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Massive retroperitoneal haemorrhage after extracorporeal shock wave lithotripsy (ESWL)

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Abstract

A 76-year-old male suffering from nephrolithiasis developed a shock syndrome 5 days after extracorporal shock wave lithotripsy (ESWL). CT scan of the abdomen showed massive haemorrhage around the right kidney. Although nephrectomy was performed immediately, the haemorrhage could not be controlled. Numerous units of erythrocytes were transfused, but the patient died. The autopsy revealed massive retroperitoneal haemorrhage around the right kidney. The kidney showed a subcapsular haematoma and a rupture of the capsule. The right renal artery was dissected. The inferior vena cava was lacerated. Accordingly, a hemorrhagic shock as the cause of death was determined, which might mainly have resulted from the laceration of the inferior vena cava due to ESWL. ESWL seems to be a relatively non-invasive modality, but one of its severe complications is perirenal hematoma. The injuries of the blood vessels might have been caused by excessive shock waves. Subsequently, anticoagulation therapy had been resumed 3 days after EWSL, which might have triggered the haemorrhage. Physicians should note that a haemorrhage after an ESWL can occur and they should pay attention to the postoperative management in aged individuals especially when they are under anticoagulation therapy.

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References

  1. Chaussy C, Schuller J, Schmiedt E, Brandl H, Jocham D, Liedl B (1984) Extracorporeal shock-wave lithotripsy (ESWL) for treatment of urolithiasis. Urology 23:59–66

    Article  CAS  PubMed  Google Scholar 

  2. Skolarikos A, Alivizatos G, de la Rosette J (2006) Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention. Eur Urol 50:981–990

    Article  PubMed  Google Scholar 

  3. Miller NL, Lingeman JE (2007) Management of kidney stones. BMJ 334:468–472

    Article  PubMed  Google Scholar 

  4. Choi KS, Kim MH (2006) Extracorporeal shock wave lithotripsy for the treatment of pancreatic duct stones. J Hepatobiliary Pancreat Surg 13:86–93

    Article  PubMed  Google Scholar 

  5. Labanaris AP, Kühn R, Schott GE (2007) Peritoneal hematomas induced by extracorporeal shock wave lithotripsy (ESWL): therapeutic management. Scientific World Journal 7:1563–1566

    PubMed  Google Scholar 

  6. Dhar NB, Thornton J, Karafa MT, Stream SB (2004) A multivariate analysis of risk factors associated with subcapsular hematoma formation following electromagnetic shock wave lithotripsy. J Urol 172:2271–2274

    Article  PubMed  Google Scholar 

  7. Uemura K, Takahashi S, Shintani-Ishida K, Nakajima M, Saka K, Yoshida K (2008) A death due to perirenal hematoma complicating extracorporeal shockwave lithotripsy (ESWL). J Forensic Sci 53:469–471

    Article  PubMed  Google Scholar 

  8. Törő K, Kardos M (2008) Fatal renal haemorrhage after extracorporeal shock wave lithotripsy. J Forensic Sci 53:1191–1193

    Article  PubMed  Google Scholar 

  9. Douketis JD, Johnson JA, Turpie AG (2004) Low-molecular-weight heparin as bridging anticoagulation during interruption of warfarin. Arch Intern Med 164:1319–1326

    Article  CAS  PubMed  Google Scholar 

  10. Crowther MA, Warkentin TE (2008) Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood 111:4871–4879

    Article  CAS  PubMed  Google Scholar 

  11. Hylek EM, Chang YC, Skates SJ, Hughes RA, Singer DE (2000) Prospective study of the outcomes of ambulatory patients with excessive warfarin anticoagulation. Arch Intern Med 160:1612–1617

    Article  CAS  PubMed  Google Scholar 

  12. Schulman S, el Bouazzaoui B, Eikelboom JW, Zondag M (2008) Clinical factors influencing the sensitivity to warfarin when restarted after surgery. J Intern Med 263:412–419

    Article  CAS  PubMed  Google Scholar 

  13. Fracasso T, Karger B, Pfeiffer H, Sauerland C, Schmeling (2009) Immunohistochemical identification of prevalent right ventriclar ischemia causing right heart failure in cases of pulmonary fat embolism. Int J Leg Med. doi:10.1007/s00414-009-0382-3

    Google Scholar 

  14. Patel J, Sheppard MN (2009) Cystic tumour of the atrioventricular node: three cases of sudden death. Int J Leg Med. doi:10.1007/s00414-009-0399-7

    Google Scholar 

  15. Schmeling A, Fracasso T, Pragst F, Tsokos M, Wirth I (2009) Unassisted smothering in a pillow. Int J Leg Med 123:517–519

    Article  Google Scholar 

  16. Ortmann C, Wüllenweber J, Brinkmann B, Fracasso T (2010) Fatal mycotic aneurysm caused by Pseudallescheria boydii after near drowning. Int J Leg Med 124:243–247

    Article  CAS  Google Scholar 

  17. Turpin I, State D, Schwartz A (1977) Injuries to the inferior vena cava and their management. J Am Surg 134:25–32

    Article  CAS  Google Scholar 

  18. Jan WA, Samad A, Anwar R (2004) Mortality and morbidity of abdominal inferior vena-cava injuries. J Coll Physicians Surg Pak 14:622–625

    PubMed  Google Scholar 

  19. Smith BM, Holcomb GW III, Richie RE, Dean RH (1984) Renal artery dissection. Ann Surg 200:134–146

    Article  CAS  PubMed  Google Scholar 

  20. Kanofsky JA, Lepor H (2007) Spontaneous renal artery dissection. Rev Urol 9:156–160

    PubMed  Google Scholar 

  21. Vella M, Caramia M, Maltese M, Melloni D, Caramia G (2007) ESWL prediction of outcome and failure prevention. Urol Int 79:47–50

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Legal Medicine, Essen University Hospital, Duisburg-Essen University, Hufelandstrasse 55, 45122, Essen, Germany

    Hiromasa Inoue, Thomas Kamphausen, Thomas Bajanowski & Kurt Trübner

  2. Department of Forensic Medicine and Sciences, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan

    Hiromasa Inoue

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  1. Hiromasa Inoue
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  2. Thomas Kamphausen
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  4. Kurt Trübner
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Correspondence to Hiromasa Inoue.

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Inoue, H., Kamphausen, T., Bajanowski, T. et al. Massive retroperitoneal haemorrhage after extracorporeal shock wave lithotripsy (ESWL). Int J Legal Med 125, 75–79 (2011). https://doi.org/10.1007/s00414-010-0489-6

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  • DOI: https://doi.org/10.1007/s00414-010-0489-6

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