腸腰筋内血腫から難治性下肢痛を生じた1例

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  • A patient with intractable lower limb pain due to iliopsoas hematoma
  • ショウレイ チョウ ヨウキン ナイ ケッシュ カラ ナンジセイ カシツウ オ ショウジタ 1レイ

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A 55-year-old man underwent mitral valve replacement. After recovery from anesthesia, he developed cardiac arrest and was successfully resuscitated by the use of a percutaneous cardiopulmonary system (PCPS) via the right femoral arterial and venous cannulations. Following recovery of consciousness, he complained of paralysis and severe pain in the left leg. A computed tomographic scan of the abdomen demonstrated a hematoma in the left psoas muscle. Surgical evacuation of the hematoma was not indicated because of unstable hemodynamics and necessity of anticoagulant therapy for the artificial valve. He was treated conservatively including analgesics and neurolytic lumber sympathetic block. However, the effects of these therapies on the pain were minimal and severe pain was persistent. The hematoma had disappeared two month later but severe pain and paralysis of the left leg remained. At present, one and a half years later, he is taking oral morphine sulfate (MS containTM) 450mg/day for control of the pain.<br>Nerve blocks for pain control of iliopsoas hematomas are difficult because hematomas commonly result from coagulopathy or anticoagulant therapy. This case suggests that surgical evacuation of iliopsoas hematomas should be considered when severe pain is persistent.

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