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Guild TT, Crawford AM, Striano BM, Mortensen S, Wixted JJ. The epidemiology and management of iliopsoas hematoma with femoral nerve palsy: A descriptive systematic review of 174 cases. Injury 2023; 54:280-287. [PMID: 36586813 DOI: 10.1016/j.injury.2022.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Iliopsoas hematoma with femoral nerve palsy is a rare phenomenon with no consensus treatment algorithm. The objective of this study was to perform a systematic review of all reported cases of femoral nerve palsy secondary to iliopsoas hematoma to better elucidate it's optimal treatment. MATERIALS AND METHODS Queries of the PubMed, Embase, and Cochrane databases were performed for reports available in English of femoral nerve palsy secondary to iliopsoas, psoas, or iliacus hematoma. 1491 articles were identified. After removal of duplicated publications and review of abstract titles via a majority reviewer consensus, 217 articles remained for consideration. Dedicated review of the remaining articles (including their reference sections) yielded 122 articles representing 174 distinct cases. Clinical data including patient age, sex, medical history, use of pharmacologic anticoagulation, sensory and motor examination at presentation and follow-up, hematoma etiology and location, time to intervention, and type of intervention were collected. Descriptive statistics were generated for each variable. RESULTS Femoral nerve palsy secondary to iliopsoas hematoma occurred at a mean age of 44.5 years old. A majority of patients (60%) were male, and a majority of hematomas (54%) occurred due to pharmacologic anticoagulation. Most hematomas (57%) were treated conservatively, and almost half (49%) - regardless of treatment modality - resulted in persistent motor deficits at final follow-up. A minority of patients treated surgically (34%) had residual motor deficit at final follow-up, while 66% of those treated medically had resultant motor deficits, although no direct statistical comparison was able to be performed. DISCUSSION AND CONCLUSIONS The disparate available data on iliopsoas hematoma with femoral nerve palsy precludes the completion of a true metanalysis, and therefore any conclusions on an optimal treatment algorithm. Based on review of the literature, small to moderate hematomas are often treated conservatively, while larger hematomas with progressive neurological symptoms are usually managed with a percutaneous decompression or surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Theodore T Guild
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA.
| | - Alexander M Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Sharri Mortensen
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Boston, MA
| | - John J Wixted
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Gonzales R, De Robles MS, Winn R. Pneumoretroperitoneum - is it always an ominous sign? ANZ J Surg 2022; 93:1040-1041. [PMID: 36222827 DOI: 10.1111/ans.18074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Raphael Gonzales
- Department of Surgery, Wollongong Hospital, Wollongong, Australia
| | - Marie Shella De Robles
- Department of Surgery, Wollongong Hospital, Wollongong, Australia.,Graduate School of Medicine, University of Wollongong, Keiraville, Australia.,Department of Surgery, Shoalhaven District Memorial Hospital, Nowra, Australia
| | - Robert Winn
- Department of Surgery, Wollongong Hospital, Wollongong, Australia
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Lee PS, Baikunje S, Teh SP, Chan T. A Case of Spontaneous Perinephric Hematoma From Rivaroxaban. Cureus 2022; 14:e29429. [PMID: 36159357 PMCID: PMC9492981 DOI: 10.7759/cureus.29429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Spontaneous perinephric hematoma is an uncommon but serious condition that is typically caused by tumor hemorrhage or vascular disease such as polyarteritis nodosa. We describe a 78-year-old Chinese gentleman with underlying chronic kidney disease, renal cysts, non-obstructive renal stones, hypertension, ischemic heart disease, and atrial fibrillation who was on rivaroxaban and clopidogrel. He developed spontaneous perinephric hematoma complicated by acute kidney injury, anemia, and myocardial infarction who underwent angioembolization and packed cell transfusion. He did not have further bleeding episodes, and his kidney function improved before discharge.
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4
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Retroperitoneal hemorrhage caused by rupture of superior mesenteric artery: A case report. Asian J Surg 2022; 45:2058-2059. [DOI: 10.1016/j.asjsur.2022.04.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/21/2022] [Indexed: 11/24/2022] Open
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Uddin MM, Mir T, Khalil A, Bhat Z, Noronha AM. Spontaneous retroperitoneal haemorrhage secondary to anticoagulation polypharmacy. BMJ Case Rep 2021; 14:e242934. [PMID: 34404650 PMCID: PMC8375756 DOI: 10.1136/bcr-2021-242934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/04/2022] Open
Abstract
Retroperitoneal haemorrhage (RH) is not uncommon in patients with provoking events like trauma. However, spontaneous RH (SRH) is a rare and life-threatening complication described as the development of bleeding into the retroperitoneal cavity, appearing spontaneously and without a preceding history of trauma or other predisposing illness. We are reporting a case of an elderly patient with recurrent deep vein thrombosis who had developed SRH secondary to concurrent use of multiple anticoagulation agents, resulting from poor healthcare follow-up and lack of sufficient medication reconciliation. This article highlights the significance of recognising risk factors for SRH, as well as management strategies through literature review.
