Serious complication after subcutaneous injection of heparin for prophylaxis of thromboembolism. Case report

摘要

Subcutaneous application of low-dose heparin before and after surgery is a routine procedure to avoid thromboembolic complications. Advances in development of anticoagulants, reduction of intervals between applications, modern injection tools, and training of the personnel have already reduced the incidence of severe complications. However, the case presented shows impressively that a life-threatening complication is still possible and has to be kept in mind in perioperative thrombosis prophylaxis.After postoperative subcutaneous injection of low-close-heparin in the right lower abdominal wall, a 76-year-old female patient suffered from an extensive, hemodynamically active hematoma located in the M. rectus abdominis as a sequela of perforating the A. epigastrica superficialis. Consequently hypovolemic shock led to cardiopulmonary circulatory arrest. After immediate resuscitation, surgical hemostasis was performed and the hematoma was removed. Post-interventional stabilization of circulation and wound healing were trouble free.