Backstabbed: routine lumbar puncture complicated by retroperitoneal hematoma and hemorrhagic shock

Horani, George; Kaur, Kulvinder Kochar; Mendez, Dianelys; Nanavati, Sushant; Berlin, Fred S.; Leou, Konstantinos

doi:10.1016/j.radcr.2021.05.060

Cited by 2 publications

(1 citation statement)

References 13 publications

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“…An RH is spontaneous if it is not caused by an invasive procedure, trauma, surgery, or abdominal aortic aneurysm [ 1 ]. Retroperitoneal hematomas may manifest as hemodynamic instability, new-onset neurologic deficits, or pain not explained otherwise [ 6 - 8 ]. Procedures such as lumbar plexus blockade have been reported to be associated with RHs [ 2 , 3 , 5 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Retroperitoneal Hematoma After Total Hip Arthroplasty

DeLeon¹,

Gande²,

Tomas³

2023

Cureus

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Spontaneous retroperitoneal hematomas are a rare yet potentially devastating occurrence associated with antiplatelet and anticoagulant therapies. We present a case of a spontaneous retroperitoneal hematoma post-operatively after a total hip arthroplasty surgery performed under a midline approach spinal anesthetic. A 79-year-old male with a BMI of 25.72 kg/m 2 presented for anterior total hip arthroplasty. A midline approach with an uncomplicated spinal anesthetic was performed. On the night of postoperative day 0, the patient received a prophylactic dose of dalteparin. The patient reported back pain, contralateral leg numbness, and weakness that began overnight on postoperative day 0. A computed tomography (CT) scan confirmed a 10 cm, contralateral retroperitoneal hematoma. The patient underwent interventional radiology embolization followed by surgical evacuation and demonstrated improvement in the neurologic function of his affected leg. Despite the rarity of a spontaneous retroperitoneal hematoma formation in the perioperative period, it could be simultaneously evaluated when performing an MRI to rule out spinal hematoma if a patient suffers a post-op neurologic deficit after a neuraxial technique. Understanding the evaluation and timely treatment of patients at risk for a perioperative retroperitoneal hematoma could help clinicians prevent a permanent neurologic deficit.

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