Correct the Coagulopathy and Scoop It Out: Complete Reversal of Anuric Renal Failure through the Operative Decompression of Extraperitoneal Hematoma-Induced Abdominal Compartment Syndrome

Abstract

We report two cases of extraperitoneal compression of the intra-abdominal space resulting in abdominal compartment syndrome (ACS) with overt renal failure, which responded to operative decompression of the extra-peritoneal spaces. This discussion includes patient presentation, clinical course, diagnosis, interventions, and outcomes. Data was collected from the patient's electronic medical record and a radiology database. ACS appears to be a rare but completely reversible complication of both retroperitoneal hematoma (RH) and rectus sheath hematoma (RSH). In patients with large RH or RSH consideration of intra-abdominal pressure (IAP) monitoring combined with aggressive operative drainage after correction of the coagulopathy should be considered. These two cases illustrate how a relatively benign pathology can result in increased IAP, organ failure, and ultimately ACS. Intervention with decompressive laparotomy and evacuation of clot resulted in return to normal physiologic function.

Rectus Sheath Hematoma—A Rare and Dangerous Complication of Anticoagulation Therapy<br/>—A Case Report and Review of Current Literature

“…According to the severity of bleeding and its associated complications we recommend complete reversal of the anticoagulant or antithrombotic therapy under careful consideration of the primary indication of these therapies. In 2012 two cases were described [18] in which RSH lead to an abdominal compartment syndrome with renal failure and complete recovery after surgical decompression. After optimization of coagulation and surgical decompression with drainage of the hematoma these patients recovered.…”

A 72-Year-Old Man Presenting With Melena and Multiple Falls Becomes Acutely Decompensated

“…4 Patients usually report severe abdominal pain and a palpable mass is notable; however, some patients may present with abdominal compartment syndrome and multiorgan failure. 5 Th e management is usually supportive with correction of coagulopathy; with abdominal compartment syndrome, surgical decompression and interventional embolization may be required. 4 -6 Point-of-care ultrasound is useful for making the diagnosis and appears as shown in Video 8.…”

Rectus Sheath Hematoma: An Unfortunate Consequence of Novel Anticoagulants

“…Rectus sheath hematomas (RSH) are often misdiagnosed and overlooked as a cause of acute abdominal pain. It has been estimated that RSH account for 1.5–2% of unexplained abdominal pain in hospitalized patients, 1 but with the widespread use of newer agent anticoagulants this number is likely on the rise.…”