Update on retroperitoneal hematoma in children / 世界急诊医学杂志（英文）

BACKGROUND@#We read with great interest the recent article by Badheka et al published in your esteemed journal. Hereby we would like to address few additional points related to childhood retroperitoneal hematoma (RPH).

Early Abdominal Closure Achieved through Retroperitoneal Hematoma Evacuation after Endovascular Aneurysm Repair and Open Abdominal Management for a Ruptured Aortic Aneurysm / 日本心臓血管外科学会雑誌

Abdominal compartment syndrome (ACS) is an important postoperative complication of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysms (rAAA). Open abdominal management (OAM) has been reported to be effective in EVAR ; however, only a limited number of reports are available on when and how to close the abdomen. Here we report a case of early abdominal wall closure achieved through the combined use of retroperitoneal hematoma evacuation after EVAR and OAM for rAAA. The patient was a 79-year-old woman who underwent EVAR for rAAA on an emergency basis. She developed ACS after EVAR and underwent OAM. Four days after surgery, a decrease in intraabdominal pressure was confirmed, and subsequent contrast-enhanced computed tomography revealed the absence of an endoleak ; retroperitoneal hematoma evacuation was performed, during which the abdominal wall was closed. The postoperative course was good, and the patient was discharged. Early closure of the abdomen may be possible by concomitant retroperitoneal hematoma evacuation after EVAR and OAM for rAAA.

Hemoperitoneo en el post parto secundario a la rotura aneurismática de la arteria ovárica: Caso Clínico / Post partum hemoperitoneum secondary to ovarian aneurysm rupture: Case Report

Resumen El hallazgo de hemoperitoneo en el post parto secundario a la rotura aneurismática de la arteria ovárica es una situación clínica extremadamente rara que presenta un cuadro clínico inespecífico y puede poner en riesgo la vida del paciente. El ultrasonido es una modalidad segura y rápida para la detección de líquido libre intraperitoneal. (1) . La tomografía computada es la herramienta de elección para un diagnóstico rápido y seguro (2) ; y la angiografía con embolización durante el mismo procedimiento es una alternativa útil y altamente efectiva para la resolución del cuadro. (3). Presentamos el caso de una multípara puérpera de 34 años que consulta en el servicio de urgencia por intenso dolor abdominal. La paciente se encontraba hemodinámicamente estable y afebril. La tomografía computada demostró un hematoma retroperitoneal y hemoperitoneo asociado a un aneurisma de la arteria ovárica derecha. Fue evaluada por el servicio de radiología intervencional y se trasladó de emergencia al pabellón angiográfico donde se realizó la embolización de la lesión mediante la cateterización vascular supra selectiva. La paciente evolucionó de manera favorable y fue dada de alta una semana después. Es necesario tener un alto índice de sospecha en pacientes de riesgo para lograr un diagnóstico y tratamiento oportuno.

SUMMARY Spontaneous ovarian artery aneurysm rupture is a rare postpartum life-threatening event with non-specific clinical manifestations. The present article reports the case of a 34 year old multiparous post partum women who came to the emergency department with acute onset of intense abdominal right flank pain. Patient was afebrile and hemodynamically stable. A computed tomography revealed a retroperitoneal haematoma and hemoperitoneum related to an aneurysm of the right ovarian artery. The patient was taken to the interventional radiology suite and selective embolization was performed. Following the procedure, the patient symptoms subsided and 7 days later she was discharged. A high index of suspicion in patients with risk factors can lead to a prompt diagnosis and treatment. Computed tomography is the image modality for a fast and safe evaluation, although diagnostic angiography and subsequent transcatheter embolization are thought to be effective for treatment.

Retroperitoneal hematoma following common iliac artery injury in a child / 世界急诊医学杂志（英文）

@#A six-month-old child with a history of coarctation of aorta repair admitted to our hospital with recoarctation. She underwent cardiac catheterization for stent placement via right femoral access. Reportedly, there was difficulty inserting and removing the sheath. There was no bleeding or hematoma and the distal pulse well felt at the completion of the procedure. While in recovery unit child acutely deteriorated with tachycardia, oxygen desaturation, and hypotension. She was then endotracheally intubated and started on fluid resuscitation and on vasopressors infusion. Upon arrival to the pediatric intensive care unit (PICU) child was tachycardic, pale and noted a mass on the right lower quadrant of the abdomen. Her hemoglobin dropped from 12 gm/dL to 5 gm/dL. Given the child with hemorrhagic shock, and with right lower quadrant abdominal mass, a possibility of retroperitoneal hematoma (RPH) was considered. Other possible causes of hemorrhagic shock, such as vascular access site bleeding, pleural and pericardial effusions were ruled out.

