Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Register      Login

VOLUME 11 , ISSUE 1 ( January-April, 2022 ) > List of Articles

CASE REPORT

Retroperitoneal Hematoma as a Complication of Anticoagulation Therapy with Heparin

Gaby Jabbour, Rachel Beekman, Taylor Powell, Kevin Gobeske

Keywords : Arterial embolization, Deep vein thrombosis, Heparin, Protamine, Spontaneous retroperitoneal hemorrhage

Citation Information : Jabbour G, Beekman R, Powell T, Gobeske K. Retroperitoneal Hematoma as a Complication of Anticoagulation Therapy with Heparin. Panam J Trauma Crit Care Emerg Surg 2022; 11 (1):51-53.

DOI: 10.5005/jp-journals-10030-1372

License: CC BY-NC 4.0

Published Online: 04-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: We report the case of a large spontaneous retroperitoneal hemorrhage in a patient receiving a heparin infusion. He was treated by blood transfusion, reversal with protamine, and angioembolization. Background: Spontaneous retroperitoneal hemorrhage can present as a rare life-threatening event characterized by sudden onset of bleeding into the retroperitoneal space, occurring in association with bleeding disorders, tumors, or anticoagulation. Case description: We report the case of a patient with central cord syndrome who was treated with heparin infusion for upper limb deep vein thrombosis. This was complicated by a large spontaneous retroperitoneal hemorrhage, which was treated by blood transfusion, reversal with protamine, and angioembolization. Retroperitoneal bleeding is a medical emergency that is often difficult to diagnose due to its rarity and the nonspecific symptoms with which it presents. Treatment may vary. In our case, blood transfusion, reversal of heparin with protamine, and interventional treatment were performed as active bleeding was recognized on angiography. Conclusion: Idiopathic retroperitoneal hemorrhage is an uncommon condition that may lead to shock if not promptly recognized. Timely diagnosis and treatment help improve outcomes. Clinical significance: This is a rare and challenging complication. Timely diagnosis requires high clinical suspicion. Management depends on hemodynamic stability. This case highlights the importance of early detection and treatment and opens the door for more studies to minimize related complications.


PDF Share
  1. Sunga KL, Bellolio MF, Gilmore RM, et al. Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med 2012;43(2):e157–161. DOI: 10.1016/j.jemermed.2011.06.006
  2. Ibrahim W, Mohamed A, Sheikh M, et al. Antiplatelet therapy and spontaneous retroperitoneal hematoma: A case report and literature review. Am J Med Case Rep 2017;18:85–89. DOI: 10.12659/ajcr.901622
  3. Chan YC, Morales JP, Reidy JF, et al. Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery?. Int J Clic Pract 2008;62(10):1604–1613. DOI: 10.1111/j.1742-1241.2007.01494.x
  4. Wolff JM, Jung PK, Adam G, et al. Spontaneous retroperitoneal haemorrhage associated with renal disease. JR Coll Surg Edinb 1998;43:53–56. PMID: 9560512.
  5. Pless T, Loertzer H, Brandt S, et al. Atraumatic retroperitoneal hemorrhage: interdisciplinary and differential diagnostic considerations based on a case report. Anaesthesiol Reanim 2003;28:50–53. PMID: 12756966.
  6. Seropian IM, Angiolillo DJ, Zenni MM, et al. Should endovascular approach be the first line of treatment for retroperitoneal bleeding with hemodynamic shock following percutaneous intervention? A case series. Catheter Cardiovasc Interv 2017;90(1):104–111. DOI: 10.1002/ccd.26775
  7. Surani S, Estement B, Manchandan S, et al. Spontaneous extraperitoneal lumbar artery hemorrhage. J Emerg Med 2011;40:e111–e114. DOI: 10.1016/j.jemermed.2008.01.029
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.