Yonsei Med J.  2011 Mar;52(2):358-361. 10.3349/ymj.2011.52.2.358.

Abdominal Compartment Syndrome Due to Spontaneous Retroperitoneal Hemorrhage in a Patient Undergoing Anticoagulation

• Won DY
• Kim SD
• Park SC
• Moon IS
• Kim JI

• KMID: 1779676
• DOI: http://doi.org/10.3349/ymj.2011.52.2.358

Abstract

Spontaneous retroperitoneal hemorrhage is one of the most serious and often lethal complications of anticoagulation therapy. The clinical symptoms vary from femoral neuropathy to abdominal compartment syndrome or fatal hypovolemic shock. Of these symptoms, abdominal compartment syndrome is the most serious of all, because it leads to anuria, worsening of renal failure, a decrease in cardiac output, respiratory failure, and intestinal ischemia. We report a case of a spontaneous retroperitoneal hemorrhage in a 48-year-old female who had been receiving warfarin and aspirin for her artificial aortic valve. She presented with a sudden onset of lower abdominal pain, dizziness and a palpable abdominal mass after prolonged straining to defecate. Computed tomography demonstrated a huge retroperitoneal hematoma and active bleeding from the right internal iliac artery. After achieving successful bleeding control with transcatheter arterial embolization, surgical decompression of the hematoma was performed for management of the femoral neuropathy and the abdominal compartment syndrome. She recovered without any complications. We suggest that initial hemostasis by transcatheter arterial embolization followed by surgical decompression of hematoma is a safe, effective treatment method for a spontaneous retroperitoneal hemorrhage complicated with intractable pain, femoral neuropathy, or abdominal compartment syndrome.

Keyword

Spontaneous retroperitoneal hematoma; abdominal compartment syndrome; femoral neuropathy; anticoagulation

MeSH Terms

Abdomen
Anticoagulants/*adverse effects
Compartment Syndromes/*etiology
Female
Gastrointestinal Hemorrhage/chemically induced/*congenital
Hematoma/etiology/surgery
Humans
Iliac Artery/pathology/radiography
Middle Aged
Tomography, X-Ray Computed

Figure

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  Fig. 1 Computed tomography showing a large retroperitoneal hematoma with contrast extravasation (arrows) consistent with active bleeding.

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  Fig. 2 (A) The angiography showing active extravasation from the right internal iliac artery (arrows). (B) The post-embolization angiography showing complete occlusion of the bleeding (arrows) from the right internal iliac artery.

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