Hematoma retroperitoneal espontáneo concurrente con una atonía uterina poscesárea / Concurrent Spontaneous Retroperitoneal Hematoma with Uterine Atony Post Cesarean

El hematoma retroperitoneal espontáneo durante el embarazo es una complicación infrecuente definido como el sangrado en el espacio retroperitoneal que ocurre sin historia de trauma reciente, tratamiento anticoagulante o enfermedad vascular. El objetivo del trabajo es presentar un caso grave poco usual en que el hematoma retroperitoneal coexistió en una paciente con atonía uterina. Se presenta una gestante de 21 años y 39 semanas que acudió al Cuerpo de Guardia del Hospital Ginecobstétrico de Guanabacoa en noviembre 2016 por presentar dolor abdominal. Se ingresa en Cuidados perinatales. Los exámenes complementarios, físico y la cardiotocografía fueron normales. Cuatro horas después aqueja dolor lumbar y se detectó dolor a la palpación en región intercostal posterior derecha sin otro hallazgo ni alteraciones hemodinámicas. No hay dinámica uterina y frecuencia fetal 140 latidos/minuto. Dos horas después, presentó un cuadro que el familiar informa como una "convulsión", no observada por personal médico o de enfermería. No hay toma de conciencia y los signos vitales normales, se comprueba una bradicardia fetal que motiva la indicación de cesárea de urgencia. La hemoglobina descendió a 70 g/L. Se repone volumen y se extrae un neonato con Apgar 1-3. Se produce atonía uterina que no cedió al tratamiento medicamentoso y/o masaje. Se realiza técnica de B- Lynch para la hemostasia que se logra. Se comprueba hematoma retroperitoneal no activo desde borde superior hepático hasta flanco derecho. Se estabiliza hemodinámicamente. El neonato fallece a las 72 horas. El diagnóstico y tratamiento precoz del hematoma retroperitoneal contribuye a disminuir la morbilidad y mortalidad materna.

Spontaneous retroperitoneal hematoma during pregnancy is an uncommon complication defined as bleeding in the retroperitoneal space that occurs without a history of recent trauma, anticoagulant treatment or vascular disease. The objective of this study is to present an unusual case in which the retroperitoneal hematoma coexisted in a patient with uterine atony. A 21 year old pregnant woman of 39 weeks who went to the Emergency Room at Guanabacoa Gynecobstetric Hospital in November 2016, due to abdominal pain. The patient is admitted to perinatal care. Complementary studies and physical examination were normal, including cardiotocography. Four hours later, she suffered back pain, which was detected on palpation in the right posterior intercostal region without any other finding or hemodynamic changes. There were no uterine dynamics and fetal frequency was 140 beats / minute. Two hours later, this patient presented a "seizure," according to her family member that was not observed by medical or nursing staff. There was no loss of consciousness and her vital signs were normal. A fetal bradycardia is verified that motivates the indication of emergency caesarean section. Hemoglobin decreased to 70 g / L. Volume was replaced and an Apgar 1-3 neonate was extracted. There was uterine atony that did not yield to drug treatment and massage. The B-Lynch technique was performed for the hemostasis that was achieved. A non-active retroperitoneal hematoma was found from the superior border of the liver to the right flank. The patient was hemodynamically stabilized. The neonate died at 72 hours. The diagnosis and early treatment of retroperitoneal hematoma help to reduce maternal morbidity and mortality.

Sudden motor and sensorial loss due to retroperitoneal hematoma during postoperative periods: a case report / Súbita perda sensitiva e motora devido a hematoma retroperitoneal durante os períodos de pós-operatório: relato de caso

Abstract A 68 year-old male patient was hospitalized for radical prostatectomy. He had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L3-4 interspace for intraoperative and postoperative analgesia. After surgery for nine hours, he developed confusion and flaccid paralysis of bilateral lower extremities occurred. No pathology was detected from cranial computed tomography and diffusion magnetic resonance imaging no pathology was detected. His thoracic/lumbar magnetic resonance imaging. Intraabdominal pressure was shown to be 25 mmHg, and abdominal ultrasonography revealed progression in the inflammation/edema/hematoma in the perirenal region. The Bromage score was back to 1 in the right foot on the 24th hour and in the left foot on the 26th hour. Paraplegia developed in patients after epidural infusion might be caused by potentiated local anesthetic effect due to retroperitoneal hematoma and/or elevated intra-abdominal pressure.

