Massive Retroperitoneal Hematoma Research Articles

Massive retroperitoneal hematoma caused by intercostal artery bleeding after blunt trauma: a case report

BackgroundThe occurrence of massive retroperitoneal hematoma caused by intercostal artery bleeding is exceedingly uncommon.Case presentationA middle-aged male presented to the hospital after a fall. Computed tomography scan revealed a massive retroperitoneal hematoma without any evidence of organ or major vessel rupture. The angiogram revealed extravasation from a branch of the twelfth intercostal artery, and successful transcatheter arterial embolization was performed on this specific artery.ConclusionsThe possibility of intercostal artery rupture should be considered in cases of retroperitoneal hematomas, and accurate diagnosis can be achieved through imaging studies. Transcatheter arterial embolization represents an effective treatment modality.

A case of massive retroperitoneal hematoma secondary to hernia repair and review of the literature

Retroperitoneal hematomas are very rare and possibly fatal complications of hernia surgery. In this study, we report the case of a 24-year-old patient who developed a massive left preperitoneal and retroperitoneal hematoma following vessel injury during Shouldice hernia repair. Despite a packing during haemostasis surgery and being well resuscitated, the patient died in haemorrhagic shock. This case highlights the importance of early detection of signs of postoperative bleeding in the outcome of patients undergoing hernia repair.

Percutaneous thrombin injection under contrast-enhanced ultrasound guidance to control active extravasation not associated with pseudoaneurysm.

The technique of percutaneous thrombin injection (PTI) under contrast-enhanced ultrasound (CEUS) guidance for control of acute hemorrhage-active extravasation not associated with pseudoaneurysm is demonstrated in three cases: 1) Massive spontaneous retroperitoneal hematoma in a patient with multiple comorbidities. Contrast-enhanced computed tomography (CT) showed extensive active extravasation, which was only partially controlled by transarterial embolization. CEUS was performed in the angiography suite. Contrary to unenhanced US and colour Doppler US (CDUS), CEUS confirmed persistent extravasation; CEUS-guided PTI was performed immediately thereafter. 2) Large rectus sheath hematoma in a patient on anticoagulant therapy. Contrast-enhanced CT and unenhanced US/CD could not definitely diagnose extravasation. CEUS clearly showed extravasation and was used for guidance of PTI. 3) Chest wall hematoma complicating central venous catheter placement in a patient with coronavirus on anticoagulant therapy. CDUS was inconclusive. CEUS was performed at the bedside, clearly showed active extravasation, and was used for guidance of PTI. In all three cases, post-PTI CEUS confirmed the absence of residual enhancement of the hematomas, and the hemodynamic status of the patients improved. PTI appears to be effective in selected cases of hematomas associated with active extravasation. In this context, CEUS may be the most suitable modality for guidance and for an immediate evaluation of the treatment effect.

Clinical case of a pelvic fracture with massive retroperitoneal hematoma

Pelvic fracture is a serious injury that carries a significant risk of mortality. The cause of death in these victims is the formation of a retroperitoneal hematoma and massive bleeding. The article presents a clinical case of a pelvic fracture with a massive retroperitoneal hematoma in a 30-year-old man who was brought to the regional hospital in hemorrhagic shock 5 hours after falling from the 5th floor. Upon admission, computed tomography (CT) showed a rupture of the pubic joint, a multifragmentary fracture of the sacrum, and the presence of a hematoma in the right parts of the pelvic cavity. Despite immobilization of the fracture and massive transfusion, it was not possible to stabilize the patient's hemodynamics and improve the parameters of the patient's general blood analysis. Due to the clinic of active bleeding, the patient repeatedly underwent control ultrasound examinations of the abdominal cavity and pleural sinuses, but the presence of free fluid in the abdominal cavity could be confirmed only after 12 hours of treatment. At the emergency laparotomy, a hematoma was found, which spread through the retroperitoneal space to the level of the diaphragmatic crura and the root of the small-bowel mesentery in a relatively thin layer, which explained the impossibility of its visualization by ultrasound or CT. Despite the intensive care measures, over the next few days the patient's condition gradually worsened, multiple organ failure developed. On the 3rd day after the operation, the patient died due to progressive multiple organ failure. The described case demonstrates the severity of the condition of victims with a traumatic retroperitoneal hematoma and the difficulty of diagnosis and effective treatment using conservative methods.

