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Retroperitoneal haematoma and small bowel intramural haematoma caused by warfarin and miconazole interaction
Int. J. OralMaxillofac. Surg. 1997;27:485 Printedin Denmark. All rightsreserved
Copyright 9 Munksgaard 1998 ln~TmeooalJoumalof
Ord &
Max~ofacid Surgery ISSN 0901-5027
Letter to the editor
Retroperitoneal haematoma and small bowel intramural haematoma caused by warfarin and miconazole interaction
Dear Sir, A previously well 73-year-old woman presented with a one-day history of severe right sided lower abdominal pain and profuse bilious vomiting. The patient was on long-term warfarin due to previous episodes of deep venous thrombosis and pulmonary embolism. Haemoglobin was 11.7 gr/dl, WCC was 14, and I N R was 24. The abdomen was distended and there was tenderness on the right hypochondrium. No signs of frank peritonism were elicited. The coagulation status was corrected using intravenous fresh frozen plasma.
Emergency abdominal and pelvic CT scan showed a retroperitoneal haematoma arising from the midright psoas measuring 5 x 2 x 5 cm. On questioning the patient about her drug history she said she had been prescribed oral miconazole by her general dentist two days prior to her admission into hospital. The patient had a prolonged ileus with intermittent abdominal distension and vomiting. Small bowel enema showed a submucosal intramural haematoma. Three weeks later the patient's symptoms resolved and she was allowed home. This case illustrates the need for colleagues to check possible interactions with warfarin derivates, paxticulaxly those that potentiate the action of warfarin.
Fig. 2 Fig. 1
Fig. 1 shows a retroperitoneal haematoma arising from the right psoas muscle. Fig. 2 shows an intramural haematoma in the small bowel. MARIA MARCO ANDREW J. GUY
Address: Maria Marco FRCS Specialist Registrar General Surgery Leighton Hospital Middlewich Rd Crewe, Cheshire CW1 4QJ UK
Copyright 9 Munksgaard 1998 ln~TmeooalJoumalof
Ord &
Max~ofacid Surgery ISSN 0901-5027
Letter to the editor
Retroperitoneal haematoma and small bowel intramural haematoma caused by warfarin and miconazole interaction
Dear Sir, A previously well 73-year-old woman presented with a one-day history of severe right sided lower abdominal pain and profuse bilious vomiting. The patient was on long-term warfarin due to previous episodes of deep venous thrombosis and pulmonary embolism. Haemoglobin was 11.7 gr/dl, WCC was 14, and I N R was 24. The abdomen was distended and there was tenderness on the right hypochondrium. No signs of frank peritonism were elicited. The coagulation status was corrected using intravenous fresh frozen plasma.
Emergency abdominal and pelvic CT scan showed a retroperitoneal haematoma arising from the midright psoas measuring 5 x 2 x 5 cm. On questioning the patient about her drug history she said she had been prescribed oral miconazole by her general dentist two days prior to her admission into hospital. The patient had a prolonged ileus with intermittent abdominal distension and vomiting. Small bowel enema showed a submucosal intramural haematoma. Three weeks later the patient's symptoms resolved and she was allowed home. This case illustrates the need for colleagues to check possible interactions with warfarin derivates, paxticulaxly those that potentiate the action of warfarin.
Fig. 2 Fig. 1
Fig. 1 shows a retroperitoneal haematoma arising from the right psoas muscle. Fig. 2 shows an intramural haematoma in the small bowel. MARIA MARCO ANDREW J. GUY
Address: Maria Marco FRCS Specialist Registrar General Surgery Leighton Hospital Middlewich Rd Crewe, Cheshire CW1 4QJ UK