PriMera Scientific Surgical Research and Practice (ISSN: 2836-0028)

Research Article

Volume 6 Issue 3

Acute Lower Extremity Nerve Compression Syndromes caused by Retroperitoneal Haematoma; Medical, Surgical & Rehabilitation Perspectives

Subramanya Adiga* and Steven Vates

August 21, 2025

DOI : 10.56831/PSSRP-06-206

View PDF

Abstract

Acute lower extremity nerve compression syndromes due to retroperitoneal haematomas within the psoas major and iliacus muscle compartments are increasingly common clinical entities. Historically these were rare clinical presentations associated with haemophilia & other bleeding diathesis [1]; however, the increased utilisation of anticoagulation and antiplatelet medications in clinical practice has contributed to a rising incidence of haemorrhagic complications [2]. Associated with this is an apparent increase in the incidence of retroperitoneal haematomas and consequent nerve injuries.

There is limited awareness of the neurological sequelae of retroperitoneal haematomas amongst clinicians, leading to delays in diagnosis and management observed within clinical practice [3, 4] which may contribute to adverse clinical outcomes. This is further compounded by the lack of clear guidelines for diagnostic investigations, management and rehabilitation protocols [5]. Available literature is largely restricted to case reports and case series/reviews that are limited by both their heterogeneity and the use of non-uniform language.

This article aims to reflect the current state of knowledge around this clinical issue by reviewing the available scientific publications, alongside the authors’ clinical insights and reasoning in order to improve awareness amongst clinicians.

