Warfarin induced Ovarian Haematoma Mimicking Torsion Ovarian Tumour
Warfarin toxicity presenting as acute abdomen in a woman with chronic anticoagulation is rare. A 29 year old woman with Rheumatic heart disease with history of mitral Valve replacement who was on anticoagulation with warfarin presented with pain abdomen of 2 weeks duration and she was clinically diagnosed as torsion ovarian cyst. On USG abdomen there was a complex adnexal mass of 6x8 cms with Doppler flow. Her International Normalised Ratio was more than 10 and hence a diagnosis of Ovarian haematoma was entertained and she was managed medically with dose titration of anticoagulants and her pain abdomen subsided and she was discharged home after normalising her International normalised ratio and laparotomy was thus avoided.
(1) Jain SK, Jain V, Srivastav M, Chaudhary S, Garg KM. Life Threatening Bilateral Corpus Luteal Bleed Due To Warfarin Toxicity –A Rare Case Report, Int J Med Sci Clin Inv 2014:1(09)| 452-454.
(2) Bangal VB, Shinde KK,Borawake SK, Warfarin toxicity presenting as ruptured Ovarian tumour with haemoperitoneum: a case report.IJBAR.2012:3: 203-209. 3. Shikdar S, Bhattacharya  PT. International Normalized Ratio (INR) [Updated 2019 Mar 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507707/
(3) Anticoagulation commissioning guide.NICE; May; 2013; nice.org.uk4. Deaton JG, Nappe TM. Warfarin Toxicity. [Updated 2019 Jun 7]. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2019 Jan-.Available from: https://www.ncbi.nlm.nih.gov/books/NBK431112/
(4) Ansell J, Hirsh J, Dalen J, et al. Managing oral anticoagulant therapy. Chest 2001;119(1 Suppl):22S-38S.
(5) Esin KURTULUŞ ÖZTÜRK1, Berat ACU2, Saffet ÖZTÜRK2, Murat BEYHAN3, Erkan GÖKÇE4, Orhan ÖNALAN Anticoagulation related abdominal haematomas:clinical and CT findings: 2018: 50-66
(6) Agarwal M, Prybot JE, Dhirasaria A. Rupture corpus luteal cyst in woman on anticoagulant: Conservative or surgical management-a clinical dielemma. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):5164-5165
(7) Ryu JK, Jin W, Kim Gy. Sonographic appearance of small organising haematomas and thrombi mimicking superficial soft tissue tumours.J Ultrasound Med 2011; 30:1431–1436 | 0278-4297 | www.aium.org.
(8) Sayasneh A, Eckechi C, Ferrara L, Kauser J, Stalder C, Sur S et al. The characteristic ultrasound features of specific types of Ovarian pathology (Review).Int j Oncol.2015;46:445-458.
(9) Dohan A, Darnige L, Sapoval M, Pellerin O. Spontaneous soft tissue hematomas. Diagn Interv Imaging 2015;96:789-96.
(10) March KL, Patel KS, Twilla JD. Attempted suicide by massive Warfarin ingestion Conservatively managed using Phytonadione. Case reports in haematology. 2016; http://dx.doi.org/10.1155/2016/7095251
(11) Tideman PA, Trimacco R, J,ohn AS, Roberts GW, How to manage Warfarin Therapy. Australian Prescriber.2015;38:44-48.
(12). Tideman PA, Trimacco R, J,ohn AS, Roberts GW, How to manage Warfarin Therapy. Australian Prescriber.2015;38:44-48