Postoperative Retroperitoneal Hematoma: A Case of Saw Palmetto and the Importance of Primary Care Intervention.

Publisher: Emerald Medical Education, a subsidiary of HCA Healthcare Physician Services, Inc Country of Publication: United States NLM ID: 9918316187606676 Publication Model: eCollection Cited Medium: Internet ISSN: 2689-0216 (Electronic) Linking ISSN: 26890216 NLM ISO Abbreviation: HCA Healthc J Med Subsets: PubMed not MEDLINE

Original Publication: Nashville, TN : Emerald Medical Education, a subsidiary of HCA Healthcare Physician Services, Inc., [2020]-

Introduction: A middle-aged male with a history of bilateral inguinal hernia repair was admitted for acute abdominal pain. The patient reported that he took prescribed hydrocodone and a saw palmetto supplement prior to surgery. He denied any recent trauma after the procedure, and he was unable to schedule a follow-up appointment with the surgeon or the primary care physician.
Clinical Findings: Diagnosis: The CT angiography of the abdomen/pelvis was indicative of new interval development of a large left retroperitoneal hematoma. Intervention: No emergent intervention was required following the evaluation by the surgery and interventional radiology (IR) departments. Outcome: There was no evidence of overt bleeding over the 3-day hospital course, and his hemoglobin was within normal limits. The patient was stable for discharge as the hematoma would slowly absorb over the next 2 months.
Conclusions: A retroperitoneal hematoma (RPH) has a multi-factorial etiology, such as endovascular procedures and surgeries. Detection and presentation of an RPH serves as a guide in management. There are various modes of detection. However, a multi-detector computer tomography-angiography (MDCTA) provides greater information in regards to the anatomical etiology and extent of RPH. Despite the common risk factors associated with a RPH, there are understudied and underreported influences of medications and herbal supplements, such as saw palmetto, in the development of this outcome. A large portion of the population consume herbal and/or dietary supplements, which belong to the category of complementary and alternative medicine (CAM). The challenge for health care providers, especially in the primary-care setting, is the unregulated use of herbal supplements and the associated effects. It is imperative for primary-care physicians to recognize these unknown risks and attempt to inquire about supplement use. Future education should be aimed at integrating CAM into the medical curriculum to improve physician-patient interaction in addressing this topic.
Competing Interests: Conflicts of Interest The authors declare they have no conflicts of interest.
(© 2020 HCA Physician Services, Inc. d/b/a Emerald Medical Education.)

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Keywords: complementary therapies; dietary supplements, adverse effects; hematoma; medical history taking; retroperitoneal hematoma; saw palmetto extract; serenoa

Date Created: 20230710 Latest Revision: 20230718

20230718

PMC10324748

10.36518/2689-0216.1027

37426613