Retroperitoneal hemorrhage following spinal anesthesia: A case report

Serious neurological problems following spinal anesthesia are rare, although they can occur. We report a case of a 31-year-old female patient, parturient, Gravida 2 Para 1, with a body mass index (BMI) of 25 kg/m2 who had a paramedian approach spinal anesthesia using 23-gauge Quincke spinal needle for an emergent cesarean section due to failure to progress. Four attempts were required to achieve successful spinal blockade. The procedure was successfully performed with no complications. On the first postoperative day, the patient started to complain of pressure headache and abdominal pain radiating to the lower back. Magnetic resonance imaging (MRI) lumbar spine revealed right peri-nephric and retroperitoneal subacute hematoma and no evidence of cerebrospinal fluid (CSF) leak or collection. Computed tomography (CT) angiography affirmed the diagnosis of large retroperitoneal hematoma extending to inferior vena cava, measuring about 5 × 15 × 16 cm in its maximum antero-posterior, transverse, and cranio-caudal diameters, respectively, corresponding to about 620 ml volume. No active bleeding was demonstrated.