References

  1. Goodfellow J, Fearn CBDA and Matthews JM. “Iliacus Haematoma. A Common Complication of Haemophilia”. The Journal of Bone and Joint Surgery 49B.4 (1967): 748-756.
  2. Gurbuz O., et al. “Femoral Nerve Palsy due to Anticoagulant Induced Retroperitoneal Haematoma”. Case Reports in Medicine (2014): 450750.
  3. Nefiss M., et al. “Femoral Nerve Paralysis Complicating a Post-Traumatic Iliopsoas Haematoma”. British Medical Journal Case Reports (2018): bcr2017220446.
  4. Lefevre N., et al. “Complete Paralysis of the Quadriceps Secondary to Post-Traumatic Iliopsoas Haematoma: A Systematic Review”. European Journal of Orthopedic Surgery and Traumatology 25 (2015): 39-43.
  5. Guild TT., et al. “The Epidemiology and Management of Iliopsoas Haematoma with Femoral Nerve Palsy: A Descriptive Systematic Review of 174 Cases”. Injury 54 (2023): 280-287.
  6. Schuenke M, Schulte E and Schumacher U. “Thieme Atlas of Anatomy, Volume 1 General Anatomy and Musculoskeletal System”. Thieme Medical Publishers, USA (2015).
  7. Drake RL, Vogl AW and Mitchell AWM. “Gray's Anatomy for Students, Third Edition”. Churchill Livingstone, USA (2015).
  8. Abrahams P, Craven J and Lumley J. “Illustrated Clinical Anatomy, Second Edition”. Hodder Arnold, United Kingdom (2011).
  9. Rubin DI. “Brachial and lumbosacral plexopathies: A review”. Clinical Neurophysiology Practice 5 (2020): 173-193.
  10. Neto FJM., et al. “Demystifying MR Neurography of the Lumbosacral Plexus: From Protocols to Pathologies”. Biomed Research international (2018): 9608947.
  11. Harshavardhana NS and Dabke HV. “The Furcal Nerve Revisited”. Orthopaedic Reviews 6 (2014): 5428.
  12. Andrews FJ. “Retroperitoneal Haematoma after Paracetamol increased Anticoagulation”. Emergency Medicine Journal 19 (2002): 84-85.
  13. Kong WK., et al. “Femoral Neuropathy due to Iliacus Muscle Hematoma in a Patient on Warfarin Therapy”. Journal of Korean Neurosurgery 51 (2012): 51-53.
  14. Parker A., et al. “Iliacus Minor and Psoas Quartus Muscles Traversing the Femoral Nerve”. Morphologies 106 (2022): 307-309.
  15. Horwitz MT. “The Anatomy of (A) the Lumbosacral Nerve Plexus- Its Relation to Variations of Vertebral Segmentation and (B) the Posterior Sacral Nerve Plexus”. The Anatomical Record 74.1 (1939): 91-107.
  16. Apostolopoulos A., et al. “Femoral Nerve Palsy Secondary to Iliopsoas Spontaneous Haematoma in a Patient under Warfarin Treatment”. Cureus 12.4 (2020): e7610.
  17. Kawarat V., et al. “A Rare Case of iliopsoas Haematoma in a Patient with von Willebrand’s disease”. International Surgery Journal 7.3 (2020): 873-875.
  18. Pirouzmand F and Midha R. “Subacute Femoral Compressive Neuropathy from Iliacus Compartment Hematoma”. Canadian Journal of Neurological Sciences 28 (2001): 155-158.
  19. Ishii C., et al. “Delayed Lumbar Plexus Palsy due to Giant Psoas Hematoma Associated with Vertebral Compression Fracture and Direct Oral Anticoagulants: a case report”. BMC Musculoskeletal Disorder 22 (2021): 377.
  20. Stewart-Wynne EG. “Iatrogenic Femoral Neuropathy”. British Medical Journal 1 (1976): 263.
  21. Robinson DE, Ball KE and Webb PJ. “Iliopsoas Hematoma with Femoral Neuropathy Presenting a Diagnostic Dilemma After Spinal Decompression”. Spine 26.6 (2001): E135-138.
  22. Almazrua IS., et al. “Psoas Hematoma and Late Femoral Nerve Palsy After Extreme Lateral Interbody Fusion and Posterior Spinal Fusion with Instrumentation: A Case Report”. Orthopaedic Research and Reviews 12 (2020): 127-132.
  23. Yogarajah M, Sivasambu B and Jaffe EA. “Spontaneous Iliopsoas Haematoma: A Complication of Hypertensive Urgency”. British Medical Journal Case Reports (2015): bcr207517.
  24. Andreani L., et al. “Compressive Femoral Neuropathy Associated with Iliopsoas Hematoma”. Journal of Orthopaedic Case Reports 7.5 (2017): 3-6.
  25. Gillanders IA, Nakielny R and Channer KS. “Spontaneous iliopsoas haemorrhage- an unusual complication of streptokinase therapy”. Postgraduate Medical Journal 66 (1990): 862-863.
