Clinical features and outcomes in spontaneous intramural small bowel hematoma: cohort study and literature review
- Author:
Eun Ae KANG
1
;
Seung Jun HAN
;
Jaeyoung CHUN
;
Hyun Jung LEE
;
Hyunsoo CHUNG
;
Jong Pil IM
;
Sang Gyun KIM
;
Joo Sung KIM
;
Hyuk YOON
;
Cheol Min SHIN
;
Young Soo PARK
;
Nayoung KIM
;
Dong Ho LEE
;
Hyun Chae JUNG
Author Information
- Publication Type:Original Article
- Keywords: Hematoma; Intestine, small; Treatment outcome
- MeSH: Body Weight; Cohort Studies; Comorbidity; Drug Therapy; Duodenum; Hematoma; Humans; Intestine, Small; Length of Stay; Leukocytes; Medical Records; Platelet Aggregation Inhibitors; Retrospective Studies; Stroke; Tertiary Care Centers; Thrombocytopenia; Treatment Outcome
- From:Intestinal Research 2019;17(1):135-143
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: Spontaneous intramural small bowel hematoma (SISBH) is an extremely rare complication of anticoagulant or antiplatelet therapy. We assessed the clinical characteristics and outcomes of patients with SISBH according to the anatomical location of the hematoma. METHODS: From January 2003 to February 2016, medical records for all patients hospitalized for SISBH at 2 tertiary referral hospitals were retrospectively reviewed. The primary outcome was requirement for surgery. RESULTS: A total of 37 patients were enrolled. The mean age was 74.1 years. Among them, 33 patients (89.2%) were taking anticoagulant and/or antiplatelet agents. Duodenal intramural hematoma was detected in 4 patients (10.8%), jejunal in 16 (43.2%), and ileal in 17 (45.9%). Compared to jejunal and ileal involvement, duodenal intramural hematoma was significantly associated with high Charlson comorbidity index and low levels of white blood cells, hemoglobin, and platelets in the blood. SISBH in the duodenum was related to thrombocytopenia in 3 patients following systemic chemotherapy for malignancy. All patients with SISBH showed clinical improvement with conservative therapy. Mean length of hospital stay was 9.35 days. Independent predictors of a hospital stay of more than 7 days were body weight less than 60 kg (odds ratio [OR], 12.213; 95% confidence interval [CI], 1.755–84.998; P=0.011) and a history of cerebrovascular accidents (OR, 6.667; 95% CI, 1.121–39.650; P=0.037). CONCLUSIONS: Compared to jejunal and ileal involvement, thrombocytopenia may result in spontaneous duodenal intramural hematoma among patients who are treated with systemic chemotherapy for malignancies. Patients with SISBH have excellent clinical outcomes with conservative therapy regardless of the anatomical location of the hematoma.
