Endovascular Management of Surgically Uncontrolled Hemorrhage Following Post-Radical Nephrectomy: A Case Report

Retroperitoneal hematoma secondary to lumbar artery injury is a rare but life-threatening condition (1). Although it may be spontaneous in patients receiving anticoagulants, majority of the cases appear as a consequence of trauma or as a complication following open surgery, laparoscopic surgery or percutaneous interventions (2). Renal injury or vascular injury to the posterior abdominal wall during open or percutaneous interventions may lead to active extravasation, pseudoaneurysm or arteriovenous fistula formation (3). Pseudoaneurysms possibly will give rise to consequent acute or delayed retroperitoneal bleeding since they develop gradually from an overlooked focal arterial wall disruption and an urologist should be aware of this postoperative complication. Clinical spectrum of retroperitoneal bleeding ranges from a self-limiting hematoma to a persistent bleeding leading to hypovolemic shock (4). Treatment options for significant retroperitoneal bleeding include conservative management, transarterial embolization and surgical exploration. Persistent hemorrhage despite a proper conservative treatment should indicate a surgical or endovascular intervention to avoid severe morbidity and mortality. Conventional management of persistent bleeding has been surgical exploration and ligation of the bleeding artery. Endovascular treatment has been shown to be a very effective procedure in the management of arterial bleeding in various locations and it can also be used in case of persistent bleeding after surgical exploration (2).