一個案例報告與文獻回顧：蓄意使用長效抗凝血劑導致呈現膀胱腫瘤樣態的膀胱壁內血腫

鄭苑伶、蒙恩、孫光煥、于大雄、卓育慶

三軍總醫院泌尿外科部

Case Report and Literature Review: Deliberate Ingestion of Long-Acting Anticoagulant Rodenticides Resulting in Bladder Intramural Hematoma, Mimicking Bladder Neoplasm

Yuan-Ling Cheng, En Meng, Guang-Huan Sun, Dah-Shyong Yu, and Yu-Chin Juho

Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Abstract:

Bromadiolone, commonly known as super warfarin, is a potent long-acting rodenticide categorized under coumarin dicoumarin compounds. Its primary mechanism involves inhibiting vitamin K1 epoxide reductase, thus impacting the synthesis of crucial coagulation factors like II, VII, IX, and X. This disruption leads to impaired blood clotting function and widespread hemorrhaging across multiple organ systems (Chen, Zhang et al. 2022).

Instances of coagulopathy and bleeding complications in the United States have been linked to synthetic cannabinoids contaminated with long-acting anticoagulant rodenticides (LAARs) (Bahouth, Kraus et al. 2019). A study in the US found hematuria to be the most common bleeding symptom upon presentation (Bahouth, Kraus et al. 2019).

Therefore, we present a rare case involving deliberate self-poisoning with long-acting anticoagulant rodenticides, complicated by bladder intramural hematoma, mimicking a bladder tumor's appearance. Upon abdominal computed tomography, the patient exhibited multiple mass lesions in the urinary bladder. Suspicion of a bladder tumor prompted a biopsy. Subsequent transurethral tumor biopsy and histological analysis revealed benign tissue with hematoma and significant inflammatory cell infiltration.