Spontaneous intramural small bowel hematoma is a rare complication of anticoagulant therapy that can mimic acute abdomen or mechanical bowel obstruction. This report describes a 66-year-old man with valvular heart disease who was receiving long-term warfarin therapy after surgical aortic valve replacement and presented with diffuse abdominal pain. Computed tomography revealed long-segment bowel wall thickening of the distal jejunum with submucosal edema, findings consistent with an intramural hematoma. During hospitalization, the patient developed a marked hemoglobin decrease, from 13.0 to 6.0 g/dL, along with radiological progression of the hematoma and hemoperitoneum. However, he remained hemodynamically stable and was successfully managed conservatively with bowel rest, intravenous vitamin K, and transfusion of fresh frozen plasma and packed red blood cells. This case suggests that spontaneous intramural small bowel hematoma should be considered in the differential diagnosis of acute abdomen in anticoagulated patients. Even in the presence of severe anemia and hemoperitoneum, conservative management may be safe and effective in hemodynamically stable patients and may help avoid unnecessary surgical intervention.

Adhesive small bowel obstruction (ASBO) is a common postoperative complication and remains a leading cause of emergency surgical admissions. This review synthesizes current evidence regarding the diagnosis, conservative management, and surgical treatment of ASBO, focusing on the role of standardized protocols in optimizing patient outcomes. ASBO most often develops following abdominal or pelvic surgery, especially after open procedures. Conservative management, including nasogastric decompression, water-soluble contrast studies (e.g., Gastrografin), and nutritional support, is effective in 65% to 80% of cases without ischemia or strangulation. However, fever, leukocytosis, persistent pain, or computed tomographic findings (e.g., the whirl sign or bowel wall thickening) necessitate early surgical intervention. Evidence indicates that extending conservative management beyond 3 to 5 days in nonresponders increases both morbidity and mortality. Recent studies do not support routine antibiotic or antispasmodic use in uncomplicated ASBO. Although analgesics and ambulation may provide symptom relief, their impact on surgical timing remains unclear. Laparoscopic adhesiolysis has demonstrated reduced morbidity and shorter hospital stays versus open surgery in appropriately selected patients. Accurate differentiation between ASBO and postoperative ileus is essential for effective treatment. Conservative management remains the first-line approach in cases of partial ASBO, but clinicians must be vigilant for signs of clinical deterioration. Surgical management, including laparoscopic intervention, should be promptly pursued if conservative therapy fails or patients exhibit clinical decline. Implementing evidence-based guidelines and individualized decision-making improves patient safety, reduces complications, and enhances overall outcomes. Ongoing research is needed to refine conservative strategies and identify predictive markers for early surgical intervention.

Although liver lacerations are relatively common following blunt trauma, hepatic artery injuries are rare, with only a few cases of hepatic artery dissection caused by blunt trauma reported to date. Due to its rarity, no standardized treatment protocol exists for managing such injuries. We report the case of a 22-year-old female patient referred with a suspected pancreatic injury and liver laceration following blunt trauma. Upon arrival, she presented severe abdominal pain, and a physical examination revealed significant epigastric tenderness. Emergency laparotomy confirmed pancreatic contusion and liver laceration, for which peritoneal irrigation and wide drainage were performed. On postoperative day 17, hepatic artery dissection was incidentally diagnosed with computed tomography, although the patient remained asymptomatic and laboratory tests were within normal limits. Conservative management with an antiplatelet agent was initiated. A follow-up computed tomography scan performed 4 months post trauma demonstrated complete resolution of hepatic artery dissection.