Resumo Paciente do sexo masculino, 68 anos, hospitalizado para prostatectomia radical. O paciente não tinha história médica anormal, inclusive nem déficit neurológico, antes da operação. Antes da anestesia geral, um cateter peridural foi inserido no espaço intermédio L3-4 para analgesia no intra e pós-operatório. Após a cirurgia, que durou nove horas, o paciente desenvolveu confusão e paralisia flácida bilateral dos membros inferiores. Tomografia computadorizada de crânio e imagem de difusão por ressonância magnética não detectaram lesão. Os achados nas imagens de ressonância magnética torácica/lombar eram normais. A pressão intra-abdominal era de 25 mmHg e o ultrassom abdominal revelou progressão de inflamação/edema/hematoma na região perirrenal. O escore de Bromage voltou a 1 no pé direito na 24a hora e no pé esquerdo na 26a hora. A paraplegia desenvolvida nos pacientes após a infusão epidural pode ter sido causada por um efeito potencializado do anestésico local devido a hematoma retroperitoneal e/ou pressão intra-abdominal elevada.

Dengue shock syndrome with retroperitoneal haematoma requiring repeated artery angioembolization

A 53-year-old lady was admitted with decompensated dengue shock syndrome during the febrile phase, complicated by massive retroperitoneal bleeding requiring angioembolization. She was initially stabilized by fluid resuscitation at emergency department prior to ICU admission. While in ICU, her haemoglobin level plummeted from 17.5 g/dL to 5.8 g/dL without any obvious source of bleeding. She had hemodynamic instability and worsening acidosis. The abdominal ultrasound performed showed complex ascites and CT abdomen revealed a large right retroperitoneal hematoma with ongoing bleeding. The patient’s hemodynamic was restored and bleeding resolved after angioembolization of the right L2 lumbar artery and right phrenic artery.

Hematoma retroperitoneal de causa infrecuente: a propósito de un caso / Retroperitoneal hematoma of unusual cause: a case report

The spontaneous retroperitoneal hematoma (SRH) is defined as a spontaneous hematic collection located in any of the retroperitoneal compartments. The most frequently encountered cause of retroperitoneal hemorrhage is a ruptured abdominal aortic aneurysm, followed by renal and adrenal tumors, along with some other less common causes. Performing accurate diagnosis of patients at admission has proven to be difficult, given that the clinical presentation is ample and variable and may mimic other pictures of abdominal or lower back pain. Imaging techniques, mainly angiography, computed tomography, and MR Imaging, represent a fundamental tool for both timely diagnosis and proper management of the condition. We report the case of a 56-year-old male patient with diagnosis of HIV, who presented with a history of abdominal pain and palpable abdominal mass. After a thorough imaging evaluation, patient was diagnosed with retroperitoneal hematoma, whose histological analysis revealed a Burkitt lymphoma.

El hematoma retroperitoneal espontáneo (HRE) se define como una colección hemática espontánea, situada en cualquiera de los compartimentos retroperitoneales. Dentro de las causas más frecuentes se encuentran las roturas de aneurisma de aorta abdominal, tumores renales y suprarrenales, entre otras. Habitualmente es difícil realizar el diagnóstico al ingreso del paciente, ya que la presentación clínica es variable y puede simular otros cuadros de dolor abdominal o lumbar. Las técnicas de imagen, especialmente la angiografía, tomografía computada y resonancia magnética, son una herramienta fundamental en el diagnóstico y manejo oportuno del cuadro. Presentamos el caso de un varón de 56 años de edad con diagnóstico de VIH en tratamiento, que debutó como un cuadro de dolor y masa abdominal palpable. Luego de un acabado estudio de imágenes, se diagnosticó un HRE cuyo estudio histológico reveló un Linfoma de Burkitt.

Clinical analysis of 75 patients with traumatic retroperitoneal hematoma / 中国基层医药

ObjectiveTo explore the diagnosis,treatment and prognosis situation of traumatic retroperitoneal hematoma(TRH). Methods The full clinical data of 75 patients with TRH were retrospectively analyzed. Results5 cases of 62 surgical patients died,accounted for surgery patients more than 8.1%.57 cases all cured.Including one for knife led to the rupture of the spleen vessel,abdominal aortic injury,surgery died in hemorrhagic shock,the cumulative loss amounted to 5 000ml;1 case with severe traumatic brain injury,died of a cerebral herniation.The other 3 cases died of cancer and multiple organ failure.13 cases of conservative treatment of all discharged.70 cases were cured,the cured rate was 93.3%. ConclusionMultiple trauma should pay special attention the existence of TRH.When conditions allowed,CT examination should be taken to clear the presence of retroperitoneal hematoma and the presence of abdominal organ injuries,and accurate knowledge of the principles of TRH treatment,strictly control surgical indications and retroperitoneal hematoma detection indication should be grasped to save lives and reduce mortality.

