Small bowel intramural hematoma caused by warfarin: case report and literature review.

BACKGROUND: Intramural hematoma of the small bowel is a rare yet acute gastrointestinal condition typically linked with impaired coagulation function, often posing diagnostic challenges. It is principally encountered in patients undergoing prolonged anticoagulant therapy, specifically warfarin. CASE PRESENTATION: We reported a case of intramural hematoma associated with warfarin use. The patient was admitted to hospital with abdominal pain and had received anticoagulant therapy with warfarin 2.5 mg/day for 4 years. Laboratory examination showed decreased coagulation function, abdominal CT showed obvious thickening and swelling of part of the jejunal wall, and abdominal puncture found no gastroenteric fluid or purulent fluid. We treated the patient with vitamin K and fresh frozen plasma. The patient was discharged after the recovery of coagulation function. Then we undertaook a comprehensive review of relevant case reports to extract shared clinical features and effective therapeutic strategies. CONCLUSION: Our analysis highlights that hematoma in the small intestinal wall caused by warfarin overdose often presents as sudden and intense abdominal pain, laboratory tests suggest reduced coagulation capacity, and imaging often shows thickening of the intestinal wall. Intravenous vitamin K and plasma supplementation are effective non-surgical strategies. Nevertheless, in instances of severe obstruction and unresponsive hemostasis, surgical resection of necrotic intestinal segments may be necessary. In the cases we reported, we avoided surgery by closely monitoring the coagulation function. Therefore, we suggest that identifying and correcting the impaired coagulation status of patient is essential for timely and appropriate treatment.

[Effect of Runing II on expression of vascular endothelial growth factor in transplanted tumor of mammary cancer MA-891 in TA2 mice].

OBJECTIVE: To study the effect of Runing II on expression of vascular endothelial growth factor (VEGF) in transplanted tumor of mammary cancer MA-891 in TA2 mice. METHODS: The MA-981 mice mammary cancer cell cultivated in vivo was inoculated into the right axilla subcutaneously of TA2 mice to establish the transplanted tumor model, which were treated with Runing II. RESULTS: Runing II could inhibit the growth of transplanted tumor and the occurrence of lung metastasis (P < 0.05), reduce the expression of VEGF protein and mRNA in tumor tissue (P < 0.05). CONCLUSION: Runing II could reduce the expression of VEGF protein and mRNA, hence to inhibit the growth of tumor and lung metastasis.