Warfarin-induced gastric bleeding and intestinal obstruction

Oral anticoagulant therapy with warfarin is commonly used to prevent thromboembolic events in patients at risk. The degree of anticoagulation is variable among individuals and is influenced by many factors; therefore, patients must be monitored frequently to assess potential adverse effects related to treatment. There is a direct relationship between excessive anticoagulation and the risk of bleeding. We present a patient who came in with an acute abdomen, anemia, and increased international normalized ratio. Gastroscopy revealed a large amount of blood in the stomach. Hemodynamic instability necessitated urgent laparotomy. The small bowel was found to be ischemic due to increased intraluminal pressure. Upon enterotomy, liters of old hematoma were evacuated and the intestine resumed its blood supply. To our knowledge, we describe the first reported case of intraluminal hematoma as a rare cause of obstructive mechanical ileus during warfarin treatment. This case highlights an unknown, but potentially lethal, manifestation of warfarin therapy.