Bad Blood: An Unusual Case of Small Bowel Obstruction From Hematoma-Induced Intussusception.

Small bowel obstruction (SBO) is a frequent surgical emergency with a broad differential diagnosis, ranging from adhesions and malignancy to rare causes such as intraluminal blood clots and spontaneous intramural hematomas. These uncommon etiologies are often associated with anticoagulation therapy and can present diagnostic and therapeutic challenges. We report the case of a 73-year-old male with a history of abdominal aortic aneurysm (AAA) and long-term antihypertensive therapy, presenting with a three-day history of diffuse abdominal pain and persistent vomiting. Imaging revealed small bowel intussusception with associated hematoma, raising concern for a neoplastic lead point. Emergent laparotomy confirmed a mid-ileal intussusception and an intraluminal hematoma, prompting segmental small bowel resection. The postoperative course was complicated by new-onset atrial fibrillation, septic shock, pancytopenia, and acute kidney injury, requiring intensive multidisciplinary management. A second-look laparotomy identified a hematoma at the anastomotic site, which was evacuated successfully. This case illustrates a rare cause of SBO hematoma-induced intussusception, potentially related to vascular comorbidities. Early surgical intervention based on clinical suspicion and radiographic findings was essential. The complexity of the patient's postoperative course underscores the importance of coordinated multidisciplinary care in managing similar high-risk patients. Uncommon etiologies such as intraluminal and intramural hematomas should be considered in the differential diagnosis of SBO, particularly in patients on anticoagulation or with significant vascular disease. Timely diagnosis and appropriate surgical management are critical for favorable outcomes. This case contributes to the limited literature on hematoma-induced intussusception and reinforces the importance of vigilant postoperative monitoring.