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

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.

Blood loss and transcapillary refill in uncontrolled treated hemorrhage in dogs

Objetive: This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment. Methods: Initial blood volume was determined with Tc99m-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 ± 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer's for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5 percent NaCl plus 6.0 percent dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes. Results: Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer's and 7.5 percent NaCl plus 6.0 percent dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer's (group II). Conclusions: Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer's solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.

Retroperitoneal Hematoma Following Enoxaparin Treatment in an Elderly Woman -A Case Report.

Retroperitoneal hematoma may occur as a result of trauma, rupture of arterial aneurysms (aortic or iliac), surgical complications, tumors and anticoagulation therapy. A life threatening retroperitoneal hemorrhage or hematoma is an infrequent complication of anticoagulation treatment. Enoxaparin is a low-molecular-weight heparin (LMWH) with several advantages over unfractionated heparin. Nevertheless, enoxaparin use is not without risk and severe retroperitoneal bleeding may occur following its use with a potentially fatal outcome. We report a case of sixty six years old female patient who develops a fatal retroperitoneal hematoma two days after enoxaparin treatment for acute coronary syndrome.

Retroperitoneal Hematoma as a Serious Complication of Endovascular Aneurysmal Coiling

Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be life-threatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.

Retroperitoneal Hematoma Caused by Ruptured Pancreaticoduodenal Artery Aneurysm

A ruptured aneurysm of the pancreaticoduodenal arteries is an emergency condition, with a high mortality rate. Therefore, early diagnosis and adequate management are needed. Recently, treatment with a transcatheter arterial embolization has decreased the mortality rate. A 68-year-old man presented with persistent abdominal pain and dyspnea. Contrast abdominal computed tomography revealed a large retroperitoneal hematoma, with an actively bleeding focus. An urgent celiac and superior pancreaticoduodenal arteriogram showed a contrast extravasation, about 15 X 8 mm in size, with a saccular aneurysm of the distal anterior superior pancreaticoduodenal artery; therefore transcatheter arterial embolization was performed. The patient's condition improved without complication after the embolization.

A Case of Successful Percutaneous Transarterial Embolization to Injured Pelvic Artery after Vaginal Delivery / 대한산부인과학회잡지

Even though arterial embolization was introduced as a treatment tool for postpartum hemorrhage, it is not performed frequently. As authors applied arterial embolization successfully to the patient who contracted retroperitoneal hematoma after delivery, we reported this case with a brief review of literature.

Retroperitoneal Hematoma Secondary to Terminal Branch of Segmental Artery Injury during Intertransverse Discectomy through Paramedian Muscle Splitting Approach

A 47-year-old man underwent the surgery of intertransverse discectomy through paramedian muscle splitting due to extraforaminal type of far lateral disc herniation at 4th-5th interspace of lumbar vertebrae. The authors encountered the terminal branch of the segmental artery that traversed the extruded disc around the dorsal root ganglion during the sugery. We coagulated the artery by a bipolar coagulator and cut the artery for the discectomy. There was no active bleeding during the surgery. However, the patient suffered from abdominal, right leg and flank pain at the first postoperative day. The follow-up magnetic resonance imaging revealed a retroperitoneal hematoma at the operation site. The patient underwent removal of the retroperitoneal hematoma. We identified the cause of bleeding as the rupture of coagulated terminal branch of the segmental artery around the dorsal root ganglion. The retroperitoneal hematoma was evacuated completely. The ruptured artery was clipped by a small metal clip, and his symptoms subsequently were resolved.

Spontaneous Rupture of Lumbar Artery & Inferior Epigastric Artery in a Hemodialysis Patient / 대한신장학회잡지

We report a case of retroperitoneal hemorrhage and abdominal wall hemorrhage due to spontaneous lumbar artery and inferior epigastric artery rupture, in a patient with chronic renal failure treated with hemodialysis. There was no history of specific trauma. The bleeding was confirmed by CT and angiography, and controlled successfully by selective angiographic embolization. We suggest that a possibility of spontaneous retroperitoneal bleeding should be considered in a case of abdominal pain or mass in a hemodialysis patient.

