Lateral abdominal wall hematoma as a rare complication after carotid artery stenting: a case report

Lateral abdominal wall hematoma is a rare condition that can give rise to an acute abdomen [1]. Predisposing factors include anticoagulant therapy [1-3]. With the increase in carotid artery stenting in patients in whom activated clotting time is prolonged for prevention of cerebral infarction, we must be aware of the possibility of abdominal wall hematoma. Moreover, accurate diagnosis allows us to avoid unnecessary surgical intervention. We report a right lateral abdominal wall hematoma caused by rupture of the superficial circumflex iliac artery after carotid artery stenting. The hematoma was treated by transcatheter arterial embolization.A 72-year-old man with no neurological symptoms was admitted to our hospital because of severe stenosis of the origin of the right internal carotid artery. We performed carotid artery stenting for the targeted lesion with an activated clotting time of more than 300 seconds, and good patency was obtained. Postoperative magnetic resonance imaging showed no evidence of cerebral infarction. After 2 hours, he complained of right lateral abdominal pain. Abdominal computed tomography revealed an extensive hematoma in the right lateral abdominal wall; at this stage, activated clotting time was 180 seconds (Fig. 1A). Because he was alert and hemodynamically stable at that time, we opted for watchful waiting. After 7 hours the patients developed nausea, and had a regular pulse of 140 beats per minute and a systolic blood pressure of 80 mmHg. Hemoglobin level dropped from 13.9 to 11.3 g/dl. Subsequent computed tomography showed enlargement of the hematoma (Fig. 1B). Emergent selective angiography of the external iliac artery revealed active bleeding from the right superficial circumflex iliac artery (Fig. 2). After red blood cell transfusions, transcatheter arterial embolization with Gelfoam and microcoils was performed successfully. The postoperative course was uneventful and he was discharged on the 14th day. To date, no recurrence of the