Unclear Abdominal Pain - Not Always a Gastroenterological Emergency

• Published in: Deutsche medizinische Wochenschrift (1946) Vol. 142; no. 7; p. 530
• Main Authors: Aschoff, Anna Teresa, Pech, Maciej, Fischbach, Frank, Ricke, Jens, Luani, Blerim, Braun-Dullaeus, Rüdiger Christian, Herold, Jörg
• Format: Journal Article
• Language: German
• Published: Germany 01.04.2017
• Subjects: Abdominal Muscles - drug effects; Abdominal Pain - chemically induced; Abdominal Pain - diagnosis; Abdominal Pain - prevention & control; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Diagnosis, Differential; Female; Gastrointestinal Diseases - chemically induced; Gastrointestinal Diseases - diagnosis; Hematoma - chemically induced; Hematoma - diagnosis; Hematoma - prevention & control; Heparin, Low-Molecular-Weight - adverse effects; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Middle Aged; Muscular Diseases - chemically induced; Muscular Diseases - diagnosis; Muscular Diseases - prevention & control; Treatment Outcome
• ISSN: 1439-4413
• DOI: 10.1055/s-0042-122121

An 84-year old patient with persistent atrial fibrillation and chronic renal failure received a subcutaneous injection with low molecular weight heparin (LMWH) during a hospital stay. Over the course of her hospitalization, the patient developed abdominal pain. There was a marked hematoma at the injection site. A large tumor was palpable in the right abdominal quadrant.  Due to the significant reduction in hemoglobin, we performed a CT-angiogram of the abdomen.  We were able to visualize an intramuscular hematoma within the rectus abdominis muscle.  After visualization with digital subtraction angiography and application of microcoils and histoacryl-glue, we were able to stop bleeding. After implantation of left atrial appendage occluder, oral anticoagulation therapy could be stopped.  LMWH-treated patients with nonspecific abdominal pain should be meticulously examined to exclude iatrogenic abdominal muscle hematoma.