Spontaneous iliopsoas muscle haematoma during anticoagulant treatment
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Hellenic Journal of Surgery (2015) 87:5, 434-436
Spontaneous Iliopsoas Muscle Haematoma During Anticoagulant Treatment I.N. Retselas, C.K. Vaiopoulos, P.N. Chronopoulos, G.N. Kaisidis, Ch.E. Fotopoulou, I.K. Skandalos
Abstract Spontaneous iliopsoas muscle haematoma is a rare complication in patients receiving anticoagulants. We present the case of spontaneous iliopsoas muscle haematoma in a 68-year-old male patient under anticoagulant therapy with dicumarol in combination with acetylsalicylic acid 100 mg. The patient was admitted with clinical symptoms of sudden pain and extensive swelling along his left abdominal lower quadrant, and clinical findings of a hard, pulseless, painful swelling of the left lateral abdomen with pain extending along the left femoroinguinal region. His pulse rate was 92/min and blood pressure 120/85 mm Hg. Laboratory investigations indicated a grossly deranged INR (17.7) and a drop in Hct (22.0%). The diagnosis of a left iliopsoas muscle haematoma was established with ultrasonography and computed tomography. The patient was managed conservatively with administration of fluids and a blood transfusion while the coagulation profile was corrected with vitamin K and fresh frozen plasma. The spontaneous iliopsoas muscle haematoma in patients who are on anticoagulant treatment is uncommon and its management controversial since approaches to therapy vary among conservative, interventional radiology and open surgery, depending on the cause and volume of the haematoma, timing of diagnosis, degree of neurological impairment and haemodynamical stability. Key words: Anticoagulants; bleeding; haematoma; iliopsoas muscle; retroperitoneal haematoma
Spontaneous iliopsoas muscle haematoma is a rare complication occurring in patients receiving anticoagulants [1,2]. The clinical manifestations are not clear and the situation must be differentially diagnosed from other types of vascular or visceral retroperitoneal haemorrhage since they can mimic orthopaedic or neurological conditions. Depending on the rapidity of the haemorrhage and volume of blood loss, the patient may also display massive bleeding or shock [3]. Diagnosis is based on clinical manifestations and imaging studies such as ultrasonography, contrastmaterial enhanced computed tomography (CECT) or magnetic resonant imaging (MRI). Treatment of iliopsoas haematoma is generally conservative and requires correction of the coagulation profile. Interventional radiological or surgical treatment may be required in patients with haemodynamically unstable and active bleeding [4,5]. We report a case of a spontaneous iliopsoas haematoma that I.N. Retselas, C.K. Vaiopoulos, P.N. Chronopoulos, G.N. Kaisidis, I.K. Skandalos Surgical Department General Hospital Kilkis, Greece Ch.E. Fotopoulou Radiology Department, General Hospital Kilkis, Greece Corresponding author: Ioannis Retselas Aggelohori, Thessaloniki, Greece – 57004, Post Box: 707 Tel.: 0030 2392057569, 0030 6972951473 e-mail: [email protected] Received 29 April 2015; Accepted 8 Aug 2015 Hellenic Journ
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