However, active retroperitoneal hemorrhage giving a large intraabdominal hemoperitoneum can be fatal and can require emergency surgery. Moreover, retroperitoneal hematoma in different anatomical position has different clinical features and treatment strategy 11. The diagnosis and treatment of traumatic retroperitoneal hematoma. Puede cursar con hemorragia intraperitoneal, o hematoma contenido. Spontaneous retroperitoneal hemorrhage in chronically hemodialyzed patients.
Lumbar plexopathy may result from hemorrhage into the retroperitoneal space, most often as a complication of anticoagulation or in association with hemophilia or other coagulation disorders. Here, a case of postpartum retroperitoneal hemorrhage presenting. Chronic expanding hematoma is a rare condition that develops after surgery, trauma, or injury. Thus, it may be asymptomatic, in which case it is usually diagnosed incidentally through imaging tests, or severe, in which case the most. Midline retroperitoneal hematoma from diaphragmatic hiatus to distal to the aortic and ivc bifurcation. It is essential that the surgeon is familiar with the anatomy of this area and has a well thought out plan for the management of each injury to a particular organ or. The purpose of this study was to report a single hospitals experience of endovascular treatment of patients with retroperitoneal hemorrhage rph secondary to anticoagulant treatment. It can also develop at any location in the body in the absence of trauma. The status of the contralateral kidney can be established, and the surgeon may avoid opening a retroperitoneal hematoma if the ivp shows an intact and functioning kidney within the hematoma.
Sep 18, 2014 we experienced four japanese patients with spontaneous retroperitoneal bleeding, a rare disease. It can be traumatic or nontraumatic spontaneous with signs and symptoms of flank or abdominal pain, hematuria and shock. Background in the early 1980s, sheldon introduced a treatment principle founded on a locationbased classification of traumatic rh as 1. The idiopathic form accounts for two thirds of all cases.
These injuries may appear as an intraperitoneal hemorrhage or as a content hematoma of the injured vessel and able to design the surgical strategy. Spontaneous retroperitoneal hematoma is a rare condition caused by extravasations of blood into the retroperitoneal space with no history of external trauma or previous vascular procedures. Practical approach to primary retroperitoneal masses in adults. In light of the risk of recurrent bleeding vs the benefi t of resuming anticoagulation for the limited remaining period, her 12week treatment course can reasonably be shortened to 10 weeks. Retroperitoneal fibrosis retroperitoneal fibrosis is a rare condition that is more common in males and is classified as idiopathic or secondary 3, 4, 50. Endovascular embolization of spontaneous retroperitoneal. There are case reports of rp hematoma after various procedures ercp, vaginal mesh, though classically it is a complication of endovascular and percutaneous procedures. Chronic expanding hematoma in the retroperitoneal space. The management of retroperitoneal hematomas remains confusing to many surgeons because the available literature frequently groups patients with blunt and penetrating etiologies together. Overview of the diagnosis and initial management of. A retroperitoneal bleed induced by enoxaparin therapy. Retroperitoneal hematoma is frequently due lo blunt trauma and is a challenging problem.
Major retroperitoneal vascular trauma abdominal key. The retroperitoneum is divided into three zones that correlate with the underlying structures and likelihood of injury to those structures. For a broader discussion, including other etiologies, please refer to the parental article on retroperitoneal hemorrhage. Shock is the most common presentation, complication and cause of mortality. Common causes are cardiac catheterization and trauma. Because the underlying injuries and their treatment may differ considerably, the nonoperative or operative. May 17, 2008 spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present as a rare lifethreatening event characterized by sudden onset of bleeding into the retroperitoneal space, occurring in association with bleeding disorders, intratumoral bleeding, or ruptures of any retroperitoneal organ or aneurysm. Rarely, later in the course, the patient may develop. Retroperitoneal hemorrhage was demonstrated by means of abdominal ct scan in all cases and bleeding origin was established in 92. Sep 06, 2012 retroperitoneal hematoma also known as retroperitoneal hemorrhage is a potentially lifethreatening condition. In general, hematomas are naturally reabsorbed and rarely cause serious problems. An overview of the injury mechanisms, recognition, and management of traumatic injury to the retroperitoneum is provided.
Intraoperative reboa for a massive zone 1 retroperitoneal. Introduction diagnosis and management of retroperitoneal. The risk of recurrent venous thromboembolism when a patient is off anticoagulation decreases with time from the initial. Retroperitoneal hematoma is a rare entity with clinical consequences that vary according to the speed and amount of bleeding. He was taken to the operating room for emergent laparotomy. The diagnosis and treatment of traumatic retroperitoneal. Spontaneous retroperitoneal hemorrhage srh is a distinctive clinical pathology of retroperitoneal bleeding without a preceding history of trauma. Pdf the management of retroperitoneal hematomas researchgate. Approach and management of traumatic retroperitoneal. In our study, retroperitoneal hematoma is classifi ed under three regions, as defi ned by selivanov et al.
The most common presentation of retroperitoneal hematoma is hypovolemia and anemia. Mar 10, 2020 a retroperitoneal hematoma is a pocket of blood found in the lower back in an area known as the retroperitoneal space. Ten patients underwent urgent surgery while conservative treatment was attempted in the remaining 17. In trauma, one must be cognizant of the clues in the trauma workup and associated injuries of the retroperitoneal organs.
