Iliacus hematoma syndrome: A systematic review of recent literature and case report

Femoral nerve palsy caused by iliacus hematoma is an infrequent diagnosis often missed because of its insidious presentation. However, due to potentially devastating outcomes, prompt recognition and management are essential.

The aim with this study was to better characterize clinical presentation, diagnosis, treatment, and prognosis of iliacus hematoma.

We performed a systematic review of recent literature regarding femoral neuropathy secondary to an iliacus hematoma. A structured literature review of multiple databases ((PubMed, Web of Science, EMBASE, and Cochrane library) referenced articles from 2000 to 2019.

A total of 25 patients from 25 published studies were identified. The average age of the patients was forty years (range, 12 to 85 years). There were 16 male patients and 9 female patients. The single most important predisposing cause of iliacus hematoma was trauma (14/25), with a pooled percentage of 56%. All patients with spontaneous hematoma were taking antiplatelet medications. Thirteen patients (52%) were treated conservatively with analgesia. Surgical decompression was performed in 10 patients (40%). At the final follow-up, complete resolution of symptoms was achieved in 12 patients (48%).

Although rare, iliacus hematoma syndrome carries significant morbidity. Spontaneous iliacus muscle hematoma should be considered in the differential diagnosis of leg pain in a patient who is on anticoagulation therapy. In patients with an iliacus hematoma and neurology deficit, conservative treatment can be considered initially if there is no progression in the symptoms evident at the time of presentation. However, prompt surgical decompression has been highly recommended in patients with progressive neurological deficits.