Extensive small bowel intramural haematoma secondary to warfarin

Intramural haematoma is a rare complication of oral anticoagulant therapy, occurring in 1 in 2500 patients treated with warfarin. This report describes a 71-year-old gentleman who presented with tachycardia, vomiting and abdominal distension on a background of anticoagulation for a metallic aortic valve. He was found to have a supratherapeutic international normalized ratio (INR) of 9.9 with an extensive small bowel intramural haematoma and secondary small bowel obstruction. He was successfully managed non-operatively with fluid resuscitation, INR reversal, bowel rest and nasogastric decompression. The patient's presentation was atypical with a lack of classic symptoms such as abdominal pain. This highlights the importance of considering intramural haematoma as a differential diagnosis for gastrointestinal symptoms in anticoagulated patients.