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Affiliation(s)
- Mohammed M Uddin
- Internal Medicine, Wayne State University, Warren, Michigan, USA
| | - Tanveer Mir
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Amir Khalil
- Internal Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Zeenat Bhat
- Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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Zhang JC, Li T. Delayed retroperitoneal hemorrhage during extracorporeal membrane oxygenation in COVID-19 patients: A case report and literature review. World J Clin Cases 2021; 9:5203-5210. [PMID: 34307568 PMCID: PMC8283594 DOI: 10.12998/wjcc.v9.i19.5203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/21/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Retroperitoneal hemorrhage (RPH) is a rare and severe complication in patients undergoing extracorporeal membrane oxygenation (ECMO). Clinical diagnosis is difficult. CASE SUMMARY Three cases of RPH patients with corona virus disease-19 (COVID-19) were included in this study. All three suffered from respiratory failure, were treated with veno-venous or veno-arterial-venous ECMO, and experienced RPH during ECMO treatment. Two of the COVID-19 cases were diagnosed after the patients experienced abdominal pain. The other patient exhibited decreases in the ECMO circuit flow rate and hemoglobin level. Two cases were treated by transcatheter arterial embolization, and one was treated conservatively. The hemorrhage in each of the three cases did not deteriorate. Satisfactory treatment results were achieved for the three patients because of prompt diagnosis and treatment. CONCLUSION Although the incidence of RPH during ECMO treatment is low, the risk is increased by anticoagulant use and local mechanical injury. If declines in blood flow velocity and hemoglobin are detected, RPH should be considered, and prompt aggressive therapy should be started.
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Affiliation(s)
- Jing-Chen Zhang
- Department of Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Tong Li
- Department of Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Jain AK, Aggarwal A, Aggarwal R. Spontaneous retroperitoneal haemorrhage post-coronary angioplasty: a case report. Eur Heart J Case Rep 2021; 5:ytab005. [PMID: 33644661 PMCID: PMC7898569 DOI: 10.1093/ehjcr/ytab005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/06/2020] [Accepted: 12/21/2020] [Indexed: 12/05/2022]
Abstract
Background Spontaneous retroperitoneal haemorrhage (SRH) is a rare cause of retroperitoneal haemorrhage in patients who are on anticoagulants or antiplatelet agents or both. Case summary We report here a rare and catastrophic complication of use of anticoagulants and antiplatelet drugs in a case undergoing coronary angioplasty. The patient had multiple coronary risk factors and developed acute myocardial infarction with pulmonary oedema and hypotension during hospitalization for treatment of lower respiratory tract infection and diabetic ketoacidosis. He underwent successful angioplasty of the culprit vessel but later developed hypotension attributable to retroperitoneal haemorrhage. No bleeding site was identified despite extensive evaluation of the aorta and iliac vessels. Discussion A diagnosis of SRH is considered when a patient on anticoagulants or antiplatelet drugs develops retroperitoneal haemorrhage without any specific identifiable site of bleeding in the retroperitoneum. Diffuse vasculopathy and atherosclerosis or vasculitis of the small vessels in the retroperitoneum may result in rupture of the most friable vessels and result in bleeding. Intense cough, forceful vomiting or sneezing may also be responsible for traumatizing the vessels and resulting in bleeding. Most cases recover with conservative management but some may benefit from interventional occlusion of the leak or surgical decompression in cases of abdominal compartment syndrome.
