Muscle hematomas: Uncommon but horrendous complication of cirrhosis liver

Abstract

Bleeding manifestations, usually cutaneous or gastrointestinal - are common in liver cirrhosis. Spontaneous intracerebral and intramuscular bleeds are reported uncommonly, often associated with gross hepatic dysfunction and severely deranged hemostatic parameters, and are often markers to imminent mortality. Male sex, alcoholic etiology, significant thrombocytopenia, severe coagulopathy, and advanced liver disease are common denominators in patients with spontaneous intramuscular bleed. We here report three cases of spontaneous muscle hematomas complicating hepatic cirrhosis. To the best of our knowledge, this is the largest single center series reporting spontaneous muscle hematomas complicating cirrhosis from the Indian subcontinent.

Spontaneous iliopsoas muscle hematoma mimicking avascular necrosis in alcoholic liver cirrhosis: a case report

“…Treatment of iliopsoas muscle hematoma complicating LC is challenging considering patients' hemostatic dysfunction and poor general health status. Nonsurgical management is suggested in the absence of gradual dysfunction of the femoral nerve or compression of the surrounding crucial tissues (11). In our case, we selected conservative therapy due to the high surgical risk associated with liver cirrhosis and no evidence of active bleeding or neurological dysfunction.…”

Spontaneous Retroperitoneal Hematoma: A Deadly Complication for Patients Awaiting Liver Transplant

“…While these factors may contribute to intramuscular and retroperitoneal hematomas, bleeding rarely starts without an extrinsic cause, such as trauma, anticoagulation therapy, hemophilia, and other congenital or acquired coagulopathies unrelated to liver disease, surgical or endovascular procedures, or vascular lesions. Multiple reports have described spontaneous intramuscular or retroperitoneal bleeding related to anticoagulation and other systemic diseases [2,15], but few cases have been reported in patients with liver cirrhosis [4,[7][8][9]16].…”

“…Due to the limitation of the current report of this lethal disease, there is no available guideline about the management of the clinical practice of sRPH. In this high-risk patient population, there are no clear guidelines for sRPH management, and past approaches have ranged from supportive care alone to interventional radiology or, rarely, surgery [4,[6][7][8][9][10][11][12].…”

Aggressive Surgical Management of Spontaneous Intramuscular Haematomas in Patients with Cirrhosis is an Important Therapeutic Option

“…This particular clinical entity has been predominantly the subject of sporadic case reports or case series. Apart from one small case series [5], the majority of the cases were summarised in a published review in 2015 [6]. Hence the most recent case report from Mongelli et al published recently in this journal [7], now becomes the 25 th case.…”

“…So why are the clinical outcomes generally so poor? Although not all of the case reports include data on the magnitude of the severity of the associated liver disease where the data is available it seems that a number of the patients 9/25 (36%) had Childs C cirrhosis and/or a MELD (Model for End-stage Liver Disease) score of 20 or higher [5,6]. Hence it is possible that the actual stage of the underlying liver disease is a risk factor for an adverse outcome along with perturbation of the coagulation indices [8].…”