We report the case of a 44-year-old woman who presented with epigastric pain associated with melenic stools in the emergency room of our hospital.
Among his antecedents, he was being followed by the Hematology and Digestive Services for having presented a Budd-Chiari syndrome and repeated miscarriages, having been diagnosed after a bone marrow study and myefibrotic stage.
Therefore, the patient was on anticoagulant treatment with oral acenocoumarol and had been included in the waiting list for transplantation due to impaired liver function.
She was admitted to our department with a significant anaemia (Hb: 9.2 g/dl) compared to her previous levels, and INR: 1.5.
Hemodynamic support measures were established and an emergency gastroscopy was performed in which an ulcer was observed affecting the posterior aspect of duodenal bulb and first knee with bleeding on the sheet, which was treated by thick fold placement of thick clips.
At 48 hours the patient presented deterioration of the general condition and new anemization, performing new endoscopy.
It was observed retention stomach with abundant fluid content, which was aspirated, normal gastric mucosa, permeable pylorus and important bulging of the duodenal wall stenosis at supraampullary level of second portion that produced a level.
An emergency abdominal CT scan showed a large retroperitoneal mass in the root of a very irregular, multilobulated and heterogeneous mesentery, compatible with a hematoma.
Its upper part was located between the gallbladder and the pancreatic head, under the first duodenal portion, compressing it and obliterating its lumen.
From there it continued with another large lobulation of 12 x 9 x 11 cm and inferiorly, in front of the aorta, vena cava and right psoas to the right iliac fossa, with a maximum size of 17 x 7 cm.
With these findings it was decided to suspend anticoagulation and perform an arteriography, without finding a bleeding point.
A radiological drainage was placed in the collection and the patient subsequently became stable without new episodes of anemization or external signs of bleeding.
However, after reversal of anticoagulation, he developed thrombosis of the jugular and subclavian veins, so the joint decision of Hematology and Digestive specialists to reintroduce the therapeutic range of anticoagulation was reached.
Currently, several months after the episode, the patient remains stable and waiting for liver transplantation.
