title: Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report.
abstract: BACKGROUND
  Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present as a rare life-threatening event characterized by sudden onset of bleeding into the retroperitoneal space, occurring in association with bleeding disorders, intratumoral bleeding, or ruptures of any retroperitoneal organ or aneurysm. The spontaneous form is the most infrequent retroperitoneal hemorrhage, causing significant morbidity and representing a diagnostic challenge.
  
  
  METHODS
  We report the case of a patient with coronary artery disease who presented with transient ischemic attack, in whom anticoagulant therapy with heparin precipitated a massive spontaneous atraumatic retroperitoneal hemorrhage (with international normalized ratio 2.4), which was treated conservatively.
  
  
  CONCLUSIONS
  Delay in diagnosis is potentially fatal and high clinical suspicion remains crucial. Finally, it is a matter of controversy whether retroperitoneal hematomas should be surgically evacuated or conservatively treated and the final decision should be made after taking into consideration patient's general condition and the possibility of permanent femoral or sciatic neuropathy due to compression syndrome.
authors.affiliation: Herz- und Diabeteszentrum Nordrhein, Westfalen, Georgstrasse, Bad Oeynhausen, Universitätsklinikum der Ruhr-Universität Bochum, Germany. sdaliak@otenet.gr
authors.forename: Stavros I
authors.initials: SI
authors.lastname: Daliakopoulos
authors.forename: Andreas
authors.initials: A
authors.lastname: Bairaktaris
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Papadimitriou
authors.forename: Perikles
authors.initials: P
authors.lastname: Pappas