Lindsey Mossler, MD, Andrew Eppstein, MD. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA Surgery Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
Introduction: Retroperitoneal hematoma is an uncommon condition seldom requiring operative intervention. Uncomplicated retroperitoneal hematoma is typically treated with observation, transfusion and correction of coagulopathy. In more complex cases, radiologic intervention and even operative intervention may be required. We describe a case of complex retroperitoneal hematoma addressed laparoscopically through an anterior extraperitoneal approach.
Methods and Procedures: A 69-year-old-male on rivaroxiban for atrial fibrillation presented to the Emergency Department with 24 hours of severe left upper thigh, flank, and abdominal pain. On exam he had left abdominal guarding and rebound tenderness. His INR was 3.0 with hemoglobin 6.2 g/dL, though he was hypertensive. Abdominal CT demonstrated a large left retroperitoneal hematoma with active extravasation. He responded to fluid resuscitation and transfusion, followed by Interventional Radiology coiling and gel foam embolization of the left fifth lumbar and left internal iliac arteries. Despite embolization, he continued to have severe left thigh pain and 2/5 strength in hip flexion and knee extension, suggesting progressive femoral nerve dysfunction. He was taken to the operating room for laparoscopic evacuation of the hematoma using an anterior extraperitoneal approach. Entry to the preperitoneal plane was accomplished using a standard TEP balloon dissector and port placement. Dissection into the lateral preperitoneal space allowed visualization and evacuation of the large hematoma with suction and a 10 mm biopsy spoon forceps. Closed suction drains were placed. There were no intraoperative complications.
Results: No further bleeding complications arose and the patient was discharged to home on postoperative day 4 with improved range of motion of his left leg and appropriate analgesia. Drains were removed prior to discharge. By his 4-week follow-up, numbness and tingling improved, though he continued to have some pain and weakness necessitating outpatient physical therapy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80232
Program Number: P137
Presentation Session: Poster (Non CME)
Presentation Type: Poster