  26. Sugiyama C., et al. “Muscle Haematoma: A Critically Important Complication of Alcoholic Liver Cirrhosis”. World Journal of Gastroenterology 15.35 (2009): 4457-4460.
  27. Nakao A., et al. “Retroperitoneal Haematoma associated with Femoral Neuropathy: a Complication under Antiplatelets Therapy”. Acta Medica Okayama 55.6 (2001): 363-366.
  28. Wada Y, Yanagihira C and Nishimura Y. “Bilateral Iliopsoas Hematomas Complicating Anticoagulant Therapy”. Internal Medicine 44.6 (2005): 641-643.
  29. Murena L., et al. “Bilateral Iliopsoas Intramuscular Bleeding following Anticoagulant Therapy with Heparin: A Case Report”. Cases Journal 2 (2009): 7534.
  30. Mwipatayi BP., et al. “Delayed Iliacus Compartment Syndrome Following Femoral Artery Puncture: Case Report and Literature Review”. Journal of Surgical Case Reports 6 (2016): rjw102.
  31. Hirji SA., et al. “Spontaneous Progressive Muscle Weakness with Persistent Leukocytosis”. Case Reports in Surgery (2019): 7085219.
  32. Al-Zamil A and Christenson JT. “Psoas Muscle Hematoma - an Acute Compartment Syndrome”. Journal of Vascular Disease 17.2 (1988): 141-143.
  33. Planner AC, Donaghy M and Moore NR. “Causes of Lumbosacral Plexopathy”. Clinical Radiology 61 (2006): 987-995.
  34. Conesa X, Ares O and Seijas R. “Massive Psoas Haematoma causing Lumbar Plexus Palsy: a Case Report”. Journal of Orthopaedic Surgery 20.1 (2012): 94-97.
  35. Mullins BM and Kelsall N. “Anatomy of the Lumbar Plexuses and Lower Limb Peripheral Neuropathy”. Surgery Orthopaedics IV Lower Limb 41.4 (2023): 193-199.
  36. Soomekh D. “Quantitative Sensory Testing”. Clinics in Podiatric Medicine and Surgery 23 (2006): 545-557.
  37. Kim JH., et al. “Iliopsoas Hematoma Presenting with Sudden Knee Extensor Weakness”. Medicine 99.50 (2020): e23497.
  38. Seddighi A., et al. “Peripheral Nerve Injury: A Review Article”. International Clinical Neuroscience Journal 3.1 (2016): 1-6.
  39. Chickova RI and Katzin L. “EMG and Nerve Conduction Studies in Clinical Practice”. Practical Neurology (2010): 32-38.
  40. Tavone AM., et al. “A Rapid Fatal Outcome of iliopsoas Hematoma: Clinical and Autopsy Findings”. Journal of Investigative Medicine High Impact Case Reports 10 (2022): 1-5.
  41. Gonzalez C., et al. “The Clinical Spectrum of Retroperitoneal Haematoma in Anticoagulated Patients”. Medicine 82.4 (2003): 257-262.
  42. Basheer A., et al. “Bilateral Iliopsoas Haematoma: Case Report and Literature Review”. Surgical Neurology International 4.1 (2013): 121-124.
  43. Adiga S. “Expansion of Intact Sensory Motor Territories in Proximal Neuraxial Lesions using Peripheral Nerve-Muscle Weeding Intervention”. Exploratory Research and Hypothesis in Medicine 9.2 (2024): 162-169.
  44. Fernandes C, Pereira P and Rodrigues M. “Spontaneous iliopsoas muscle haematoma as a complication of anticoagulation in acute cerebral venous thrombosis: to stop or not to stop (the anticoagulation)?”. British Medical Journal Case Reports (2015): bcr2014206410.
  45. Seo JG., et al. “Intramuscular Hematoma on the Psoas Muscle”. Korean Journal of Neutotrauma 15.2 (2019): 234-238.
  46. Bektaş, F. and Söyüncü, S. “Warfarin Induced Iliopsoas Hematoma Detected by Bedside Emergency Ultrasonography”. Akatos 3.1 (2012): 26-26.
  47. Akata S., et al. “MR Features of Chronic Expanding Haematoma”. Journal of Clinical Imaging 24 (2000): 44-46.
  48. Szopinski KT and Smigielski R. “Safety of Sonographically Guided Aspiration of Intramuscular, Bursal, Articular and Subcutaneous haematomas”. European Journal of Radiology 81 (2012): 1581-1583.
  49. Blum AS and Rutkove SB. “The Clinical Neurophysiology Primer”. Humana Press. USA (2007).
  50. British Orthopaedic Association. Diagnosis and Management of Compartment Syndrome of the Limbs. BOA.ac.uk (2014).
  51. Leong K and Wright JE. “An Unusual Case of Difficulty Walking: a Psoas Haematoma”. Geriatric Medicine (2008): 664-665.
  52. Emamhadia M., et al. “Successful restoration of knee extension after transferring of the anterior branch of the obturator nerve: a case study”. International Journal of Neuroscience 132.11 (2022): 1128-1131.