Excess anticoagulation as a cause of small-bowel obstruction: a report of two cases

Spontaneous intramural haemorrhage is a rare cause of small-bowel obstruction, occurring most commonly in those who are anticoagulated. We describe two cases that presented with a history and imaging suggestive of small-bowel obstruction; both had International Normalized Ratios of above 10 on admission. The first case, a 62-year-old lady on warfarin for atrial fibrillation, was managed conservatively with good effect. In contrast, the second case, a 57-year-old gentleman on warfarin for his metallic aortic valve, underwent diagnostic laparotomy that revealed a 30-cm segment of proximal jejunum with spontaneous intramural haemorrhage. In this study, we emphasize the merit of conservative management for this rare cause of small-bowel obstruction.