不當使用滅鼠藥（長效抗凝血劑）中毒併發膀胱壁內血腫，以膀胱腫瘤型態表現之案例報告及文獻回顧

楊承翰、許玄昀^1,2、曹智惟¹、蒙恩¹、吳勝堂¹、查岱龍¹、卓育慶¹

三軍總醫院 外科部 泌尿科；¹三軍總醫院 外科部 泌尿科；²國軍桃園總醫院 外科部 泌尿科

Deliberate self-poisoning with long-acting anticoagulant rodenticides complicated with bladder intramural hematoma, which mimics bladder tumor

Cheng-Han Yang, Hsuan-Yun Hsu^1,2, Chih-Wei Tsao¹, En-Meng¹, Sheng-Tang Wu¹, Tai-Lung Cha¹, Yu-Chin Jhuo¹

Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China;¹Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China; ²Division of Urology, Department of Surgery, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan, Republic of China

Background

              Bromadiolone, commonly known as super warfarin, is a long-acting coumarin dicoumarin rodenticide. Its mechanism of toxicity involves inhibition of vitamin K₁ epoxide reductase, which disrupts the synthesis of coagulation factors II, VII, IX, and X, leading to coagulopathy and systemic hemorrhage (Chen, Zhang et al. 2022). In the United States, cases of synthetic cannabinoid contamination with long-acting anticoagulant rodenticides (LAARs) have been reported, resulting in coagulopathy and bleeding complications (Bahouth, Kraus et al. 2019). Hematuria was described as the most common bleeding symptom in such cases.

Case presentation

               We report a rare case of deliberate self-poisoning with a long-acting anticoagulant rodenticide, complicated by bladder intramural hematoma mimicking a bladder tumor. The patient presented with hematuria, and abdominal computed tomography revealed multiple mass-like lesions in the urinary bladder. A bladder tumor was initially suspected, and transurethral biopsy was performed. Histopathological findings demonstrated benign tissue with hematoma formation and marked inflammatory cell infiltration, confirming a non-neoplastic etiology.

Conclusion

               This case highlights an unusual manifestation of bromadiolone intoxication presenting as a bladder intramural hematoma, which may closely resemble a bladder tumor radiologically. Awareness of this rare presentation is essential to avoid unnecessary invasive procedures and to ensure appropriate management of anticoagulant poisoning.