Retroperitoneal hemorrhage is rarely associated with acute deep vein thrombosis (DVT). We present a case of retroperitoneal hemorrhage due to disruption of the external iliac vein associated with acute DVT, which was carefully treated with an anticoagulant. A 78-year-old woman complained of acute abdominal pain. Contrast-enhanced computed tomography (CT) showed left retroperitoneal hematoma and venous thrombosis from just above the bifurcation of the inferior vena cava to the left femoral vein. She was admitted for conservative treatment without an anticoagulant. The next day, she developed pulmonary embolism (PE), but administration of an anticoagulant was not started because of the possibility of rebleeding. Forty-four hours after the onset of PE, unfractionated heparin was administrated intravenously. After initiation of anticoagulation, retroperitoneal hemorrhage did not expand and PE did not get worse. Follow-up contrast-enhanced CT suggested May-Thurner syndrome (MTS). She was uneventfully discharged home on the 35th day with oral warfarin. Retroperitoneal hemorrhage is rarely caused by acute DVT in the case of potential causes such as MTS. In such cases, the timing of initiation of anticoagulation is difficult considering the possibility of rebleeding from retroperitoneal hemorrhage. We should start anticoagulation based on both the state of hemostatic and preventive procedures for PE.
Retroperitoneal hemorrhage is rarely caused by acute deep vein thrombosis because of the iliac vein rupture. The subsequent occurrence of pulmonary embolism (PE) makes it more complicated and critical because treatment strategies for these two conditions are the opposite: hemostasis versus anticoagulation. The initiation of administration of an anticoagulant should be determined based on status of patients, the procedures of hemostasis, and prevention of PE.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Cardiology Cases
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Predictors of mortality from spontaneous soft-tissue hematomas in a large multicenter cohort who underwent percutaneous transarterial embolization.Radiology. 2019; 291: 250-258
- Management of spontaneous soft-tissue hemorrhage secondary to anticoagulant therapy: a cohort study.Am J Emerg Med. 2018; 36: 2177-2181
- Spontaneous retroperitoneal hematoma associated with iliac vein rupture.J Vasc Surg. 2010; 52: 1278-1282
- Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report.Chest. 2021; 160: e545-e608
- Successful staged management of a spontaneous iliac vein rupture associated with may-thurner syndrome: a case report.Eur Heart J Case Rep. 2021; 5: ytab316
- Diagnosis and management of spontaneous lumbar venous retroperitoneal hematoma in setting of deep venous thrombosis: a case report and algorithm.Case Rep Radiol. 2016; 2016: 3183985
- Inferior vena cava compression caused by a retroperitoneal hematoma following an abdominal aortic aneurysm rupture.Ann Vasc Dis. 2019; 12: 87-90
- Spontaneous iliac vein rupture: case report and comprehensive review of the literature.Ann Vasc Surg. 2006; 20: 258-262
- Endovascular management of a case of spontaneous retroperitoneal haematoma complicated with deep vein thrombosis and pulmonary embolism.BMJ Case Rep. 2017; 2017bcr2017222217
- Spontaneous retroperitoneal hematoma with deep venous thrombosis of left lower limb managed conservatively.J Sci Soc. 2015; 42: 116-119
Published online: December 31, 2022
Accepted: December 10, 2022
Received in revised form: November 19, 2022
Received: September 29, 2022
Publication stageIn Press Corrected Proof
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.