Spontaneous Intramural Hemorrhage of the Colon

Abstract

Anticoagulants are well-established adjuncts in management of coronary thrombosis, cerebral thrombosis or embolism, certain ophthalmologic disorders, thrombophlebitis, and recurrent pulmonary embolism. The increasing number of patients receiving anticoagulants on a long-term and outpatient basis is not without hazard.¹ Gilbert et al in their review state that minor bleeding occurs in 4% to 22% of patients, major bleeding in 2% to 3%, and gastrointestinal hemorrhage in 1.8%. Hematuria is the most common manifestation, followed by epistaxis, bleeding gums, melena, and subcutaneous ecchymosis. Less common but more serious were epidural hematomas, hemorrhage into the abdominal cavity, and retroperitneal hemorrhage. Mosely et al¹⁵ in their series noted that in over 50% of their patients major hemorrhage was associated with previously unsuspected disorders including colon carcinoma, polycystic renal disease, peptic ulcer, esophageal hiatal hernia, and diverticulitis. Recently attention has been given in the literature to hemorrhagic and occlusive vascular lesions of the