Abstract
A 14-year-old boy with hemophilia A presented at our pediatric outpatient department because of pain of unknown cause in the left femoral region, which had subsequently developed into severe pain in the left inguinal region.
Upon admission, severe pain was evident upon flexion of the left hip and knees. Lower limb muscle force could not be measured, as the patient was unable to perform active movement. Paresthesia and hypesthesia were evident in the left anterior femur, and CT scan identified a hematoma in the left iliopsoas muscle.
Bed rest and supplementation of factor VIII were prescribed. Due to severe pain, inability to ambulate, and advanced neural disorder, a thrombectomy was performed on the second day of admission. Subsequently, pain upon extension of the left hip joint and paresthesia in the anterior femur decreased. At 7 months after the procedure, the sensory sluggishness had improved, the MMT score recovering to 4 in the left iliopsoas muscle and 4 in the quadriceps femoris muscle.
Iiliopsoas hematoma is a known complication of hemophilia. For a hemophiliac patient with accompanying femoral nerve paralysis due to iliopsoas hematoma, conservative treatment is generally chosen. However, early thrombectomy with sufficient supplementation of coagulation factors is desirable to avoid irreversible damage to the nerve if the pain is severe and accompanied by advanced paralysis.
