Article Text
Statistics from Altmetric.com
Description
We present a case of a 44-year-old woman who underwent a percutaneous patent foramen ovale (PFO) repair. The procedure was complicated by a retroperitoneal bleeding secondary to accidental puncture of the right iliac artery. Following the procedure the patient became hypotensive and complained of severe abdominal pain. She had an urgent CT scan which showed 11×8×9 cm haematoma (figure 1). She was treated conservatively; however, she was admitted repeatedly for urinary retention as the haematoma was displacing the bladder to the left (figure 2A). The haematoma was assessed for suitability of drainage, however, it was noted to be solid and the risk of infection postaspiration would be too high.
PFO is a common type of atrial septal defect but often goes undiagnosed due to lack of symptoms. Stroke remains the main indication for intervention. Surgical treatment is indicated when medical treatment fails. Percutaneous technique for PFO repair was introduced in the 1990s.1
The CT scan showed that the haematoma is mimicking the urinary bladder in retention (figure 2A, B). A bladder scan or an ultrasound would confuse this haematoma with a full bladder, with possible disastrous consequences if attempts at urethral catheterisation failed and a supra pubic catheter was opted for.
Learning points
-
Haematoma is a recognised complication in minimal access surgery.
-
We reiterate the importance of thorough history taking in an acute setting.
-
Radiological investigation is the key when diagnosis is not clear.
Reference
Footnotes
-
Contributors RJ was involved in the first draft of case report and edit imaging. KAJ has helped in drafting case report, edit imaging and consent. AB drafted the report and carried out literature search. JK is responsible for supervision and final report.
-
Competing interests None.
-
Patient consent Obtained.
-
Provenance and peer review Not commissioned; externally peer reviewed.