Hemorragia digestiva alta como forma de presentación de hematoma retroperitoneal espontáneo gigante secundario a anticoagulación en una mujer con reordenación del gen JAK2

espanolPresentamos el caso de una mujer de 44 anos de edad con antecedentes de abortos de repeticion y sindrome de Budd-Chiari secundario a una mielofibrosis primaria en tratamiento anticoagulante. Consulta por melenas y astenia, presentando anemizacion progresiva. En una gastroscopia inicial se aprecia una compresion extrinseca a nivel supraampular de segunda porcion duodenal, con una ulcera asociada en cara posterior de bulbo y primera rodilla. Posteriormente se diagnostica mediante una tomografia computarizada de un hematoma retroperitoneal espontaneo secundario a anticoagulacion. Se trata con drenaje percutaneo y retirada de anticoagulacion con buena respuesta inicial. No obstante, presenta complicaciones tromboticas (trombosis subclavia y yugular) y se reintroducen los anticoagulantes con dosis en el limite bajo del rango terapeutico. EnglishWe present the case of a 44-year-old woman with past history of repeated miscarriage and Budd-Chiari syndrome secondary to primary myelofibrosis. Because of this she was under treatment with oral anticoagulant agents. The patient was admitted in hospital as she presented with gastrointestinal bleeding (melena), asthenia and progressive anemia. In an initial upper endoscopy an extrinsic duodenal compression associated with an ulcer on the posterior face of the first portion of duodenum and upper duodenal knee was observed. In the following days a huge spontaneous retroperitoneal hematoma due to anticoagulation was diagnosed by computed tomography. This was treated with a percutaneous drainage and withdrawal of the antithrombotic drugs. The evolution of the patient was initially satisfactory but she suffered subclavian and jugular vein thrombosis, and reintroduction of anticoagulant agents at the lowest therapeutic doses was required.