A surgical case of anti-coagulant ileus mimicking small-bowel tumors: a case report
Abstract Background Anti-coagulant ileus, characterized by intramural hematoma due to excessive anti-coagulant therapy, presents a diagnostic challenge. Although previously considered uncommon, recently, reporting cases of anti-coagulant ileus have become more frequent. Herein, we report a rare surg...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Japan Surgical Society
2024-01-01
|
| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40792-023-01795-5 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849693189636620288 |
|---|---|
| author | Hideyuki Masui Hiroyuki Kobayashi Yusuke Sakamoto Shintaro Yagi Satoshi Kaihara |
| author_facet | Hideyuki Masui Hiroyuki Kobayashi Yusuke Sakamoto Shintaro Yagi Satoshi Kaihara |
| author_sort | Hideyuki Masui |
| collection | DOAJ |
| description | Abstract Background Anti-coagulant ileus, characterized by intramural hematoma due to excessive anti-coagulant therapy, presents a diagnostic challenge. Although previously considered uncommon, recently, reporting cases of anti-coagulant ileus have become more frequent. Herein, we report a rare surgical case of anti-coagulant ileus mimicking small-bowel tumors. Case presentation A 79-year-old man was admitted to our hospital for fatigue. He had been administered warfarin for 5 months for atrial fibrillation. On admission, the patient exhibited mild epigastric tenderness. Laboratory test results revealed anemia (hemoglobin, 8.4 g/dL); unmeasurably prolonged prothrombin time (PT) with international normalized ratio (INR) > 8; and elevated soluble interleukin 2 receptor (sIL-2R) levels (849 IU/mL; normal range, 122–496 IU/mL). Abdominal plain computed tomography (CT) showed a circumferentially thickened intestinal wall at one site in the jejunum and two in the ileum. After hospitalization, bowel obstruction did not improve with conservative treatment. Suspecting small-bowel tumors such as lymphoma, the patient subsequently underwent open surgery on day 3 after admission. No obvious tumor mass was observed intra-operatively. However, only thickened and hemorrhagic segments were identified at the suspected sites. We performed partial jejunal and ileal resections of 12 and 27 cm, respectively. Histopathology confirmed submucosal congestion, edema, and hemorrhage in each area without tumor components, leading to the final diagnosis of intramural hematoma. The postoperative course was uneventful, and he was discharged on postoperative day 9. No recurrence occurred during the 5-year follow-up period. Conclusions We encountered a surgical case of anti-coagulant ileus, which was difficult to differentiate from malignant lymphoma based on CT findings and high sIL-2R levels. The possibility of anti-coagulant ileus should always be considered in patients on long-term anticoagulation medication and bowel obstruction with high PT-INR values. |
| format | Article |
| id | doaj-art-c2a34f07f8a74c72afad3d8012ba8564 |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-c2a34f07f8a74c72afad3d8012ba85642025-08-20T03:20:30ZengJapan Surgical SocietySurgical Case Reports2198-77932024-01-011011610.1186/s40792-023-01795-5A surgical case of anti-coagulant ileus mimicking small-bowel tumors: a case reportHideyuki Masui0Hiroyuki Kobayashi1Yusuke Sakamoto2Shintaro Yagi3Satoshi Kaihara4Department of Surgery, Kobe City Medical Center General HospitalDepartment of Surgery, Kobe City Medical Center General HospitalDepartment of Surgery, Kobe City Medical Center General HospitalDepartment of Surgery, Kobe City Medical Center General HospitalDepartment of Surgery, Kobe City Medical Center General HospitalAbstract Background Anti-coagulant ileus, characterized by intramural hematoma due to excessive anti-coagulant therapy, presents a diagnostic challenge. Although previously considered uncommon, recently, reporting cases of anti-coagulant ileus have become more