Spontaneous intramural gastric haematoma in an anticoagulated patient.

We report a case of a 77-year-old woman presented to the Emergency Unit with a history of several hours of epigastric pain accompanied by nausea and vomiting. She had a past medical history of rheumatic mitral valve disease with commissurotomy in 1982 and permanent atrial fibrillation, currently on anticoagulation therapy with acenocoumarol. On admission, the patient was in atrial fibrillation at 50 beats per minute and her blood pressure was 90/55 mmHg. Laboratory tests showed haemoglobin 10.2 g/dL, INR 2.31 and markers of myocardial damage were normal. A computed tomography (CT) of the chest and abdomen was performed, revealing the presence of a large intramural haematoma located on the greater curvature and posterior wall of the stomach, measuring 13 x 10 x 6 cm, accompanied by haemoperitoneum (Fig. 1). Vitamin K and prothrombin complex were given to reverse the anticoagulant therapy with a good result, and the patient did not require blood transfusion.