Retroperitoneal hemorrhage presenting as a vaginal. Rarely, vaginal hematoma can be secondary to a distant, lifethreatening hemorrhage. Zone 2 is located in the paracolic gutters bilaterally and. Three of the 4 patients did not have a bleeding tendency as indicated by laboratory data obtained at. Symptoms the patient may complain of intense flank pain or back pain. Retroperitoneal hematoma associated with pelvic fracture had a mortality of 19%. Hemoglobin concentration, platelet count, and coagulation parameters should be measured to guide transfusion and other therapy. Spontaneous retroperitoneal hemorrhage occurs in critically ill patients who are taking anticoagulant or antiplatelet medications, or both femoral vascular access common etiology of clinically silent large retroperitoneal hematoma formation traumatic retroperitoneal hematoma can occur after either blunt or penetrating trauma. Trauma in the retroperitoneal compartment has the highest mortality rates. Despite all the advances in the fi elds of technology and surgical techniques, retroperitoneal hematoma caused by the penetrating and blunt injuries still remains. Axial computed tomographic scan of the pelvis shows hematoma arrows. Diagnosis and treatment of retroperitoneal hematoma in. Clinical findings and various diagnostic imaging modalities can aid in the differential diagnosis of this condition. Retroperitoneal bleeding refers to an accumulation of blood found in the retroperitoneal space.
Pattern of presentation of retroperitoneal hematoma among. Gigantic retroperitoneal hematoma as a complication of. Ten consecutive patients treated in an intensive care unit and needing blood transfusions due to rph secondary to anticoagulation were referred for digital subtraction angiography dsa to detect the bleeding. Retroperitoneal hemorrhage radiology reference article. The most frequently encountered cause of retroperitoneal hemorrhage is a ruptured abdominal aortic aneurysm, followed by renal and adrenal tumors, along with some other less common causes. Eastern association for the surgery of trauma practice. Penetrating zone i trauma causing vascular injuries is most common of all. The retroperitoneal hematoma in centro medial zone is usually the consequence of the injury of duodenum, pancreas or great vessels. In the abdomen, there was a massive zone 1 retroperitoneal hematoma causing the intestinal contents to be pushed out of the abdominal cavity. We categorized the clinical characteristics of spontaneous retroperitoneal bleeding in these patients treated in our hospital and discuss the risk factors of spontaneous retroperitoneal bleeding. Incidence of this complication in adults is high, but in childhood is uncommon. Retroperitoneal hematoma an overview sciencedirect topics.
Management of trauma to the retroperitoneum differs based upon mechanism of injury and zone of injury. Retroperitoneal hemorrhage or retroperitoneal hematoma rph refers to an accumulation of blood found in the retroperitoneal space1. Idiopathic retroperitoneal hematoma is a rare, but potentially life threatening cause of an acute surgical abdomen. Nine patients survived multiple trauma index grade iii, hanover polytrauma index, three patients with very severe injuries died immediately multiple trauma index grade iv. Signs the patient may develop tachycardia and hypotension if the rate of hemorrhage is rapid. The retroperitoneum is a large space bounded anteriorly by the posterior parietal peritoneum, posteriorly by the transversalis fascia, and superiorly by the diaphragm. Initially diagnosis may be overlooked, leading to unnecessary exploration, which may have implications for prognosis of the patient. Pdf spontaneous retroperitoneal hematoma is a rare condition. Incidence of respiratory failure for entire series, excluding head trauma, was 29%. Retroperitoneal hemorrhage vaginal hematoma postpartum vaginal hematoma is a rare, painful, and benign event, most commonly due to localized hemorrhage 1.
Hemodynamically unstable patients with retroperitoneal hematoma represent an intraoperative diagnostic challenge. From 1984 to 1991 20 multiple trauma patients with pelvic fractures and retroperitoneal bleeding from pelvic vessels underwent angiographic localization and embolization of massively bleeding arterial vessels. The spontaneous form is the most infrequent retroperitoneal hemorrhage. Contained retroperitoneal hematoma the retroperitoneum is divided into three zones. A high clinical suspicion is needed to recognize and appropriately manage retroperitoneal injuries. The presence of progressive sign and symptoms, increased amylase in. Each of these zones has a specific number of organs which are at risk for injuries. There are three anatomical zones which define the retroperitoneum. Its clinical presentation can be insidious, evolving for a few days, or sudden, depending on the amount of bleeding. The spontaneous retroperitoneal hematoma srh is defined as a spontaneous hematic collection located in any of the retroperitoneal compartments. Traumatic retroperitoneal hematoma is the common complication of abdominal or pelvic injuries. In our experience, in cases of spontaneous retroperitoneal hemorrhage, ct scan is the.
Respiratory failure occurred in 37% of patients with zone. Zone i spans the midline of the abdomen and can be divided into the supramesocolic and inframesocolic regions. Retroperitoneal hemorrhage an overview sciencedirect topics. In this case, intravascular volume repletion is the first priority table 643. A hematoma forms when blood collects within an enclosed place, such as the soft tissues found among organs and their supporting membranes. Surgeons should always suspect an abdominal vascular injury when trauma to the trunk or a deceleration mechanism is present. Traumatic retroperitoneal hematoma spreads through the interfascial planes volume 593, september 2005, pp 595608 2. The retroperitoneum is one of the most challenging areas of the abdomen. Retro peritoneum contains a number of visceral and vascular structures in the gastrointestinal, genitourinary, vascular, musculoskeletal and nervous systems. The secondary form is related to neoplasms, infections, trauma, and other conditions.