攝護腺癌患者注射諾雷德®所致血腫: 個案報告

何承儒、王紹全、陳文榮、謝佐宜、宋文瑋、楊旻鑫、陳順郎

中山醫學大學附設醫院 泌尿科

ZOLADEX® injection related hematoma in prostate cancer patients: cases report

Cheng-Ju Ho, Shao-Chuan Wang, Wen-Jung Chen, Tzuo-Yi Hsieh, Wen-Wei Sung, Min-Hsin Yang, Sung-Lang Chen

Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan

Introduction: Androgen deprivation therapy (ADT) has been extensively applied in different stages of prostate cancer. Periodic administer with LHRH agonist or antagonist may be the treatment of choices for prostate cancer management. ZOLADEX® (goserelin acetate implant) is one of most used agents among them, however potentially fatal complications including rectal sheath hematoma caused by inferior epigastric artery injury. Herein, we report two cases with giant rectus sheath hematoma resulting from goserelin acetate injection.

Cases report: An 85-year-old man attended to emergency department and complained of right lower abdomen pain and tender swelling with bruise 5 days after goserelin acetate (ZOLADEX®) injection at outpatient department for his prostate cancer. He had past history of atrial fibrillation, vulvar heart disease under apixaban 2.5mg twice a day, and monthly outpatient 3.6 mg goserelin acetate injection for T2bN0M1b prostate cancer since 2017. At emergency department, vital signs are relatively stable without tachycardia, dyspnea, or hypotension, and he was oriented and cooperative. Laboratory data showed WBC: 10170/ul, Hb: 7.0g/dl, platelet: 204000/ul, prothrombin time: 11.4sec, activated partial thromboplastin time: 24sec, and prothrombin time INR: 1.12 on presentation. Contrast-inhanced CT scan (Figure 1) demonstrated approximately 20 cm * 6 cm * 6 cm hyperdense fluid collection along the right rectus abdominis muscle, consistent with an abdominal wall hematoma. The patient was then resuscitated with packed red blood cells and intravenous crystalloid fluids. During hospitalization, the patient required an incision and drainage of the right abdominal wall hematoma with blood clot evacuation. The patient’s hemoglobin level was back to baseline after blood transfusion and surgical intervention throughout the hospitalization. Second case was a 71-year-old man, newly diagnosed as bone metastasis prostate cancer (cT2cN0M1b, Gleason score 4 + 3, with initial PSA of 212.98 ng/ml). Combination ADT with goserelin acetate (ZOLADEX®) 3.6 mg injection and bicalutamide (CASODEX®) 50 mg was prescribed to him as outpatient. He denied past history of anticoagulant or antiplatelet therapy usage. However, he came back to emergency department about 8 hours after 4th time of goserelin acetate injection with chief complaint of painful swelling over right lower abdomen. At emergency department, his vital signs were all within normal limits. Laboratory evaluation demonstrated hemoglobin of 15.1 g/dl, and platelet 506000/ul on presentation. Sonography demonstrated approximately 10cm * 6cm * 3cm in size hematoma within rectus sheath (Figure 2A). Pain control, ice packing, and tranexamic acid intravenous injection were administered immediately. Follow-up sonography at outpatient department showed limited size of hematoma 2 days later (Figure 2B).