Abstract
Spontaneous retroperitoneal hemorrhage (SRH) is a potentially lethal complication of anticoagulation therapy. The signs and symptoms vary from clinical silence to abdominal pain or hemorrhagic shock. The diagnosis of SRH may be difficult, especially in its early clinical course, due to its varied symptoms. Physicians need to have a high degree of suspicion for its early diagnosis. Delayed diagnosis of SRH can lead to serious complications or death. Bleeding complications in anticoagulated patients are well known; however, reports about SRH with fatal outcomes are sporadic. Here, we describe a case of massive SRH in a patient receiving enoxaparin. In our case, the patient died due to delayed diagnosis and treatment. We, therefore, emphasize that physicians should always consider SRH in any patient receiving anticoagulants who presents with abdominal pain.
Highlights
Spontaneous retroperitoneal hemorrhage (SRH) is a rare complication in patients undergoing anticoagulant therapy
We present a case of massive fatal SRH in a patient taking enoxaparin
SRH is defined as a retroperitoneal hemorrhage that is unrelated to surgery, invasive procedures, trauma, or any underlying pathology (Salemis et al, 2014)
Summary
Spontaneous retroperitoneal hemorrhage (SRH) is a rare complication in patients undergoing anticoagulant therapy. A 74-year-old woman (height, 151 cm, and body weight, 48.4 kg) was admitted to our hospital for aggravation of dyspnea Her medical history included atrial fibrillation, hypothyroidism, iron deficiency anemia, and rheumatic heart disease. She had an anticoagulant (rivaroxaban) prescription since her CHA2DS2-VACs score was 4 points. She had received diuretics, digoxin, and thyroid hormone replacement for an extended period at local hospitals. Laboratory investigations revealed a hemoglobin level of 8.5 g/dl, hematocrit level of 27.2%, and platelet count of 157 × 103/mm3 Abdominal radiography showed both psoas muscle shadows to be intact. She died of hypovolemic shock 36 hours after symptom onset
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