Femoral neuropathy and anticoagulants.

Abstract

Case 1. N. H., a 51-year-old man entered the hospital with pain in the left lower quadrant of the abdomen, left groin and thigh. He had been hospitalized 3 weeks earlier for phlebitis and was receiving 15 mg. of sodium warfarin daily at discharge. Severe bilateral talipes equinovarus had been present since birth and had never been corrected. Prothrombin time on the day before admission was 43.7 minutes (control time 11.7 minutes). Abdominal tenderness in the left lower quadrant, a questionable mass and pain on extension of the hip were present on physical examination. Diverticulitis or pelvic thrombophlebitis were among the initial diagnostic considerations. The dose of sodium warfarin was reduced because of prolonged prothrombin time. Initial hemoglobin and white blood cell count were 12.2 Gm./100 ml. and 4,490. Subsequently the hemoglobin fell to 5.7 Gm./100 ml. and the mass in the left lower quadrant became obvious. The patient developed a left quadriceps femoris weakness, an absent knee jerk and hypesthesia over the distribution of the femoral nerve. There were eccymotic areas at the sites of the injections over the arms and buttocks. Barium enema x-ray showed small intestinal loops pushed to the right with a similar but lesser displacement of the recto-sigmoidal portion of the colon. Sodium warfarin was discontinued and vitamin K and a total of six units of blood were given. With splinting and physical therapy, there was partial recovery of motor and sensory function at the time of discharge one month after admission. At the end of additional 4 months, recovery was complete and the patient was able to return to work. Case 2. B. S., a 53-year-old woman with bilateral varicose veins was admitted with acute phlebitis in the right leg. She had