibrillation and lacunar infarction, the patient's prothrombin time was prolonged. Laparotomy revealed reducible jejuno-jejunal intussusception, and we performed a segmental resection of the intussuscepted jejunum. We identified an intramural and intraluminal jejunal hematoma as the lead point. Upon histopathological examination, angiodysplasia of the intussuscepted jejunum was found to be the bleeding focus. No similar case was found in the literature.

Keyword

Intussusception; Warfarinization; Angiodysplasia; Jejunum

MeSH Terms

Abdomen
Abdominal Pain
Adult
Aged
Angiodysplasia
Atrial Fibrillation
Hematoma
Hemorrhage
Humans
Intussusception
Jejunum
Laparotomy
Muscle Cramp
Palpation
Prothrombin Time
Stroke, Lacunar
Vomiting
Warfarin
Warfarin

Figure

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  Fig. 1 (A) Contrast-enhanced axial CT scan showing small bowel intussusception (black arrow). (B) Contrast-enhanced axial CT scan showing bowel wall thickening with the "target sign" at the origin of intussusception (black arrows).

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  Fig. 2 The resected bowel was filled with a hematoma fixed to the mucosa.

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  Fig. 3 (A-C) Ectatic vascular structures are noted in the mucosa and submucosa. Some vessels show red blood cells and fibrin clots (H&E stains, A&B: ×40; C: ×100). (D) Enlarged arteries are noted in the submucosa (elastic stain, ×40).

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