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Abstract
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Background and Aims Lumbar sympathetic block is a recommended treatment for post amputation stump pain. Here we present a case complicated by retroperitoenal hematoma due to lumbar artery injury.
Methods A 69-year-old man had a below-knee amputation because of trauma 25 years ago and had severe stump pain that had been increasing for 1 year. Medical treatment was not sufficient and he was scheduled for right lumbar sympathetic block and radiofrequency procedure. Right L2 and L3 lumbar sympathetic block and pulse radiofrequency was performed. L4 lumbar sympathetic blok was attempted but was not successful due to encountering nerve root.
Results After 6 hours patient applied to emergency service for severe right leg and groin pain and dizziness. On examination, abdominal distension, defense and rebound were observed and Hb decrease was detected in blood tests. During follow-up in the emergency room, hypotension and confusion developed. Computed tomograpy revealed right retroperitoenal hematoma. The patient was taken to the post-anesthesia care unit and angiographic imaging was planned as an emergency. Selective right lumbar artery angiography and embolization were applied to the L4 level by the interventional radiology team. Control abdominal ultrasound revealed no active bleeding. The vital signs of patient was stable and discharged after 2 days. He had no pain but nausea and fatique. Follow up for hemodynamic state is going on.
CT imaging of the hematoma area observed at the level of the 4th lumbar vertebra. It measured 16 cm in widest diameter
Angiographic imaging of active bleeding from the distal lumbar artery
Leakage in the lumbar artery stopped after embolization and was confirmed by angiographic imaging
Conclusions Interventional pain procedures around spine demand extra care to avoid the aorta related vascular structures. Lumbar artery injury after sympathetic block is a rare complication and selective anjography and embolisation is a life saving procedure.