A rare case of intestinal bleeding in patient with colorectal carcinoma on anticoagulation treatment


Authors: M. Mýtnik;  J. Petrík;  Z. Jedináková
Authors‘ workplace: Chirurgická klinika FNsP J. A. Reimana, Prešov, Slovenská republika
Published in: Transfuze Hematol. dnes,18, 2012, No. 3, p. 130-134.
Category: Comprehensive Reports, Original Papers, Case Reports

Overview

Aim:
The authors point to the risk of bleeding in patients with colorectal carcinoma, on the treatment with warfarin.

Material and methods:
The authors present a case report of the patient on treatment with warfarin. This patient has ileus due to sigmoideal cancer, and simultaneously a progressive intramural haematoma in the hepatic flexure of the colon. The patient was one of the 185 patients with colorectal cancer operated during the period 2008–2011on Surgery department of FNsP Prešov. Like in all mentioned patients all basic coagulation tests were performed (including D-dimers) and the haemocoagulation status was evaluated.

Results:
The patient belonged to the relatively small group of patients (7 cases – 3,7%), in them the prolonged coagulation tests were described. 64 patients (35%) on the long-term anticoagulation had haemocoagulation parameters in the normal range, the increased pro-coagulation activity was seen in 114 patients (61%).

Conclusion:
The haemorrhagic complications (in comparison to pro-thrombotic risk of malignant tumours) do not occur in high frequency and pose less risk in patients with colorectal carcinoma, but in association with ileous status from tumour and intramural haematoma of colon may be dangerous complication.

Key words:
colorectal cancer, bleeding, haematoma


Sources

1. Krysa J, Shahabdeen M, South LM. A case of acute large bowel obstruction, presenting in a patient taking warfarin. Emerg Med J 2003; 20: 81-85.

2. Attuwaybi B, Visco JJ, Butler BN, Barrios GG. Spontaneous rectal intramural hematoma: A rare complication of anticoagulant therapy. Dostupný z www: http://www.hcplive.com/publications/ surgical-rounds/2008/2008-03/2008-03_03 .

3. Polat C, Dervisoglu A, Guven H, Kaya E. Anticoagulant-induced intramuralintestinal hematoma. Am J Emerg Med 2003; 21: 208-211.

4. Nozu T. Idiopathic spontaneous intramural hematoma of the colon: a case report and review of the literature. Clin J Gastroenterol 2009; 3:161-165.

5. Pickhardt PJ, Kim DH, Menias CO. Evaluation of submucosal lesions of the large intestine. RadioGraphics 2007; 27: 1693-703.

6. Takekazu K, Kyoichi A, Nobuyuki M. A case of intramural hematoma of the sigmoid colon caused by anticoagulants. Gastroenterol Endosc 2000; 42: 180-184.

7. Pais R, Silaghi H, Silaghi AC, Rusu ML. Metabolic syndrome and risk of subsequent colorectal cancer. World J Gastroenterol 2009; 15(41): 5141-5148.

8. Nogales RO, Yepes BI, Hernando AA. Large intramural colonic hematoma after polypectomy. Endoscopy 2009; 41: 281-284.

9. Stuhlfaut JW, Soto JA, Lucey BC. Blunt abdominal trauma: performance of CT without oral contrast material. Radiology 2004; 233: 689-694.

10. Abbas A, Collins JM, Olden KW. Spontaneous intramural small-bowel hematoma: imaging findings and outcome. Am J Roentg 2002; 179:1389-1394.

11. Abbas SA, Upadhyay V. Hollow viscus injury in children: Starship Hospital experience. World J Emerg Surg 2007; 2: 14.

12. Chaiteerakij R, Treeprasertsuk S, Mahachai V. Anticoagulant-Induced Intramural Intestinal Hematoma. J Med Assoc Thai 2008; 91(8): 1285-1290.

13. Yin WY, Gueng MK, Huang SM. Acute colonic intramural hematoma due to blunt abdominal trauma. Int Surg 2000; 85(1): 51-54.

14. Hou MM, Tsou YK. Education and imaging. Gastrointestinal: Acute colonic intramural hematoma after blunt abdominal trauma. J Gastroenterol Hepatol 2009; 24(3): 494.

15. Karjoo M, Domachowske J, Trust S. Intramural hematoma of the descending colon after blunt abdominal trauma. Clin Pediatr 2000; 39(6): 373-374.

16. Chen YY, Su WW, Soon MS, Yen HH. Gastrointestinal intramural hematoma of the duodenum. J Gastroenterol Hepatol 2006; 21: 1071.

17. Hsiao CW, Chao PC. Warfarin-induced intramural haematoma of the ileocecal valve with obstruction. ANZ J Surg 2004; 74: 810-811.

18. Shinozaki S, Yamamoto H, Kita H, Yano T. Direct observation with doubleballoon enteroscopy of an intestinal intramural hematoma resulting in anticoagulant ileus. Dig Dis Sci 2004; 49: 902-905.

Labels
Haematology Internal medicine Clinical oncology
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account