frequent. Herein, we report a rare surgical case of anti-coagulant ileus mimicking small-bowel tumors. Case presentation A 79-year-old man was admitted to our hospital for fatigue. He had been administered warfarin for 5 months for atrial fibrillation. On admission, the patient exhibited mild epigastric tenderness. Laboratory test results revealed anemia (hemoglobin, 8.4 g/dL); unmeasurably prolonged prothrombin time (PT) with international normalized ratio (INR) > 8; and elevated soluble interleukin 2 receptor (sIL-2R) levels (849 IU/mL; normal range, 122–496 IU/mL). Abdominal plain computed tomography (CT) showed a circumferentially thickened intestinal wall at one site in the jejunum and two in the ileum. After hospitalization, bowel obstruction did not improve with conservative treatment. Suspecting small-bowel tumors such as lymphoma, the patient subsequently underwent open surgery on day 3 after admission. No obvious tumor mass was observed intra-operatively. However, only thickened and hemorrhagic segments were identified at the suspected sites. We performed partial jejunal and ileal resections of 12 and 27 cm, respectively. Histopathology confirmed submucosal congestion, edema, and hemorrhage in each area without tumor components, leading to the final diagnosis of intramural hematoma. The postoperative course was uneventful, and he was discharged on postoperative day 9. No recurrence occurred during the 5-year follow-up period. Conclusions We encountered a surgical case of anti-coagulant ileus, which was difficult to differentiate from malignant lymphoma based on CT findings and high sIL-2R levels. The possibility of anti-coagulant ileus should always be considered in patients on long-term anticoagulation medication and bowel obstruction with high PT-INR values.https://doi.org/10.1186/s40792-023-01795-5Anti-coagulant ileusAnti-coagulant therapyOver-anticoagulationWarfarinSpontaneous intramural small-bowel hematoma |
| spellingShingle | Hideyuki Masui Hiroyuki Kobayashi Yusuke Sakamoto Shintaro Yagi Satoshi Kaihara A surgical case of anti-coagulant ileus mimicking small-bowel tumors: a case report Surgical Case Reports Anti-coagulant ileus Anti-coagulant therapy Over-anticoagulation Warfarin Spontaneous intramural small-bowel hematoma |
| title | A surgical case of anti-coagulant ileus mimicking small-bowel tumors: a case report |
| title_full | A surgical case of anti-coagulant ileus mimicking small-bowel tumors: a case report |
| title_fullStr | A surgical case of anti-coagulant ileus mimicking small-bowel tumors: a case report |
| title_full_unstemmed | A surgical case of anti-coagulant ileus mimicking small-bowel tumors: a case report |
| title_short | A surgical case of anti-coagulant ileus mimicking small-bowel tumors: a case report |
| title_sort | surgical case of anti coagulant ileus mimicking small bowel tumors a case report |
| topic | Anti-coagulant ileus Anti-coagulant therapy Over-anticoagulation Warfarin Spontaneous intramural small-bowel hematoma |
| url | https://doi.org/10.1186/s40792-023-01795-5 |
| work_keys_str_mv | AT hideyukimasui asurgicalcaseofanticoagulantileusmimickingsmallboweltumorsacasereport AT hiroyukikobayashi asurgicalcaseofanticoagulantileusmimickingsmallboweltumorsacasereport AT yusukesakamoto asurgicalcaseofanticoagulantileusmimickingsmallboweltumorsacasereport AT shintaroyagi asurgicalcaseofanticoagulantileusmimickingsmallboweltumorsacasereport AT satoshikaihara asurgicalcaseofanticoagulantileusmimickingsmallboweltumorsacasereport AT hideyukimasui surgicalcaseofanticoagulantileusmimickingsmallboweltumorsacasereport AT hiroyukikobayashi surgicalcaseofanticoagulantileusmimickingsmallboweltumorsacasereport AT yusukesakamoto surgicalcaseofanticoagulantileusmimickingsmallboweltumorsacasereport AT shintaroyagi surgicalcaseofanticoagulantileusmimickingsmallboweltumorsacasereport AT satoshikaihara surgicalcaseofanticoagulantileusmimickingsmallboweltumorsacasereport |