A rare case of iliopsoas hematoma in a patient with von Willebrand disease

Iliopsoas hematoma is a serious complication that can occur in bleeding disorders, most commonly hemophillia but it can also be seen in von Willebrand disease (vWD) in less frequency. This can cause muscle pain, muscle dysfunction and sometimes even femoral nerve palsy. Iliopsoas hematomas can be diagnosed by the usage of ultrasonography, computed tomography (CT) or magnetic resonance imaging (MRI). Here we report a case of a 20-year-old boy who presented to us with complaints of pain in the right lower quadrant, flank, and inguinal region for a week. He was diagnosed with vWD type 3 when he was 10 years old. The symptoms started after he had tried to kick start his motorbike vigorously. Clinical examination revealed the patient to be in an anti-pain posture and to have tenderness at sites where he complained of pain. A subsequent CT scan showed that there was an iliopsoas hematoma of size 10×6 cm. The patient was managed conservatively with factor replacement and physiotherapy following which there was amelioration in the symptoms and the patient recovered well.

Conservative management of an iliopsoas hematoma causing walking difficulty in an elderly patient on anticoagulation therapy: a case report

Spontaneous iliopsoas hematoma is a rare complication in patients suffering from bleeding disorders like hemophilia, Von Willebrand’s disease or those taking blood thinners like aspirin and clopidogrel or anticoagulant medications like warfarin for atrial fibrillation or post-thrombotic status. It can present as severe pain, muscle dysfunction, difficult walking or neurological dysfunction due to compression on femoral nerve or lumbar plexus. A high index of suspicion with early blood and radiological investigations like contrast enhanced computed tomography (CECT) or magnetic resonance imaging (MRI) of the part is immensely helpful in diagnosis and prompt management of such patients. A low hemoglobin or hematocrit level and a high INR is supportive while CECT or MRI of the abdomen and pelvis is confirmatory. Management in a hemodynamically and neurologically stable patient include immediate withdrawl of the anticoagulant, bed rest, infusion of I.V. fluids, vitamin K, fresh frozen plasma and packed red cell transfusion, which ensures complete recovery in most of the cases. However angio-embolization to control ongoing arterial bleeding is lifesaving when feasible or emergent open decompression and bleeding control surgery can save the life or prevent permanent neurological damage to the limb. Decompression of the hematoma by ultrasound or computed tomography guided catheter drainage is helpful alternative in few selected cases. We report an elderly patient on warfarin, who suddenly developed difficulty in walking within hours of a strained defecation, diagnosed to suffer from left iliopsoas hematoma and responded to conservative management with complete resolution of symptoms by 3 weeks.

Femoral Neuropathy caused by Iliopsoas Hematoma: A Case Report / 대한정형외과학회잡지

There are a few reports of femoral neuropathy caused by an iliopsoas hematoma combined with trauma, hemophilia, and anticoagulation therapy. There is some debate as to whether conservative treatment or surgical management is the treatment of choice for femoral neuropathy. In some cases, surgical management is used to minimize the level of nerve damage and for better functional recovery. We report a case of femoral neuropathy on the other side of a total hip replacement arthroplasty (THRA) caused by an iliopsoas hematoma during heparin anticoagulation therapy.