Case Presentation: We present the case of a 49-year-old woman who presented with two days of right-sided abdominal pain radiating to the right groin and right flank. She had been seeing a chiropractor for cervical neck pain poorly controlled on daily acetaminophen, with improvement in her pain following these chiropractic sessions. At her most recent visit, she noticed an abnormal sensation during spinal manipulation. Thirty-four hours later, she began experiencing acute abdominal pain and was brought to the emergency department. She denied any recent use of aspirin or NSAIDs. Her blood pressure on arrival was 148/82 and heart rate 86. Her abdomen was tender to palpation over the right flank and inguinal region. There was no bruising present and no tenderness over the spine. A CT of the abdomen and pelvis revealed a 6.4 x 7.7 x 4.1 cm right-sided retroperitoneal hematoma between the ascending colon and right psoas muscle. Her initial hemoglobin was 13.5 g/dL which trended down to a low of 11.9 g/dL. Her platelets were 266 and INR 1.04. A subsequent CTA showed a stable hematoma with a tortuous right gonadal artery medially adjacent to the hemorrhage with no evidence of extravasation. Overnight, the patient’s hemoglobin increased to 13.1 g/dL and her pain resolved with acetaminophen. She was discharged on Hospital Day 2.
Discussion: Nearly one in four Americans have received chiropractic care during their lifetime. Complications are rare and vary in severity and presentation, ranging from a mild headache to vertebrobasilar artery strokes. This case illustrates a unique presentation of a self-limited complication from chiropractic spinal manipulation. Retroperitoneal hematomas are often associated with trauma, coagulopathies, or thrombocytopenia. In the absence of these, one should consider recent spinal manipulation as a potential etiology. In this scenario, the patient was monitored closely for signs of active bleeding to avoid detrimental sequelae.
Conclusions: With a shift toward multidisciplinary pain management, it is important for hospitalists to recognize the rare complications of chiropractic spinal manipulation. This serves as a reminder for physicians to ensure that they are aware of the full spectrum of care their patients are receiving. Furthermore, it is important that physicians assist their patients in weighing the risks and benefits associated with chiropractic treatment.