Spontaneous retroperitoneal hematoma associated with iliac vein rupture.
OBJECTIVE
Spontaneous retroperitoneal hematoma (SRH) associated with iliac vein rupture is a rare but life-threatening emergency with high operative mortality. This study summarizes our experience in providing diagnostic and therapeutic management for this rare clinical entity.


METHODS
Between May 2002 and May 2009, nine patients were admitted to our hospital for SRH and acute deep venous thrombosis (DVT). Medical data for demographics, clinical presentation, auxiliary examinations, treatment modalities, outcomes, and follow-up were retrospectively analyzed.


RESULTS
Nine patients (8 women, 1 man) were enrolled in this study. All were aged>45 years (range, 46-70 years). The common clinical manifestations were sudden onset of left lower abdominal or lumbar pain, swelling of the left lower extremity, anemia, and hypotension. Most patients were diagnosed by duplex ultrasound imaging and computed tomography scan. Three patients were treated conservatively, and six underwent surgical or combined treatments, comprising 2 repairs of iliac vein, 1 iliac vein ligation and Palma-Dale bypass graft, 1 pelvic vein ligation, 1 removal of hematoma, and 1 repair of iliac vein, thrombectomy, and endovascular stent placement. The iliac vein ruptured in five patients. May-Thurner syndrome was found in three patients. One patient died after surgery (operative mortality, 16.7%). Postoperative morbidity was 50%. Mean volume of perioperative blood transfusion was 900±640 mL (range, 0-2000 mL). Mean lengths of stay were 2.7±1.4 days (range, 2-5 days) in the intensive care unit and 16.9±2.4 days (range, 14-21 days) in the hospital. Eight patients were postoperatively treated with 6 months of warfarin. Mean follow-up was 30.5±15.0 months (range, 6-50 months). The occurrence rate of chronic venous insufficiency was 87.5% during follow-up.


CONCLUSIONS
SRH with concomitant DVT, especially in women aged >45, should be considered in patients with sudden lower abdominal or lumbar pain, leg swelling, anemia, and shock. Spontaneous iliac vein rupture and the presence of May-Thurner syndrome should be considered in these patients. Surgical interventions were associated with high mortality and morbidity. In our experience, conservative therapy was safer than open surgical procedures.
Jiang
Jianjun
J
Department of Vascular Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
Ding
Xiangjiu
X
Zhang
Guangyong
G
Su
Qingbo
Q
Wang
Zhanmin
Z
Hu
Sanyuan
S
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001803:Blood Transfusion; D002681:China; D057510:Endovascular Procedures; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014656:Vascular Surgical Procedures; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy
D000925:Anticoagulants