Bai Yan, Zhou Xinqiao, Zeng Lingqing, Zhou Xiaokai, Rao Zhuqing, Liu Cunming, Pan Yinbing, Sun Xiaodi
Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 300 Guangzhou Road, Jiangsu, China.
BMC Neurol. 2025 Feb 20;25(1):70. doi: 10.1186/s12883-024-03808-8.
The lumbar sympathetic nerve block stands as a pivotal approach in managing complex regional pain syndrome (CRPS) in the lower limbs. Retroperitoneal hemorrhage is an extremely rare and severe complication of lumbar sympathetic nerve block. Here, we report for the first time a case of retroperitoneal hemorrhage that initially presented with symptoms of femoral nerve compression.
An 81-year-old elderly female was diagnosed with CRPS. After undergoing an ultrasound-guided lumbar sympathetic nerve block at our hospital, discomfort in her right lower back was experienced, followed by stabbing pain, numbness in the anterior thigh, and significant lower limb movement impairment. We considered that the femoral nerve might be compressed by a hematoma or abscess. An emergency percutaneous drainage was performed, resulting in partial symptom relief. However, two days later, signs of hemorrhagic shock were observed in the patient. An emergency lumbar arterial embolization was performed, effectively stabilizing her vital signs. One week later, lower limb pain and numbness disappeared, and right lower limb motor function fully recovered.
When retroperitoneal hemorrhage is suspected, prompt computed tomography (CT) or bedside ultrasound should be conducted. Once imaging supports the diagnosis, immediate digital subtraction angiography (DSA) could be utilized to identify the bleeding source and conduct embolization.
腰交感神经阻滞是治疗下肢复杂性区域疼痛综合征（CRPS）的关键方法。腹膜后出血是腰交感神经阻滞极为罕见且严重的并发症。在此，我们首次报告一例最初表现为股神经受压症状的腹膜后出血病例。
一名81岁老年女性被诊断为CRPS。在我院接受超声引导下腰交感神经阻滞后，她感到右下腹不适，随后出现刺痛、大腿前部麻木以及明显的下肢活动障碍。我们认为股神经可能被血肿或脓肿压迫。进行了紧急经皮引流，症状部分缓解。然而，两天后患者出现失血性休克体征。进行了紧急腰动脉栓塞，有效稳定了她的生命体征。一周后，下肢疼痛和麻木消失，右下肢运动功能完全恢复。
当怀疑腹膜后出血时，应及时进行计算机断层扫描（CT）或床边超声检查。一旦影像学支持诊断，可立即利用数字减影血管造影（DSA）确定出血源并进行栓塞。
