Sciatic nerve compression during anticoagulation therapy. Computerized tomography aids in diagnosis.
Severe hip pain developed in a patient who was receiving anticoagulation therapy of heparin sodium and warfarin sodium (Coumadin) for femoral vein phlebitis. The patient had exquisite tenderness but no ecchymoses along the sciatic nerve. A drop in the hemoglobin level showed a large volume loss of blood. Retroperitoneal hematoma with lumbar plexopathy was suspected, but a computerized tomographic scan revealed instead hemorrhage into the gluteal muscles. The anticoagulation therapy was corrected with the addition of protamine sulfate and vitamin K; the patient's pain lessened and the hemoglobin level stabilized. Computerized tomography allowed clear visualization of the hematomas in the buttock, and invasive studies were avoided. Hip pain and a falling hemoglobin level in a patient receiving anticoagulation therapy should alert one to the possibility of bleeding into the retroperitoneal space, thigh, or buttock.
D000925:Anticoagulants / Q000009:adverse effects*; D002081:Buttocks / Q000000981:diagnostic imaging; D006406:Hematoma / Q000139:chemically induced / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000139:chemically induced / Q000150:complications / Q000000981:diagnostic imaging; D009408:Nerve Compression Syndromes / Q000000981:diagnostic imaging / Q000209:etiology*; D012584:Sciatic Nerve; D014057:Tomography, X-Ray Computed
D000925:Anticoagulants