Abstract
Spontaneous iliopsoas muscle haematoma is a rare complication in patients receiving anticoagulants.
We present the case of spontaneous iliopsoas muscle haematoma in a 68-year-old male patient under anticoagulant therapy with dicumarol in combination with acetylsalicylic acid 100 mg. The patient was admitted with clinical symptoms of sudden pain and extensive swelling along his left abdominal lower quadrant, and clinical findings of a hard, pulseless, painful swelling of the left lateral abdomen with pain extending along the left femoroinguinal region. His pulse rate was 92/min and blood pressure 120/85 mm Hg. Laboratory investigations indicated a grossly deranged INR (17.7) and a drop in Hct (22.0%). The diagnosis of a left iliopsoas muscle haematoma was established with ultrasonography and computed tomography. The patient was managed conservatively with administration of fluids and a blood transfusion while the coagulation profile was corrected with vitamin K and fresh frozen plasma.
The spontaneous iliopsoas muscle haematoma in patients who are on anticoagulant treatment is uncommon and its management controversial since approaches to therapy vary among conservative, interventional radiology and open surgery, depending on the cause and volume of the haematoma, timing of diagnosis, degree of neurological impairment and haemodynamical stability.
Similar content being viewed by others
References
Wysowski DK, Nourjah P, Swartz L. Bleeding complications with warfarin use-a prevalent adverse effect resulting in regulatory action. Arch Intern Med 2007;167:1414–9
Murena L, Vulcano E, Salvato E, Marano M, D'Angelo F, Cherubino P. Bilateral iliopsoas intramuscular bleeding following anticoagulant therapy with heparin: a case report. Cases J 2009;2:7534. doi: 10.4076/1757-1626-2-7534.
Wada Y, Yanagihara C, Nishimura Y. Bilateral Iliopsoas hematomas complicating anticoagulant therapy. Internal Medicine (Tokyo) 2005;44:641–3.
Parmer SS, Carpenter JP, Fairman RM, Velazquez OC, Mitchell ME. Femoral neuropathy following retroperitoneal hemorrhage: case series and review of the literature. Ann Vasc Surg 2006;20:536–40.
Ozkan OF, Guner A, Cekic AB, Turan T, Kaya U, Reis E. Iliopsoas haematoma: a rare complication of warfarin therapy. J Coll Physicians Surg Pak 2012;22:673–4.
Oake N, Jennings A, Forster AJ, Fergusson D, Doucette S, Walraven CV. Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis. CMAJ 2008;179:235–44.
Ho KJ, Gawley SD, Young MR. Psoas haematoma and femoral neuropathy associated with enoxaparin therapy. Int J Clin Pract 2003;57:553–4.
Yogarajah M, Sivasambu B, Jaffe EA. Spontaneous iliopsoas haematoma: a complication of hypertensive urgency. BMJ Case Rep 2015 Feb 26;2015. pii: bcr2014207517. doi:10.1136/bcr-2014-207517.
Risch O, Alfidja A, Mulliez A, et al. Severe non-traumatic bleeding events detected by computed tomography: do anticoagulants and antiplatelet agents have a role? J Cardiothorac Surg 2014;9:166.
Dunning J, Versteegh M, Fabbri A, et al; EACTS Audit and Guidelines Committee. Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg 2008;34:73–92.
Parmer SS, Carpenter JP, Fairman RM, Velazquez OC, Mitchell ME. Femoral neuropathy following retroperitoneal hemorrhage: case series and review of the literature. Ann Vasc Surg 2006;20:536–40.
Choa GP, Lim CS. Iliopsoas hematoma: An uncommon differential diagnosis for groin pain. Hong Kong J Emerg Med 2011;18:173–6.
Seijo-Martinez M, Castro del Rio M, Fontoira E, Fontoira M. Acute femoral neuropathy secondary to an iliacus muscle hematoma. J Neurol Sci 2003;209:119–22.
Jamjoom ZA, al-Bakry A, al-Momen A, Malabary T, Tahan AR, Yacub B. Bilateral femoral nerve compression by iliacus hematomas complicating anticoagulant therapy. Surg Today 1993;23:535–40.
Sharma D, Saker R, Govind A. Emergency department ultrasound diagnosis of spontaneous iliopsoas haemorrhage in a patient on warfarin. BMJ Case Rep 2013;2013. pii: bcr2013201291. doi:10.1136/bcr-2013-201291.
Muttarak M, Peh WC. CT of unusual iliopsoas compartment lesions. Radiographics 2000;20:S53–66.
Qanadli SD, EI Hajjam, Mignon F, Bruckert F, Chagnon S, Lacombe P. Life-threatening spontaneous psoas haematoma treated by transcatheter arterial embolization. Eur Radiol 1999;9:1231–4.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Retselas, I.N., Vaiopoulos, C.K., Chronopoulos, P.N. et al. Spontaneous iliopsoas muscle haematoma during anticoagulant treatment. Hellenic J Surg 87, 434–436 (2015). https://doi.org/10.1007/s13126-015-0254-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13126-015-0254-x