Hemophilia A is a congenital bleeding disorder characterized by a deficiency of coagulation factor VIII. Intramural hematoma of the colon is a very rare complication of this disease. We report a case of intramural hematoma of the cecum serving as the lead point of intussusception in a 65-year-old man with hemophilia A. The patient presented with right-sided abdominal pain and bloody stool. Palpation of his abdomen revealed a fist-sized mass. Abdominal computed tomography (CT) showed a circular mass with concentric rings, consistent with an intussuscepted intestine. Because his activated partial thromboplastin time (APTT) was prolonged, we gave him a continuous infusion of factor VIII during and after surgery. Laparotomy revealed an irreducible colo-colic intussusception and we identified a cecal hematoma as the lead point. After an unsuccessful attempt at Hutchinson's maneuver, we performed right colectomy. We report this case to illustrate the necessity of monitoring APTT in patients with hemophilia A who undergo surgery.
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"The most common physiology might be the rupture of the terminal arteries as they enter the muscle layer of the intestinal wall. The hemorrhage dissects the wall between the muscularis mucosae and the muscle layers, but the viability of the mucosa is preserved [29,30]. Computerized tomography is the diagnostic method of choice because it is highly sensitive and it defines the location and extension of the hemorrhage [1,32]. "
"The bleeding is usually self-limited. However, if bleeding continues, subsequent intramural hematoma can dissect through a plain between submucosal and muscular layers, and thereby may involve a long segment of the bowel [3,4] . Intramural hematoma eventually obstructs the intestinal lumen, which results in a partial or complete mechanical bowel obstruction [1,2,5]. "
[Show abstract][Hide abstract]ABSTRACT: Although spontaneous intramural hematomas of the gastrointestinal tract are very rare, they may be observed with the use of oral anticoagulant, though less frequently in cases of hematological malignancy and other bleeding disorders. Cases diagnosed as spontaneous intramural hematoma have been assessed in our clinic.
The cases, which were diagnosed as spontaneous intramural hematoma in the gastrointestinal tract (SIHGT) following anamnesis, physical examination, biochemical, radiological and endoscopic findings from July 2008 to July 2012, have been assessed retrospectively.
Seven out of 13 cases were women and the mean age was 65.1 years (34 to 82 years). The most frequent complaint on admission was abdominal pain. The most frequent location of SIHGT was the ileum (n = 8). Oral anticoagulant use was the most common cause of etiology (n = 12). In 10 cases, International normalized ratio values were higher than treatment range (2 to 3, where mechanical valve replacement was 2.5 to 3.5) and mean value was 7.6 (1.70 to 23.13). While 12 cases were discharged without problems with medical treatment, one case with acute myeloid leukemia died in the intensive care unit following cerebrovascular attack.
Spontaneus bleeding and hematomas that may arise in connection with bleeding diathesis may be fatal in cases with long-term oral anticoagulant treatment and insufficient follow-up. In management of these cases, it may be necessary to arrange conservative follow up and/or initialize low molecular weight heparin, and administer vitamin K as well as replace blood products and coagulation factors when indicated.
Full-text · Article · Aug 2013 · Journal of the Korean Surgical Society
"The main reasons for surgery in the recent cases were uncontrollable bleeding and colonic obstruction [3, 8, 24]. Hematoma itself induces obstruction, and in some cases, develops into the lead point of intussusception  . On the other hand, onethird of the patients were followed up with conservative therapy without operation. "
[Show abstract][Hide abstract]ABSTRACT: An 82-year-old man visited our hospital for abdominal discomfort and constipation lasting 3days. He did not have a history
of trauma or bleeding tendency. His laboratory studies showed slight anemia and inflammatory reactions, but other data including
coagulation profiles were all normal. Computed tomography (CT) demonstrated a 6-cm high-density mass in the left upper quadrant
and slight ascites. Contrast-enhanced CT revealed that the lesion was not enhanced. Colonoscopy could not detect the lesion.
Laparotomy was performed because malignancy could not be ruled out. The mass was located in the transverse colon, and histologic
examination showed intramural hematoma. Neither arteriovenous malformation nor a foreign body such as a fish bone was identified,
indicating that the mass was considered to be idiopathic intramural colonic hematoma. We present this rare case and also a
review of the literature.
Preview · Article · Jun 2009 · Clinical Journal of Gastroenterology