Intra-abdominal bleeding as a rare complication after colonic endoscopic mucosal resection in a patient taking direct or
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CASE REPORT
Intra‑abdominal bleeding as a rare complication after colonic endoscopic mucosal resection in a patient taking direct oral anticoagulants Yoshinori Sato1 · Yusuke Satta1 · Hiroshi Yasuda1 · Hirofumi Kiyokawa1 · Masaki Yamashita1 · Yasumasa Matsuo1 · Fumio Itoh1 Received: 27 March 2020 / Accepted: 22 June 2020 © Japanese Society of Gastroenterology 2020
Abstract We describe the case of an 84-year old female who was taking rivaroxaban 30 mg/day and had a medical history of atrial fibrillation. She underwent endoscopic mucosal resection of a 5-mm adenoma located in the hepatic flexure of the transverse colon. Following the procedure, she developed gradually intensifying abdominal pain, with the appearance of small amount of blood in the feces. For that reason, she visited our facility on the 5th day post-endoscopic mucosal resection. At the time of the visit, contrast-enhanced abdominal computed tomography revealed no extravasation or free air; however, bloody ascites was confirmed in the peritoneal cavity. Thus, the patient was diagnosed with post-endoscopic mucosal resection intraabdominal hemorrhage and hospitalized the same day. After admission, rivaroxaban was discontinued and patient condition monitored. Because subsequent abdominal computed tomography revealed no distinct increase in bloody ascites, no interventional radiological or surgical procedure was performed, and the patient was discharged after providing only conservative treatment. While hemorrhage and perforation are the main complications after colonic endoscopic mucosal resection, so far, there have been a few reports on the occurrence of intra-abdominal hemorrhage following endoscopic mucosal resection. Emergency treatment is sometimes required in patients with intra-abdominal hemorrhage. It is important to keep in mind that this complication, although very rare, may occur, particularly in patients taking anticoagulants. Keywords Intra-abdominal bleeding · Colonic endoscopic mucosal resection · Complication · Direct oral anticoagulants
Introduction Intra-abdominal hemorrhage is a condition that sometimes requires emergency treatment involving an interventional radiological or surgical procedure, and it is classified as traumatic or non-traumatic based on its etiology [1]. Nontraumatic causes may be iatrogenic or tumor-related or may include clotting abnormalities, gynecological diseases, and vascular lesions such as aneurysms [1]. The source of bleeding in intra-abdominal hemorrhage cases is often unknown, and reports suggest that bleeding is associated with warfarin
* Yoshinori Sato y2satou@marianna‑u.ac.jp 1
Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2‑16‑1, Miyamae‑ku, Kawasaki, Kanagawa 216‑8511, Japan
intake and Ehlers–Danlos syndrome, among other reasons [2, 3]. Regarding endoscopy-related complications, intraabdominal hemorrhage was reported in a case of splenic injury after colonoscopy [4, 5] and in another case after retrograd
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