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

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.

Antikoagülan ilişkili abdominal hematomlarin: Klinik ve BT bulgulari

“…Clinical symptoms vary from femoral neuropathy to ACS or fatal hypovolemic shock. ACS is the most serious condition associated with anuria; intestinal ischemia; and renal, cardiac, and respiratory failure (24,25). Similarly, in this study, one patient with retroperitoneal hematoma presented with bowel dilatation and increased intra-abdominal pressure-triggering ACS (Figure 2).…”

Spontaneous Retroperitoneal Hematoma Simulating Ruptured Infrarenal Aortic Aneurysm in a Patient with End-Stage Renal Disease

“…It should be emphasized that LMWH can cause SRH even in the absence of renal disease. 35,36 Our patient was treated with aspirin and clopidogrel, although the association between SRH and aspirin or clopidogrel is rare. Clopidogrel inhibits platelet aggregation and delays clot retraction induced by adenosine diphosphate.…”

Spontaneous retroperitoneal haematoma resulting in bowel ischaemia

“…A review of the literature demonstrated that femoral neuropathy,9 abdominal compartment syndrome10 and hypovolemic shock11 are the major reported complications of retroperitoneal haematomas. However, we were unable to find any published cases where these haematomas resulted in an isolated bowel ischaemia and subsequent bowel perforation.…”