title: Retroperitoneal hemorrhage from an unrecognized puncture of the lumbar right segmental artery during lumbar chemical sympathectomy: diagnosis and management.
abstract: Lumbar chemical sympathectomy has been performed using fluoroscopic guidance for needle positioning. An 84 year old woman with atherosclerosis obliterans was referred to the pain clinic for intractable cold allodynia of her right foot. A thermogram showed decreased temperature of both feet compared with temperatures above both ankles. The patient agreed to undergo lumbar chemical sympathectomy using fluoroscopy after being informed of the associated risks of nerve injury, hemorrhage, infection, transient back pain, and transient hypotension. During the procedure and three hours afterward, no abnormal signs or symptoms were found except an increase in right leg temperature. The patient was ambulatory after the procedure. However, one day after undergoing lumbar chemical sympathectomy, she visited our emergency department for abdominal discomfort and postural dizziness. Her blood pressure was 80/50 mmHg, and flank tenderness was noted. Retroperitoneal hemorrhage from the second right lumbar segmental artery was shown on computed tomography and angiography. Vital signs were stabilized immediately after embolization into the right lumbar segmental artery.
authors.affiliation: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, 626-770, Korea.
authors.forename: Ho-Jin
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, 626-770, Korea.
authors.forename: Yun-Mi
authors.initials: YM
authors.lastname: Choi
authors.affiliation: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, 626-770, Korea.
authors.forename: Hye-Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, 626-770, Korea.
authors.forename: Sun-Jae
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, 626-770, Korea.
authors.forename: Seok-Hyun
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, 626-770, Korea. Electronic address: pain@pusan.ac.kr.
authors.forename: Kyung-Hoon
authors.initials: KH
authors.lastname: Kim
mesh_terms: D000369:Aged, 80 and over; D000792:Angiography; D001158:Arteries / Q000293:injuries*; D001162:Arteriosclerosis Obliterans / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology / Q000628:therapy; D008159:Lumbar Vertebrae / Q000098:blood supply / Q000473:pathology; D012187:Retroperitoneal Space; D013563:Sympathectomy, Chemical / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: Atherosclerosis; hemorrhage; lumbar chemical sympathectomy; spinal artery; therapeutic embolization