Case Report DOI 10.3349/ymj.2011.52.2.358 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 52(2):358-361, 2011 Abdominal Compartment Syndrome Due to Spontaneous Retroperitoneal Hemorrhage in a Patient Undergoing Anticoagulation Dae-Yeon Won, Sang-Dong Kim, Sun-Chul Park, In-Sung Moon, and Ji Il Kim Department of General Surgery, Seoul St. Maryʼs Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. Received: April 14, 2009 Revised: June 8, 2009 Accepted: June 11, 2009 Corresponding author: Dr. Ji Il Kim, Department of General Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Korea. Tel: 82-2-2258-6103, Fax: 82-2-2258-6838 E-mail: cmckji@catholic.ac.kr ∙ The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non- Commercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Spontaneous retroperitoneal hemorrhage is one of the most serious and often lethal complications of anticoagulation therapy. The clinical symptoms vary from femo- ral neuropathy to abdominal compartment syndrome or fatal hypovolemic shock. Of these symptoms, abdominal compartment syndrome is the most serious of all, because it leads to anuria, worsening of renal failure, a decrease in cardiac output, respiratory failure, and intestinal ischemia. We report a case of a spontaneous ret- roperitoneal hemorrhage in a 48-year-old female who had been receiving warfarin and aspirin for her artificial aortic valve. She presented with a sudden onset of lower abdominal pain, dizziness and a palpable abdominal mass after prolonged straining to defecate. Computed tomography demonstrated a huge retroperitoneal hematoma and active bleeding from the right internal iliac artery. After achieving successful bleeding control with transcatheter arterial embolization, surgical de- compression of the hematoma was performed for management of the femoral neu- ropathy and the abdominal compartment syndrome. She recovered without any complications. We suggest that initial hemostasis by transcatheter arterial emboli- zation followed by surgical decompression of hematoma is a safe, effective treat- ment method for a spontaneous retroperitoneal hemorrhage complicated with in- tractable pain, femoral neuropathy, or abdominal compartment syndrome. Key Words: Spontaneous retroperitoneal hematoma, abdominal compartment syndrome, femoral neuropathy, anticoagulation INTRODUCTION A spontaneous retroperitoneal hemorrhage (SRH) is defined as a retroperitoneal hemorrhage that occurs without proceeding trauma or any underlying pathology.1 A SRH is an uncommon but well-known complication of anticoagulation therapy that causes significant morbidity and mortality.2-4 The treatment mainly consists of cessation or reversal of the anticoagulation, volume resuscitation, and transfusion when indicated. Surgery or radiologic intervention is performed if there is evi- dence of continued bleeding, but these two modalities have some disadvantages. The surgical management of a SRH is difficult with regards to both the identifica- 358 Yonsei Med J http://www.eymj.org Volume 52 Number 2 March 2011