Delayed perinephric hematoma following ESWL in an anticoagulated patient: A case report

Extracorporeal shock wave lithotripsy (ESWL) is a widely used non-invasive treatment for renal stones; however, it carries a risk of hemorrhagic complications, particularly in patients with comorbidities such as hypertension, diabetes, and anticoagulation therapy. Perinephric hematoma is a rare but potentially serious complication that requires prompt recognition and appropriate management.

We report a case of a 58-year-old male with hypertension, diabetes, and long-term anticoagulation who developed a massive perinephric hematoma one week after undergoing ESWL for bilateral renal stones. He presented with severe left flank pain and a significant hemoglobin drop, with imaging confirming a large perinephric hematoma. He was managed conservatively in the intensive care unit (ICU) with close monitoring, bed rest, fluid resuscitation, pain control, and temporary cessation of anticoagulation. Over 10 days, his condition improved without the need for invasive intervention, and he was discharged on oral medications with a planned follow-up for renal function assessment and anticoagulation resumption.

This case highlights the importance of early diagnosis using CT imaging in patients presenting with post-ESWL flank pain and anemia. Conservative management, including strict monitoring, supportive care, and temporary anticoagulation withdrawal, was successful in achieving hemodynamic stability without invasive intervention. This underscores the need for individualized treatment strategies based on patient risk factors and clinical presentation.

This case underscores the importance of early recognition of ESWL-associated hemorrhagic complications, particularly in high-risk patients. It also highlights the effectiveness of conservative management as a viable approach to achieving successful recovery without the need for surgical or interventional procedures.