Iliopsoas Haematoma: A Rare Complication of Warfarin Therapy

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http://www.jcpsp.pk/archive/2012/Oct2012/18.pdf

ABSTRACT

Iliopsoas haematoma is a rare complication that occurs in patients receiving anticoagulant therapy. The clinical
manifestation of iliopsoas haematoma is non-specific. It can mimic orthopaedic or neurological disorders, including
paraesthesia or paresis of the thigh and leg due to compression of the nerve plexus. Among the many available diagnostic
modalities, computed tomography is the most useful radiological method for diagnosis. Treatment approaches for iliopsoas
haematoma include conservative therapy, surgical intervention, or transcatheter arterial embolisation. Conservative
therapy consists of bed rest, restoration of circulating volume, and drug discontinuation for correcting underlying
coagulopathy. Although a conservative approach is the first choice, transcatheter arterial embolisation and surgical
intervention may be required in patients with hemodynamically unstable and active bleeding. The report described a case
of iliopsoas haematoma due to anticoagulant therapy with paraesthesia in the left leg who was successfully treated by
conservative approach.

INTRODUCTION

Haemorrhage is reported in approximately 4% of patients
receiving anticoagulant agents, especially Heparin and
Warfarin.1,2 Major locations of haemorrhage in these
patients include intracranial and retroperitoneal sites.3
Retroperitoneal is most common in patients with trauma,
hemophilia, or under treatment with anticoagulants.4
Iliopsoas haematoma is a rare complication associated
with bleeding diathesis, trauma, and anticoagulant
therapy. Symptoms of iliopsoas haematoma are nonspecific,
and may include muscle dysfunction and
abdominal or flank pain radiating into the groin, labia, or
scrotum. Compression of the femoral nerve, which
runs along the iliac muscle through the femoral canal, by
the haematoma can lead to paraesthesia or paresis
of the thigh and leg.5 Depending on the rapidity of
haemorrhage and volume of blood loss, massive
bleeding or shock may also be present. Diagnosis is
based on clinical manifestations and imaging studies
such as ultrasonography and contrast-enhanced computed
tomography (CT). On CT, iliopsoas haematoma
appears as a high density mass in the retroperitoneal
space, with enlargement of the involved muscles.6
Treatment of iliopsoas haematoma is generally conservative,
with correction of the coagulation profile.
Interventional radiological or surgical treatment may be
required in patients with haemodynamically unstable and
active bleeding.1-3
Here, we report a case of iliopsoas haematoma in an old
woman during use of warfarin who was treated conservatively.