Obstructive uropathy associated with a Retzius space hematoma following postpartum pulmonary embolism

Abstract

Obstructive uropathy associated with a Retzius space hematoma following postpartum pulmonary embolism Soo Youn Song1,† , Dan Bit Park2,† , Mina Lee2,† , Hyun Jeong Song2 , Mia Park2 , You Jin Kim2 , Byung Hun Kang2 , Young Bok Ko2 , Heon Jong Yoo1,* 1Department of Obstetrics & Gynecology, Chungnam National University Sejong Hospital, 30099 Sejong, Republic of Korea 2Department of Obstetrics & Gynecology, Chungnam National University Hospital, 301-721 Daejeon, Republic of Korea *Correspondence: bell4184@gmail.com (Heon Jong Yoo) †These authors contributed equally. Academic Editor: Michael H. Dahan Submitted: 31 August 2021 Revised: 24 October 2021 Accepted: 27 October 2021 Published: 20 May 2022 Abstract Background: To report on a case of acute renal failure associated with a Retzius space hematoma that had been extended to retroperitoneal space, following pulmonary embolism treatment in the postpartum period. Case report: A 30-year-old woman was transferred to the hospital for syncope on the first postoperative day following cesarean section. There were no active vaginal bleeding or intra-abdominal bleeding. On diagnosis of pulmonary embolism, she was treated with extracorporeal membrane oxygenation with heparinization. On day 4, ultrasonography showed newly developed hematoma at the anterior side of the uterus, and transarterial embolization was performed. On day 5, she developed acute kidney injury but there were no increase in size of the hematoma on ultrasonography. She recovered after 3 days of renal replacement therapy. However, on day 10, she showed tachycardia and increased serum creatinine. Computed tomography revealed not only a 15-cm hematoma anterior to the uterus, but also another 17-cm hematoma in the retroperitoneal space under the left kidney. Exploratory laparotomy was performed for obstructive uropathy and hematomas were evacuated. The patient’s vital sign stabilized one day following surgery. Conclusion: When treating postpartum patients with pulmonary embolism, physicians should be aware of the possibility of a concealed hemorrhage in the Retzius space and of subsequent kidney injury. Keywords: Acute kidney injuries; Postpartum; Pulmonary embolism; Retroperitoneal space