title: Abdominal compartment syndrome due to spontaneous retroperitoneal hemorrhage in a patient undergoing anticoagulation.
abstract: 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.
authors.affiliation: Department of General Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea.
authors.forename: Dae-Yeon
authors.initials: DY
authors.lastname: Won
authors.forename: Sang-Dong
authors.initials: SD
authors.lastname: Kim
authors.forename: Sun-Chul
authors.initials: SC
authors.lastname: Park
authors.forename: In-Sung
authors.initials: IS
authors.lastname: Moon
authors.forename: Ji Il
authors.initials: JI
authors.lastname: Kim
mesh_terms: D000005:Abdomen; D000925:Anticoagulants / Q000009:adverse effects*; D003161:Compartment Syndromes / Q000209:etiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000151:congenital*; D006406:Hematoma / Q000209:etiology / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants