Spontaneous Retroperitoneal Bleeding in a Patient with Primary Antiphospholipid Syndrome on Aspirin.

Petros Ioannou,George Alexakis

doi:10.1155/2018/4397893

Abstract

Retroperitoneal bleeding is a rare and difficult to diagnose condition, defined as bleeding in the retroperitoneal space without associated trauma or iatrogenic manipulation. It has been associated with hematologic diseases and malignancies and is more common in patients receiving systemic anticoagulation. A 50-year-old man on aspirin presented with abdominal pain. Physical examination revealed abdominal tenderness and a palpable mass at the left abdominal area. An abdominal CT revealed a spontaneous retroperitoneal hematoma due to bleeding of an intraparenchymal branch of the left renal artery. The patient underwent left nephrectomy in order to control the bleeding. Pathology of the kidney showed evidence of acute and chronic microangiopathy, renal artery stenosis, and renal vein thrombosis. Further work-up led to diagnosis of primary antiphospholipid syndrome. Treatment of spontaneous retroperitoneal bleeding varies from conservative in hemodynamically stable patients to invasive or even surgery in hemodynamically unstable patients. In our case, open surgery was performed due to the rapidly deteriorating patient's condition and the inability to embolize the bleeding vessel by interventional radiology. Physicians should always think of retroperitoneal bleeding in patients presenting with abdominal pain and signs of hypovolemia, especially if they have a bleeding disorder or receive anticoagulants or antiplatelets.

Highlights

Retroperitoneal bleeding is a well-recognized but rare and difficult to diagnose condition, defined as bleeding in the retroperitoneal space without associated trauma or iatrogenic manipulation
Retroperitoneal bleeding is a medical emergency that is often difficult to diagnose due to its rarity and the nonspecific symptoms with which it presents
It can be caused by several causes, such as trauma, malignancy, iatrogenic manipulation, ruptured abdominal aneurysm, and coagulopathy; spontaneous retroperitoneal bleeding is a unique entity with few cases reported in the literature [4]

Summary

Introduction

Retroperitoneal bleeding is a well-recognized but rare and difficult to diagnose condition, defined as bleeding in the retroperitoneal space without associated trauma or iatrogenic manipulation. It has been associated with hematologic diseases, malignancies, renal angiomyolipomas or infarction, and Evans syndrome [1,2,3], while it has been shown to be more common in patients receiving systemic anticoagulation, as shown in 2 recent studies [4, 5]. Compared to other sites of bleeding, retroperitoneal bleeding can be very difficult to suspect, due to the minimal specific symptoms that are associated with this condition, while its diagnosis and treatment pose difficulties. We report the case of a young patient who presented with spontaneous retroperitoneal bleeding due to spontaneous renal hemorrhage

Case Presentation

Discussion