Retroperitoneal hematoma: Vascular complication after percutaneous coronary intervention

Abstract

An 81-year old female underwent percutaneous coronary intervention (PCI) because of atrial fibrillation on current anticoagulation with 100 mg aspirin/d. 48-hours following the procedure, the patient became hypotensive. Signs of hematoma at the puncture site in the right groin were recoded on general physical examination. The abdomen was distended with tenderness in the right iliac fossa. Additionally the patient suffered from stabbing pain in the right lower abdomen. The hemoglobin level fell from 13 to 8 g/dl. An abdominal CT scan performed with administration of intravenous contrast media revealed a large, biphasic right retroperitoneal hematoma (zone II) with a craniocaudal dimension of 22 cm (Figure 1). An active bleeding from the right external iliac artery was demonstrated by an ascending contrast extravasation (arrow) between the hematoma layers (serum/corpuscular part). The patient was managed by exploratory laparotomy. Intraoperative findings were significant for a retroperitoneal hematoma (RPH) with an injured right external iliac artery due to puncture wound and diffuse bleeding. These could be surgically controlled by running suture reconstruction of the artery lesion and subtly, retroperitoneal hemostasis.