Spontaneous Iliopsoas Haematoma in Section Patients Undergoing Haemodialysis- An Enigma: A Case Series

Abstract

Chronic Kidney Disease (CKD) progression is associated with an increased risk of bleeding due to various reasons, some of which are iatrogenic. Bleeding at unusual sites, such as the iliopsoas muscle, is difficult to suspect as awareness about this condition is sparse, and the literature about the reasons for this condition is unclear. Iliopsoas bleed continues to be an enigma, and herein, the authors present a case series of three cases of spontaneous iliopsoas haematoma. The first case was a 64-year-old male with acute coronary syndrome and CKD on dual antiplatelet agents who had an iliopsoas bleed after dialysis. The second patient was a 51-year-old male with end-stage renal disease on Maintenance Haemodialysis (MHD) who bled into the iliopsoas after anticoagulation for Coronavirus Disease-2019 (COVID-19) related illness. The third patient was a 52-year-old female who had a Catheter-Related Bloodstream Infection (CRBSI) and Atrial Fibrillation (AF) requiring anticoagulation, and she developed an abdominal wall haematoma extending upto the iliopsoas. The authors highlighted the sudden occurrence, challenges in diagnosis and management of iliopsoas bleed in CKD, with a stress on the careful use of anticoagulation.

Keywords

• anticoagulation
• apixaban
• bleeding
• chronic kidney disease
• renal replacement therapy