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Affiliation(s)
- Anshul Kumar Jain
- Department of Cardiology, Sri Aggarsain International Hospital, Sector 22, Rohini, New Delhi 110086, India
- Corresponding author. Tel: +91-9810020393,
| | - Ajay Aggarwal
- Department of Cardiology, Sri Aggarsain International Hospital, Sector 22, Rohini, New Delhi 110086, India
| | - Rishabh Aggarwal
- Department of Radiodiagnosis, Sri Aggarsain International Hospital, Sector 22, Rohini, New Delhi 110086, India
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Galgano JA, Bernshteyn M, Kaul P. Spontaneous Retroperitoneal Hematoma in the Setting of Myasthenic Crisis. Cureus 2020; 12:e11116. [PMID: 33240712 PMCID: PMC7682541 DOI: 10.7759/cureus.11116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Our case highlights a patient with spontaneous retroperitoneal hematoma without clear cause in the setting of myasthenic crisis. While myasthenia gravis (MG) has been reported in the literature to be associated with vascular pathology such as polyarteritis nodosa, its association with coagulopathy and spontaneous major bleed is currently unclear. The patient in this case developed a sudden unprovoked iliopsoas hematoma while in the ICU for the management of newly diagnosed MG. Acute anemia was the only clinical sign which was later confirmed by imaging findings.
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Affiliation(s)
- Joseph A Galgano
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Michelle Bernshteyn
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Pratibha Kaul
- Critical Care Medicine, State University of New York Upstate Medical University, Syracuse, USA
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Kim SJ, Park HS, Lee DW. Iliacus hematoma syndrome: A systematic review of recent literature and case report. Injury 2020; 51:1744-1750. [PMID: 32487330 DOI: 10.1016/j.injury.2020.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femoral nerve palsy caused by iliacus hematoma is an infrequent diagnosis often missed because of its insidious presentation. However, due to potentially devastating outcomes, prompt recognition and management are essential. OBJECTIVES The aim with this study was to better characterize clinical presentation, diagnosis, treatment, and prognosis of iliacus hematoma. METHODS We performed a systematic review of recent literature regarding femoral neuropathy secondary to an iliacus hematoma. A structured literature review of multiple databases ((PubMed, Web of Science, EMBASE, and Cochrane library) referenced articles from 2000 to 2019. RESULTS A total of 25 patients from 25 published studies were identified. The average age of the patients was forty years (range, 12 to 85 years). There were 16 male patients and 9 female patients. The single most important predisposing cause of iliacus hematoma was trauma (14/25), with a pooled percentage of 56%. All patients with spontaneous hematoma were taking antiplatelet medications. Thirteen patients (52%) were treated conservatively with analgesia. Surgical decompression was performed in 10 patients (40%). At the final follow-up, complete resolution of symptoms was achieved in 12 patients (48%). CONCLUSIONS Although rare, iliacus hematoma syndrome carries significant morbidity. Spontaneous iliacus muscle hematoma should be considered in the differential diagnosis of leg pain in a patient who is on anticoagulation therapy. In patients with an iliacus hematoma and neurology deficit, conservative treatment can be considered initially if there is no progression in the symptoms evident at the time of presentation. However, prompt surgical decompression has been highly recommended in patients with progressive neurological deficits.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, Republic of Korea.
| | - Hyun-Soo Park
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, Republic of Korea.
| | - Dong-Woo Lee
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, Republic of Korea.
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Sahu KK, Mishra AK, Lal A, George SV, Siddiqui AD. Clinical spectrum, risk factors, management and outcome of patients with retroperitoneal hematoma: a retrospective analysis of 3-year experience. Expert Rev Hematol 2020; 13:545-555. [PMID: 32089021 DOI: 10.1080/17474086.2020.1733963] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Amos Lal
- Department of Medicine Performance Improvement Committee, Saint Vincent Hospital, Worcester, MA, USA
| | - Susan V. George
- Department of Medicine Performance Improvement Committee, Saint Vincent Hospital, Worcester, MA, USA
- Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ahmad Daniyal Siddiqui
- Hemato-Oncology, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
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Shadhu K, Ramlagun D, Qin J, Xia Y. A cascade of complications after liver transplantation: A case report. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tan TSE, Cheong SCW, Tan TJ. Clinics in diagnostic imaging (201). Small bowel intramural haematoma induced by anticoagulation therapy with associated reactive ileus. Singapore Med J 2019; 60:566-573. [PMID: 31781781 DOI: 10.11622/smedj.2019147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 74-year-old woman receiving long-term anticoagulation with warfarin for chronic atrial fibrillation presented with severe acute abdominal pain, diarrhoea and vomiting. Initial laboratory workup revealed a deranged coagulation profile. Computed tomography of the abdomen and pelvis demonstrated spontaneous distal jejunal intramural haematoma with associated reactive ileus. No overt pneumatosis intestinalis, intraperitoneal free gas or haemoperitoneum was seen. Based on clinical and imaging findings, a diagnosis of over-anticoagulation complicated by small bowel intramural haematoma was made. The patient was managed non-operatively with analgesia, cessation of warfarin and reversal therapy with vitamin K. Warfarin therapy was recommenced upon resolution of symptoms and optimisation of coagulation status. The clinical presentation, radiological features and overall management of anticoagulation-induced bleeding are further discussed in this article.
