Life-threatening Spontaneous Extraperitoneal Haemorrhage Secondary to Anticoagulant Therapy and its Management with Transcatheter Embolisation

MKW Yang, JYH Hui, WC Fan, JCS Chan

Hong Kong J Radiol 2006;9:36-40

This report is of 2 patients with unstable spontaneous extraperitoneal haemorrhage secondary to anticoagulant therapy. Active contrast extravasations were demonstrated on spiral computed tomography and angiograms, which is possibly a predictive factor for failure of conservative treatment. One patient had a rectus sheath haematoma due to ruptured inferior epigastric artery while taking warfarin for sick sinus syndrome and atrial fibrillation. Another patient was receiving low-molecular weight heparin for acute myocardial infarction and had extensive acute left iliopsoas haematoma due to multiple small bleeding vessels from the iliolumbar artery. Both patients were haemodynamically unstable despite fluid resuscitation, blood transfusion, and discontinuation of anticoagulant therapy. Embolisation was performed for immediate bleeding control. The role of computed tomography and embolisation in the management of this condition is discussed.