Korean J Crit Care Med.  2015 Nov;30(4):318-322. 10.4266/kjccm.2015.30.4.318.

Spontaneous Lumbar Artery Bleeding and Retroperitoneal Hematoma in a Patient Treated with Continuous Renal Replacement Therapy

• Park JK
• Kim SH
• Kim HJ
• Lee DH

• KMID: 2156188
• DOI: http://doi.org/10.4266/kjccm.2015.30.4.318

Abstract

Rupture of the lumbar artery is usually associated with trauma but rarely has been reported in association with anticoagulation. We present a 71-year-old man who developed spontaneous rupture of the lumbar artery leading to a retroperitoneal hematoma while receiving continuous renal replacement therapy (CRRT). The bleeding was confirmed by computed tomography and angiography and was controlled successfully using selective angiographic embolization. We suggest that spontaneous retroperitoneal bleeding should be considered in a case of sudden decrease in hemoglobin in a CRRT patient.

Keyword

anticoagulation; chronic kidney disease; continuous renal replacement therapy; spontaneous bleeding

MeSH Terms

Aged
Angiography
Arteries*
Hematoma*
Hemorrhage*
Humans
Renal Insufficiency, Chronic
Renal Replacement Therapy*
Rupture
Rupture, Spontaneous

Figure

• 

  Fig. 1. Chest radiograph showing bilateral pleural effusion.

• 

  Fig. 2. Computed tomography scans of the abdomen. Large (15 x 20 cm) right retroperitoneal hematoma (arrow) was seen (A). Right iliacus muscle hematoma (arrow) was also detected with retroperitoneal hematoma (B).

• 

  Fig. 3. Angiography. Contrast leakage was noted in the right lower lumbar artery (arrow) (A). Embolization with gelfoam and microcoils was successful (B).

Reference

References

1. Sclafani SJ, Florence LO, Phillips TF, Scalea TM, Glanz S, Goldstein AS, et al. Lumbar arterial injury: radiologic diagnosis and management. Radiology. 1987; 165:709–14.

2. Fortina M, Carta S, Del Vecchio EO, Crainz E, Urgelli S, Ferrata P. Retroperitoneal hematoma due to spontaneous lumbar artery rupture during fondaparinux treatment. Case report and review of the literature. Acta Biomed. 2007; 78:46–50.

3. Pathi R, Voyvodic F, Thompson WR. Spontaneous extraperitoneal haemorrhage: computed tomography diagnosis and treatment by selective arterial embolization. Australas Radiol. 2004; 48:123–8.

4. Halak M, Kligman M, Loberman Z, Eyal E, Karmeli R. Spontaneous ruptured lumbar artery in a chronic renal failure patient. Eur J Vasc Endovasc Surg. 2001; 21:569–71.

5. Pyo SH, Seo JW, Park JH, Kim KP, Kim SH, Chang JW, et al. Spontaneous rupture of lumbar artery and inferior epigastric artery in a hemodialysis patient. Korean J Nephrol. 2004; 23:992–6.

6. Anderson S, Brenner BM. Progressive renal disease: A disorder of adaptation. Q J Med. 1989; 70:185–9.

7. Sohal AS, Gangji AS, Crowther MA, Treleaven D. Uremic bleeding: pathophysiology and clinical risk factors. Thromb Res. 2006; 118:417–22.

8. Janssen MJ, van der Meulen J. The bleeding risk in chronic haemodialysis: preventive strategies in high-risk patients. Neth J Med. 1996; 48:198–207.

9. Bellomo R, Ronco C, Mehta RL. Nomenclature for continuous renal replacement therapies. Am J Kidney Dis. 1996; 28(Suppl 3):S2–7.

10. Silverstein ME, Ford CA, Lysaght MJ, Henderson LW. Treatment of severe fluid overload by ultrafiltration. N Engl J Med. 1974; 291:747–51.

11. Mehta RL. Anticoagulation strategies for continuous renal replacement therapies: what works? Am J Kidney Dis. 1996; 28(Suppl 3):S8–14.

12. Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000; 356:26–30.

13. Bouman CS, Oudemans-Van Straaten HM, Tijssen JG, Zandstra DF, Kesecioglu J. Effects of early high-volume continuous venovenous hemofiltration on survival and recovery of renal function in intensive care patients with acute renal failure: a prospective, randomized trial. Crit Care Med. 2002; 30:2205–11.

14. van de Wetering J, Westendorp RG, van der Hoeven JG, Stolk B, Feuth JD, Chang PC. Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage. J Am Soc Nephrol. 1996; 7:145–50.

15. Davenport A, Will EJ, Davison AM. Comparison of the use of standard heparin and prostacyclin anticoagulation in spontaneous and pump-driven extracorporeal circuits in patients with combined acute renal and hepatic failure. Nephron. 1994; 66:431–7.

16. Martin PY, Chevrolet JC, Suter P, Favre H. Anticoagulation in patients treated by continuous venovenous hemofiltration: a retrospective study. Am J Kidney Dis. 1994; 24:806–12.

17. Oudemans-van Straaten HM, Wester JP, de Pont AC, Schetz MR. Anticoagulation strategies in continuous renal replacement therapy: can the choice be evidence based? Intensive Care Med. 2006; 32:188–202.

18. Reddy BV, Grossman EJ, Trevino SA, Hursting MJ, Murray PT. Argatroban anticoagulation in patients with heparin-induced thrombocytopenia requiring renal replacement therapy. Ann Pharmacother. 2005; 39:1601–5.

19. Ohtake Y, Hirasawa H, Sugai T, Oda S, Shiga H, Matsuda K, et al. Nafamostat mesilate as anticoagulant in continuous hemofiltration and continuous hemodiafiltration. Contrib Nephrol. 1991; 93:215–7.