Dalteparin sodium-associated retroperitoneal hematoma in a patient with diabetic nephropathy / 대한내과학회지

Retroperitoneal Hematoma is a rare intraabdominal bleeding occurring in patients with low- molecular weight heparin anti-coagulant therapy. We report a case of dalteparin sodium-associated retroperitoneal hematoma in a 70-year-old man with diabetic nephropathy with review of this condition in the literature. He had been suffered from type 2 diabetes mellitus and hypertension for 15 years. In July 2002, he was admitted to our hospital because of unstble angina and left pleural effusion. He was treated with dalteparin sodium and aspirin for unstable angina. On the second hospital day, he was refered to division of nephrology for diabetic nephropathy. Laboratory data on admission included white blood cell count of 4,500/mm3, hemoglobin 9.6 g/dL, platelet count 294,000/mm3, BUN 58.1 mg/dL, serum creatinine 4.1 mg/dL, blood glucose 178 mg/dL, hemoglobin A1c 5.9%, PT 13.9 sec (INR: 1.09), and aPTT 50 sec. On days 6 through 8, he had lower back pain, lower extremity pain and neuropathy, anemia and hypotension. Abdominal ultrasound showed 6 x 6 cm-sized well marginated mixed echogenic lesion in psoas muscle and fluid collection in retroperitoneal cavity. Magnetic resonance imaging (MRI) showed increased signal intensity and thickening of the right psoas muscle including 4.7 x 2.3 x 2.1 cm-sized cytic lesion and 6.2X5.3X3.7 cm-sized cystic lesion on the lateral portion of right psoas muscle in T2-weighted images. Percutaneous drainage of cystic lesion was performed by right lateral approach. Hemodialysis was begun without heparinization. Abdominal CT showed 5.5X5 cm-sized high attenuated lesion in right psoas muscle and 5X3 cm, 3X2 cm, 4.5 x 2.5 cm, 4 x 2.5 cm-sized heterogenous, slightly high attenuated lesions in the right lower abdomen and cul-de-sac in the scans with no enhancement. He was treated by conservative therapy. He recovered gradually. Patients with kidney diseases receiving low molecular weight heparin (dalteparin, enoxaparin, etc.) should be closely monitored to prevent serious bleeding complications. The possibility of retroperitoneal hematoma should be considered, whenever symptoms including lower back pain, inguinal pain, leg pain, anemia, or hypotension occured during the lower molecular weight heparin anticoagulant therapy. To our knowledge, this is the first reported case of retroperitoneal hematoma in a patient during dalteparin sodium (Fragmin(R)) anticoagulant therapy.

Enoxaparin-associated Retroperitoneal Hematoma in Two Chronic Dialysis Patients / 대한신장학회잡지

Low molecular weight heparin has greater advantages over unfractionated heparin. It is more bioavailable, and laboratory monitoring is not necessary. Compared with unfractionated heparin, low molecular weight heparin does not result in increased risk of major bleeding. However, the bleeding tendency is not predictable in patients with renal failure, because elimination of low molecular weight heparin is delayed and it does not alter prothrombin times or partial thromboplastin times. Recently, we experienced two cases of enoxaparin-associated retroperitoneal hematoma in chronic dialysis patients. A 57- year-old woman developed retroperitoneal bleeding, during treatment with enoxaparin(1 mg/kg q 12 hours) and oral aspirin. The other patient, a 49- year-old man developed retroperitoneal hematoma after discontinuation of enoxaparin and aspirin. Both patients had inguinal pain, femoral neuropathy, anemia and hypotension. They recovered gradually and their hematoma size were decreased by conservative treatment. These results suggest that anti-Xa acivity monitoring may be warranted in renal insufficiency patients who are receiving low molecular weight heparin If anti-Xa activity test is not available, unfractionated heparin could be used with monitoring of activated partial thromboplastin time. And the possibility of retroperitoneal hematoma should be considered, whenever the acute symptoms including inguinal pain, leg pain, anemia, or hypotension occured during the anticoagulation therapy.

Retroperitoneal Hematoma after Excision of Lumbar Extradural Arachnoid Cyst: Case Report

Many cases of retroperitoneal hematoma related to spine surgery have been reported, however, most of them were caused by major vessel injury related to intradiscal or retroperitoneal procedures. We report an unusual case of a retroperitoneal hematoma followed by surgical excision of the lumbar extradural arachnoid cyst without intradiscal procedure. To our best knowledge, this complication without intradiscal procedure has not been described previoulsly. The pathogenetic mechanism of retroperitoneal hematoma in this report is unclear. We discuss the plausible pathophysiological mechanisms of retroperitoneal hematoma which developed after excision of arachnoid cyst.