RETROPERITONEAL HEMATOMA DUE TO RUPTURE OF A PSEUDOANEURYSM CAUSED BY ACUPUNCTURE THERAPY

Abstract

Acupuncture, an ancient technique using needle insertion at specific points on the body for a specific therapeutic effect, has now become a major alternative treatment. Approrrimately 1 million patients visited an acupuncture professional in the United States in 1994.' However, several complications have been reported, including spinal cord injury, needle migration in the medulla oblongata, fatal cardiac tamponade, pneumothorax, spinal epidural hematoma and subcutaneous pseudoaneurysm.'Z3 To our knowledge we report the first case of retroperitoneal hematoma caused by acupuncture therapy. CASE REPORT A 72-year-old Japanese woman with essential hypertension underwent acupuncture therapy performed by a physician for relief of persistent lumbago. Several needles were inserted into the right loin region, followed by electroacupuncture stimulation. Four hours later the patient visited another hospital complaining of nausea and right flank pain. Abdominal computerized tomography (CT) demonstrated a large retroperitoneal mass around the right kidney (fig. 1, A). The patient was referred to our hospital due to hypotension with tachycardia. Selective right renal arteriography revealed 3 sections of pseudoaneurysm with rupture, presumably caused by acupuncture therapy (fig. 2). Subsequent selective arterial embolization by metallic coil resulted in good function of the affected kidney (fig. 1, B). DISCUSSION Various complications due to acupuncture therapy have been reported, including spinal cord injury (acute transverse myelopathy), perineal nerve palsy, embedded type needle migration in the medulla oblongata, fatal cardiac tamponade, pneumothorax, spinal epidural hematoma and pseudaneury~m.~,~ A huge retroperitoneal hematoma requiring a subsequent hemostatic procedure is a rare and serious complication of acupuncture therapy. The diagnosis is easy to establish in cases of embedded needle, since the needle may be identified on radiography. However, a detailed patient