Annals of Vascular Surgery

, Volume 20, Issue 4, pp 536–540 | Cite as

Femoral Neuropathy following Retroperitoneal Hemorrhage: Case Series and Review of the Literature

  • Shane S. Parmer
  • Jeffrey P. Carpenter
  • Ronald M. Fairman
  • Omaida C. Velazquez
  • Marc E. MitchellEmail author
Case Reports


Femoral neuropathy due to retroperitoneal hematoma has been infrequently described in the literature. While occasionally due to trauma, it has been most commonly reported in association with various bleeding diatheses and therapeutic anticoagulation. As the indications for the use of anticoagulants and antiplatelet agents increase, associated hemorrhagic complications will likely also increase. The management of retroperitoneal hematoma with consequent femoral nerve palsy remains controversial. We present a series of four cases of femoral nerve palsy due to retroperitoneal hematoma managed by surgical decompression. Hematoma evacuation at the time of the development of femoral neuropathy results in immediate benefit, with greater likelihood of a return to pre-event neurological status. Delays in operative treatment, despite the presence of a neurological deficit, may lead to significant and prolonged neurological dysfunction. Surgical decompression should be highly considered in all patients who develop femoral neuropathy from a retroperitoneal hematoma.


Chronic Lymphocytic Leukemia Femoral Nerve Inferior Vena Cava Filter Unenhanced Compute Tomographic Retroperitoneal Hematoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Reinstein L, Alevizatos AC, Twardzik FG, et al. Femoral nerve dysfunction after retroperitoneal hemorrhage: pathophysiology revealed by computed tomography. Arch Phys Med Rehabil 1984;65:37–40PubMedGoogle Scholar
  2. 2.
    Fealy S, Paletta GA Jr. Femoral nerve palsy secondary to traumatic iliacus muscle hematoma: course after nonoperative management. J Trauma 1999;47:1150–1152PubMedGoogle Scholar
  3. 3.
    Cuvelier C. Images in clinical medicine. Psoas hematoma N Engl J Med 2001;344:349CrossRefGoogle Scholar
  4. 4.
    Silverstein A. Neuropathy in hemophilia. JAMA 1964;190:554–555PubMedGoogle Scholar
  5. 5.
    Goodfellow J, Fearn CB, Matthews JM. Iliacus haematoma. A common complication of haemophilia. J Bone Joint Surg Br 1967;49:748–756PubMedGoogle Scholar
  6. 6.
    Butterfield WC, Neviaser RJ , Roberts MP. Femoral neuropathy and anticoagulants. Ann Surg 1972;176:58–61PubMedCrossRefGoogle Scholar
  7. 7.
    Mant MJ, O’Brien BD, Thong KL, et al. Haemorrhagic complications of heparin therapy. Lancet 1977;1:1133–1135PubMedCrossRefGoogle Scholar
  8. 8.
    Forfar JC. A 7-year analysis of haemorrhage in patients on long-term anticoagulant treatment. Br Heart J 1979;42:128–132PubMedCrossRefGoogle Scholar
  9. 9.
    Nobel W, Marks SC Jr, Kubik S. The anatomical basis for femoral nerve palsy following iliacus hematoma. J Neurosurg 1980;52:533–540PubMedCrossRefGoogle Scholar
  10. 10.
    Merrick HW, Zeiss J, Woldenberg LS. Percutaneous decompression for femoral neuropathy secondary to heparin-induced retroperitoneal hematoma: case report and review of the literature. Am Surg 1991;57:706–711PubMedGoogle Scholar
  11. 11.
    Lindner A, Zierz S. Images in clinical medicine. Retroperitoneal hemorrhage. N Engl J Med 2001;344:348PubMedCrossRefGoogle Scholar
  12. 12.
    Marquardt G, Barduzal Angles S, Leheta F, et al. Spontaneous haematoma of the iliac psoas muscle: a case report and review of the literature. Arch Orthop Trauma Surg 2002;122:109–111PubMedCrossRefGoogle Scholar
  13. 13.
    Giuliani G, Poppi M, Acciarri N, et al. CT scan and surgical treatment of traumatic iliacus hematoma with femoral neuropathy: case report. J Trauma 1990;30:229–231PubMedCrossRefGoogle Scholar
  14. 14.
    Ankarath S, Campbell P. Psoas hematoma presenting as hip pain. Orthopedics 2001;24:689–690PubMedGoogle Scholar
  15. 15.
    Nakao A, Sakagami K, Mitsuoka S, et al. Retroperitoneal hematoma associated with femoral neuropathy: a complication under antiplatelets therapy. Acta Med Okayama 2001;55:363–366PubMedGoogle Scholar

Copyright information

© Annals of Vascular Surgery Inc. 2006

Authors and Affiliations

  • Shane S. Parmer
    • 1
  • Jeffrey P. Carpenter
    • 1
  • Ronald M. Fairman
    • 1
  • Omaida C. Velazquez
    • 1
  • Marc E. Mitchell
    • 2
    • 3
    Email author
  1. 1.Division of Vascular SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Division of Vascular SurgeryUniversity of Mississippi Medical CenterJacksonUSA
  3. 3.Division of Vascular SurgeryUniversity of Mississippi Medical CenterJacksonUSA

Personalised recommendations