A case of conservative therapy for serious retroperitoneal hemorrhage after performing high risk PCI

A 61-year-old woman with a history of hoemodialysis for 7 years because of SLE nephritis was referred to our hospital became she had started to suffer from anginal attacks during hemodialysis. Coronary angiography was performed from the right femoral artery and showed a significant degree of stenosis (type C lesion) in the left anterior descending artery. The patient underwent percutaneouse coronary intervention (PCI) with two drug-eluting stents, and the lesion was dilated adequately. Five hours later, as her blood pressure decreased, a small subctaneous hematoma was recognized around the puncture site. Abdominal computed tomography revealed a massive retroperitoneal hematoma. Blood transfusion was given, but the patient remained anemic and in a state of shock. Abdominal arteriography was performed to detect the site of continuous bleeding, but no signs of active bleeding were found. The patient received blood transfusion repeatedly and was strictly monitored using a Swan-Ganz catheter. After a total of 10 units of red blood cell and 10 units of platelet transfusion for 4 days, her vital signs became stable and her anemia gradually improved. This is a case of conservative treatment of serious retroperitoneal hemorrhage with circulatory insufficiency. In such a case, surgical operation should be performed prudently even for a severely ill patient.