Compressive femoral neuropathy caused by anticoagulant therapy induced retroperitoneal hematoma: A case report.
Medicine (Baltimore)
; 101(7): e28876, 2022 Feb 18.
Article
em En
| MEDLINE
| ID: mdl-35363199
ABSTRACT
RATIONALE Spontaneous retroperitoneal hematomas due to anticoagulant therapy rarely occur. Retroperitoneal hematomas can cause severe pain in the groin, quadriceps femoris muscle weakness, hemodynamic instability, and abdominal distension. They rarely cause compressive neuropathy of the femoral nerve transversing the iliacus muscle. Differential diagnosis is not easy because they have similar clinical features to retroperitoneal hematomas. PATIENT CONCERNS A 72-year-old female patient whose right arm was stuck in a bookshelf for 5âdays developed right cephalic vein thrombosis. After 5âdays of intravenous heparin therapy for venous thrombosis, she presented with sudden right groin pain, right leg paresis, hemodynamic instability, and abdominal distension. DIAGNOSIS Emergency abdominal and pelvic CT showed a large number of hematomas in the bilateral retroperitoneal space with active bleeding of the right lumbar artery. An electrodiagnostic study was performed 2âweeks later to check for neuromuscular damage in the right lower extremity, and right compressive femoral neuropathy was confirmed. INTERVENTIONS:
Heparin therapy was discontinued; emergency embolization of the lumbar artery was performed. After 2âweeks, the patient started receiving physical, occupational, and transcutaneous electrical stimulation therapies.OUTCOMES:
She became hemodynamically stable after arterial embolization; a significant decrease in hematoma and patency of the femoral nerve was confirmed on follow-up pelvic MRI. After 2âmonths of comprehensive rehabilitation, the muscle strength of the right leg significantly improved, and the pain disappeared. LESSONS Although rare, spontaneous retroperitoneal hematomas may occur in patients receiving anticoagulant medications. They may even occur in patients receiving emergency anticoagulant therapy. Compressive femoral neuropathy due to retroperitoneal hematomas should be considered if muscle weakness and groin pain are observed. Early diagnosis and appropriate treatment plan of compressive femoral neuropathy due to retroperitoneal hematoma are helpful for a good prognosis.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neuropatia Femoral
/
Síndromes de Compressão Nervosa
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
/
Screening_studies
Limite:
Aged
/
Female
/
Humans
Idioma:
En
Revista:
Medicine (Baltimore)
Ano de publicação:
2022
Tipo de documento:
Article