Femoral Neuropathy Following Spontaneous Retroperitoneal Hemorrhage After Cardiac Surgery

Abstract

A woman underwent ascending aortic aneurysm repair, aortic root and valve replacement, and coronary artery bypass grafting. Her postoperative course was complicated by stroke and status epilepticus. With supportive care and antiepileptics, her neurologic status improved. Intravenous heparin and aspirin were initiated. On postoperative day 13, she developed a large retroperitoneal hematoma with femoral neuropathy. Because her hematoma was not amenable to percutaneous drainage or surgical evacuation, and considering her comorbidities, a conservative approach was elected. Anticoagulation was held but not reversed, and she was transfused. Her impairment resolved fully after 3 days, and anticoagulation was restarted in staggered fashion.

Femoral Nerve Palsy Secondary to Iliopsoas Spontaneous Haematoma in a Patient Under Warfarin Treatment

“…Conservative management is discouraged by some researchers in severe cases [1,[2][3][4][5]. Some authors suggest that the haematoma should be percutaneously drained under CT or US guidance in order to reverse the pressure-induced nerve ischaemia [2][3][4][5]. This possibility was addressed to our radiology department but was soon rejected, as it was suggested that the haematoma was already organized and a CT aspiration would, therefore, be ineffective.…”

“…This possibility was addressed to our radiology department but was soon rejected, as it was suggested that the haematoma was already organized and a CT aspiration would, therefore, be ineffective. Open surgical debridement has also been described as a managing option depending on the severity of the femoral neuropathy and the size of the haematoma [1,4,5]. In cases of haemodynamic instability, blood transfusion and crystalloid administration may be required [7].…”

“…Femoral nerve palsy due to retroperitoneal haemorrhage is an unusual complication [1][2][3][4]. In turn, retroperitoneal bleeding is most commonly the result of pelvic or lower extremity acute trauma but has also been described to develop as a less frequent complication in patients under anticoagulant therapy and bleeding disorders [1,5].…”

“…In turn, retroperitoneal bleeding is most commonly the result of pelvic or lower extremity acute trauma but has also been described to develop as a less frequent complication in patients under anticoagulant therapy and bleeding disorders [1,5]. However, the incidence of femoral neuropathy secondary to spontaneous retroperitoneal haemorrhage around the iliopsoas muscle is unknown, but on the other hand, is a well-described complication of anticoagulant remedy [2,4].…”

“…Treatment approach to these patients remains controversial [2][3][4][5]. We present a case of a male patient who was under warfarin for atrial fibrillation and developed left femoral nerve palsy, caused by a spontaneous non-traumatic left iliopsoas haematoma.…”