Spontaneous Extraperitoneal Lumbar Artery Hemorrhage

Abstract

Spontaneous extraperitoneal hemorrhage (SEH) is an uncommon complication of anticoagulation therapy. Cases of SEH that are unresponsive to management through correction of coagulopathy, fluid resuscitation, blood transfusion, and other supportive measures are typically treated with surgery. Nevertheless, treatment of SEH with the use of angiography and arterial embolization may provide a safe, efficacious alternative to surgery. This case is presented to increase awareness among Emergency Physicians of the management options for patients with SEH. A 67-year-old man presented to the Emergency Department with hemodynamic collapse due to retroperitoneal bleeding secondary to spontaneous rupture of a lumbar artery. An emergency abdominal angiogram revealed an actively bleeding left lumbar vessel. The localized bleeding was treated with catheter embolization and detachable microcoil embolization. This resulted in stabilization of the patient's condition without surgical intervention. Overall, the improvement in hemodynamic stability and the decreased percentage of transfusion requirements can be achieved safely without surgical intervention through the prompt use of coil or catheter embolization.