Abstract | December 19, 2022

Routine UroLift Procedure Resulting in a Pelvic Hematoma Requiring Critical Care: A Case Report

Presenting Author: Adele Soutar, MD, Internal Medicine Resident PGY3, Department of Medicine, NHRMC, Wilmington, NC

Coauthors: Adele Soutar, MD, Internal Medicine, PGY3, NHRMC, Wilmington, NC; Miranda Crouch, PhD, MS3, University of North Carolina Chapel Hill, Chapel Hill, NC; Diana Rubi, MD, Internal Medicine, PGY2, NHRMC, Wilmington, NC.

Learning Objectives

  1. Recognize hemorrhagic shock, treatment, and correlation with history for potential source.

Introduction; Case Presentation:  An 85 y.o. male with a medical history of myelodysplastic syndrome, hereditary hemochromatosis, hypertension, hyperlipidemia, right subacute MCA infarct, and BPH who presented to the ED with hypotension, weakness, nausea, vomiting and 2 episodes of loose stool. He had previously undergone a UroLift procedure earlier that morning and became profoundly weak, altered, incoherent, and hypotensive (60/40), which resulted in EMS being called to his home. The patient arrived to the ED roughly 15 hours after his surgery and received IV fluids with response. He was also found to have a lactic acid of 11.9, AKI with his Cr of 2.01 and HCO3 of 16.2, WBC count of 24.5, and hemoglobin of 5.4. CT renal protocol revealed a large mesenteric hematoma with extravasation from the internal iliac artery. He had large-bore IV access and central access placed, received 2 units of PRBCs with hemoglobin correction to 8.2, interventional radiology was consulted, and the patient was transferred to the ICU for further critical care management of hemorrhagic shock.

During his first night of ICU management, pt had worsening tachycardia requiring an increase in the Levophed and required another 1L bolus of fluids, 1 unit of platelets, and another unit of PRBC. Given his leukocytosis, 42% bands, and tachycardia, there was concern for possible sepsis. Blood, urine, and sputum cultures were obtained, and the patient was placed on Cefepime, Vancomycin and Metronidazole. He underwent geofoam embolization of a branch off the left internal iliac artery and bilateral internal iliac arteries that morning. Repeat hemoglobin levels that morning were 6.3, requiring another unit of blood and 1 unit of cryoprecipitate. Hemoglobin and hematocrit were trended every 4 hours. The patient was also found to be C. difficile positive and was initiated on PO Vancomycin for 10 days. Hemoglobin was stable and he was transferred to the floor. 

 

Final/Working Diagnosis: Pelvic Hematoma due to postoperative UroLift procedure complication. 

 

Management/ Outcome/and or Follow-up: Patient remained stable once transfer out of the MICU. Due to prolonged course, he was ultimately discharged to a SNF for rehabilitation.

 

References:

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