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Affiliation(s)
| | | | - Tien Jin Tan
- Department of Radiology, Changi General Hospital, Singapore
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Schattner A, Uliel L, Dubin I. A spontaneous rectus sheath hematoma. Intern Emerg Med 2018; 13:1335-1336. [PMID: 30073473 DOI: 10.1007/s11739-018-1920-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ami Schattner
- Department of Medicine, Laniado Hospital, Sanz Medical Center, Netanya, Israel.
- Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
| | - Livnat Uliel
- Department of Imaging, Laniado Hospital, Sanz Medical Center, Netanya, Israel
| | - Ina Dubin
- Department of Medicine, Laniado Hospital, Sanz Medical Center, Netanya, Israel
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Spontaneous Retroperitoneal Bleeding in a Patient with Primary Antiphospholipid Syndrome on Aspirin. Case Rep Emerg Med 2018; 2018:4397893. [PMID: 30258659 PMCID: PMC6146633 DOI: 10.1155/2018/4397893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/28/2018] [Indexed: 12/29/2022] Open
Abstract
Retroperitoneal bleeding is a rare and difficult to diagnose condition, defined as bleeding in the retroperitoneal space without associated trauma or iatrogenic manipulation. It has been associated with hematologic diseases and malignancies and is more common in patients receiving systemic anticoagulation. A 50-year-old man on aspirin presented with abdominal pain. Physical examination revealed abdominal tenderness and a palpable mass at the left abdominal area. An abdominal CT revealed a spontaneous retroperitoneal hematoma due to bleeding of an intraparenchymal branch of the left renal artery. The patient underwent left nephrectomy in order to control the bleeding. Pathology of the kidney showed evidence of acute and chronic microangiopathy, renal artery stenosis, and renal vein thrombosis. Further work-up led to diagnosis of primary antiphospholipid syndrome. Treatment of spontaneous retroperitoneal bleeding varies from conservative in hemodynamically stable patients to invasive or even surgery in hemodynamically unstable patients. In our case, open surgery was performed due to the rapidly deteriorating patient's condition and the inability to embolize the bleeding vessel by interventional radiology. Physicians should always think of retroperitoneal bleeding in patients presenting with abdominal pain and signs of hypovolemia, especially if they have a bleeding disorder or receive anticoagulants or antiplatelets.
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Lu HY, Wei W, Chen QW, Meng QG, Hu GH, Yi XL, Bai XZ. A rare life-threatening disease: unilateral kidney compressed by huge chronic spontaneous retroperitoneal hemorrhage. Ther Clin Risk Manag 2018; 14:489-492. [PMID: 29563802 PMCID: PMC5848664 DOI: 10.2147/tcrm.s152460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To study an uncommon life-threatening disease, spontaneous retroperitoneal and perirenal hemorrhage. Case descriptions A 69-year-old male presented with pain in the left waist and back of 1 month duration. The renal abscess was suspected by magnetic resonance imaging before operation. The perirenal hematoma was cleaned by operation. In another case, the patient had a functional solitary left kidney compressed by a huge retroperitoneal mass and uropenia appeared. Results The first patient died of adult respiratory distress syndrome after surgery. The second patient died of cardiac insufficiency and pulmonary embolism on the second day after evacuation of retroperitoneal hematoma. Conclusion Conservative surgery, such as selective arterial embolization, is a reasonable approach in patients with chronic spontaneous retroperitoneal and perirenal space hemorrhage and with poor general condition. We strongly recommend drainage or interventional therapy, but not a major surgery, in patients with poor condition.
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Affiliation(s)
- Hao-Yuan Lu
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021, China
| | - Wei Wei
- Department of Radiology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021, China
| | - Qi-Wei Chen
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021, China
| | - Qing-Gui Meng
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021, China
| | - Gao-Hua Hu
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021, China
| | - Xian-Lin Yi
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021, China.,Hubei Engineering Laboratory for Synthetic Microbiology, Wuhan Institute of Biotechnology, Wuhan 430075, China
| | - Xian-Zhong Bai
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021, China
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