Non-operative management of femoral neuropathy secondary to a traumatic iliacus haematoma in an adolescent

Abstract

Iliacus haematoma is a relatively rare condition, which may cause a local compressive neuropathy. It is usually diagnosed in adults with haemophilia or those on anticoagulation treatment and may occur after trauma. We present the case of a healthy 15-year-old boy with a femoral neuropathy due to an iliacus haematoma which resolved following conservative treatment.

Iliopsoas haematoma in a rugby player

“…[7] Patients often present with undifferentiated symptoms including sudden onset of severe pain, muscle dysfunction and, in acute cases, with nerve palsy primarily affecting the femoral nerve. [5,8] The flexed position imposes the least tension on the iliopsoas muscle whereby the muscle is relaxed, with pain and limitation on passive hip extension as the muscle is stretched. [9] Owing to the strong fibrous tissue layers of the muscle, large volumes of intramuscular bleeding are entrapped causing severe pain as a result of pressure build-up.…”

“…Inhibition of muscular function with femoral nerve involvement could present a serious and potentially severe neurological dysfunction. Urgent drainage procedures of a traumatic haematoma may vary from open surgery, [3,8] to percutaneous drainage, [5] laparoscopy [1] or the most recently described retroperitoneoscopic approach. [10] The haematoma itself may account for a fatal outcome because of massive blood loss and haemorrhagic shock, especially with delayed diagnosis.…”

“…[2,4] Iliops oas haematoma is most ly described as an infrequent complication of anticoagulation therapy in older patients, however it has rarely been noted in athletes or in sports-associated incidents. [2,4,5] We report a case that occurred following a closed injury of the iliopsoas muscle in a young rugby player after he was tackled during a game.…”

Mononeuropatía femoral de etiología poco habitual

“…En casos de sangrado activo, la embolización arterial puede detener la hemorragia. El tratamiento conservador es una opción adecuada en pacientes estables, con síntomas neurológicos moderados y sin sangrado activo 6 . En el caso de nuestro paciente se revirtió la anticoagulación con vitamina K intravenosa.…”

Incidental finding in a young man

“…While blunt trauma to the posterior part of the back or buttock is the most common cause, some of them are not caused by direct impact but rather by the hyperextension of the hip [1][2][3]. Rarely, it can be seen in patients with acetabular fracture [4].…”