title: [Unclear Abdominal Pain - Not Always a Gastroenterological Emergency].
abstract: History and admission findingsAn 84-year old patient with persistent atrial fibrillation and chronic renal failure received a subcutaneous injection with low molecular weight heparin (LMWH) during a hospital stay. Over the course of her hospitalization, the patient developed abdominal pain. There was a marked hematoma at the injection site. A large tumor was palpable in the right abdominal quadrant.ExaminationsDue to the significant reduction in hemoglobin, we performed a CT-angiogram of the abdomen.DiagnosisWe were able to visualize an intramuscular hematoma within the rectus abdominis muscle.Therapy and clinical courseAfter visualization with digital subtraction angiography and application of microcoils and histoacryl-glue, we were able to stop bleeding. After implantation of left atrial appendage occluder, oral anticoagulation therapy could be stopped.ConclusionLMWH-treated patients with nonspecific abdominal pain should be meticulously examined to exclude iatrogenic abdominal muscle hematoma.
authors.affiliation: Klinik für Kardiologie und Angiologie, Otto-von-Guericke Universität, Magdeburg.
authors.forename: Anna Teresa
authors.initials: AT
authors.lastname: Aschoff
authors.affiliation: Klinik für Radiologie, Otto-von-Guericke Universität, Magdeburg.
authors.forename: Maciej
authors.initials: M
authors.lastname: Pech
authors.affiliation: Klinik für Radiologie, Otto-von-Guericke Universität, Magdeburg.
authors.forename: Frank
authors.initials: F
authors.lastname: Fischbach
authors.affiliation: Klinik für Radiologie, Otto-von-Guericke Universität, Magdeburg.
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
authors.affiliation: Klinik für Kardiologie und Angiologie, Otto-von-Guericke Universität, Magdeburg.
authors.forename: Blerim
authors.initials: B
authors.lastname: Luani
authors.affiliation: Klinik für Kardiologie und Angiologie, Otto-von-Guericke Universität, Magdeburg.
authors.forename: Rüdiger Christian
authors.initials: RC
authors.lastname: Braun-Dullaeus
authors.affiliation: Klinik für Kardiologie und Angiologie, Otto-von-Guericke Universität, Magdeburg.
authors.forename: Jörg
authors.initials: J
authors.lastname: Herold
mesh_terms: D000009:Abdominal Muscles / Q000187:drug effects; D015746:Abdominal Pain / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000175:diagnosis; D006406:Hematoma / Q000139:chemically induced* / Q000175:diagnosis* / Q000517:prevention & control; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009135:Muscular Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight