Heparin Reactions 1680, p157 - 2 Dec 2017 Various toxicities: case report A 71-year-old woman developed rectus sheath haematoma (RSH), retroperitoneal haematoma (RS), abdominal compartment syndrome (ACS), increased intra-abdominal pressure (IAP), obstructive uropathy, hydronephrosis, inferior epigastric vessel bleeding and acute renal failure (ARF) during treatment with heparin [heparin stroke protocol; dosage not stated]. The woman presented after a frontal lobe cerebrovascular accident with a suspected common carotid artery clot. Subsequently, she was initiated on infusion of heparin. Additionally, phenylephrine was initiated to achieve systolic BP goals of 170 180mm Hg. However, a week after the admission, she complained of increasing abdominal pain. Examination showed a mass in her right lower quadrant, which extended to her left lower quadrant. A CT scan and blood work showed an RSH with haemoglobin drop to 52 g/L. Consequently, the anticoagulation was reversed with vitamin K and fresh frozen plasma, however the woman continued to bleed. IAP monitoring showed average to high pressures of 40 60mm Hg. Thereafter, she developed acute renal failure secondary to an obstructive uropathy with the presence of hydronephrosis demonstrated by CT scan. She underwent an exploratory laparotomy and removal of haematoma. The decompressive laparotomy revealed a massive extraperitoneal haematoma from the rectus sheath, which extended to the left hemipelvis. A 1.5 L of haematoma was removed, but the inferior epigastric vessel continued to bleed. Hence, it was cauterised and then over sewn. The right- sided stent placement was unsuccessful. Postoperatively IAP and kidney function improved. After 24 hours, a second exploratory laparotomy was performed. The remaining haematoma cavity posterior to the left rectus muscle was irrigated and suctioned out. There was no evidence of any continued bleeding and the abdominal wall was closed. Author comment: "With increased use of anticoagulant and thrombolytic therapies RH and RSH are becoming more prevalent. . .Blunt trauma and anticoagulation are the most common causes. . .In conclusion, ACS appears to be a rare but completely reversible complication of both RSH and RH." McBeth PB, et al. Correct the coagulopathy and scoop it out: Complete reversal of anuric renal failure through the operative decompression of extraperitoneal hematoma-induced abdominal compartment syndrome. Case Reports in Medicine 2012: 26 Nov 2012. Available from: URL: http://doi.org/10.1155/2012/946103 - Canada 803284747 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals


Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
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Springer International Publishing
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
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