Conservative treatment in spontaneous yeyunal hematoma with moderate hemoperitoneum

An 87-year-old male patient with a history of atrial fibrillation, a pacemaker and anticoagulation with acenocoumarol came to the emergency room due to abdominal pain that had evolved over the previous 5 days and hyporexia. Lab workup showed Cr >4 mg/dL, Hb 8 g/dL and incoagulable INR. Abdominal CT scan with intravenous contrast revealed a jejunal segment with hyperdense concentric wall thickening as well as perihepatic, perisplenic, paracolic gutter and pelvic free fluid, compatible with spontaneous jejunal hematoma and moderate hemoperitoneum. Urgent surgical intervention was ruled out given the hemodynamic stability of the patient and absence of active bleeding. The patient presented good evolution with conservative treatment and was discharged on the 7th day of hospitalization (Fig. 1).

Figure 1