Direct Observation with Double-Balloon Enteroscopy of an Intestinal Intramural Hematoma Resulting in Anticoagulant Ileus

Ileus induced by an intramural hematoma due to exces-sive anticoagulant therapy, namely, anticoagulant ileus, was first described by Hafner et al. (1) in 1962. Warfarin is responsible for 98% of the reports of anticoagulant ileus (2), but there is no relationship between the duration of an-ticoagulation and this disease (2, 3). Most anticoagulant ileus occurs in the jejunum (2, 4). Features of anticoag-ulant ileus in the small bowel have been described using gastrointestinal radiograph series (2, 5-10), computed to-mography (CT) (9, 10), ultrasound (8, 11), and angiog-raphy (8). However, enteroscopic findings of intramural hematoma in the small bowel have not previously been reported because of the difficulty in accessing the small in-testine. We have developed a new double-balloon method of enteroscopy (12, 13). This new enteroscopy facilitates deep insertion of an enteroscope into the small bowel. Using this new method, we were able to identify a hematoma in the small intestine of a patient with anticoagulant ileus.