ABDOMINAL AORTIC ANEURYSM RUPTURE – CASE REPORT

An Abdominal Aortic Aneurysm (AAA) is a localized dilatation and weakening of the abdominal aorta, as it`s infrarenal part is most commonly affected by the disease. Risk of rupture: Size of the AAA is one of the strongest predictors of rupture, as aortic aneurysms above 5,5cm in diameter have a higher risk. Clinical manifestation: Most of the AAAs have no symptoms and are accidently found. Classis symptoms of ruptured AAA (rAAA) are suddenly occurring severe abdominal and/or back pain, arterial hypotension and pulsatile abdominal mass. Preoperative management: When rAAA is suspected, the patient should be consulted with a vascular surgeon as soon as possible. Aggressive fluid resuscitation should be avoided. Surgical treatment: Open surgery is usually performed via a transperitoneal approach with a midline laparotomy. Depending on the anatomy of the AAA and iliac arteries involvement an aorto-arotal or aorto-bifemoral bypass is constructed. Complications after repair of rAAA: Local - Lower limb(s) ischemia, Ischemia of the colon; Systemic - Cardiac, Pulmonary, Renal, Liver or Multiorgan failure, with 30-day mortality reaching up to 89%.CASE REPORT: Male patient, 81 years of age, with multiple concomitant diseases. He was diagnosed with AAA 4 months prior to the rupture. The maximal diameter of the AAA was 15,6cm, iliac arteries were not affected. The patient refused the suggested surgical or endovascular treatments. He presented at ER 4 months later with acute pain in the abdomen and back. Clinical status: severe pain in the abdomen, BP 96/57mmHg, Hgb 102 g/l with HCT -0.331 l/l. On the CT-angiography rupture of AAA was verified with massive retroperitoneal haematoma, occluded right renal artery and aneurysm of the left renal artery. Median laparotomy was conducted under common anaesthesia. Aneurysmal neck was clamped above renal arteries, with clamping time – 30 minutes. After reclamping aorto-bifemoral bypass was constructed. Postoperatively the patient was transferred to intensive care unit (ICU). In the course of ICU treatment, the patient was inadequate and lacked spontaneous diuresis. A temporary catheter for haemodialysis was placed and such was initiated. He was transferred in the Clinic of vascular surgery after stabilizing blood oxygen saturation. The patient was inadequate at the time of transfer, with jaundice present. The patient restored bowel passage, hepatoprotectors were administered and physiotherapy was initiated. On the 20th postoperative day, the patient had a rapid decline in the physical status, demonstrated by hypotonia, bradycardia and regardless of the reanimation, died.DISCUSSION: Ruptured aneurysm of abdominal aorta has high mortality. Despite the immediate surgical treatment and adequate substitution, the patient had lethal outcome. CONCLUSION: Ruptured abdominal aortic aneurysm has high 30-day mortality, ranging between 22,9%-65,9%. In cases of acute renal and/or liver failure following the surgical treatment and when haemodialysis is needed, mortality rate can reach up to 89%.

Spontaneous retroperitoneal hematoma: a case report

BackgroundSpontaneous retroperitoneal hematoma is defined as bleeding in the retroperitoneal space without any triggers such as trauma, invasive procedures, and abdominal aortic aneurysm.Case presentationA 48-year-old Japanese man who experienced sudden abdominal pain, severe hypotension, and decreased hemoglobin was diagnosed with spontaneous retroperitoneal hematoma. Contrast-enhanced computed tomography revealed massive left retroperitoneal hematoma; however, neither extravasation nor causative aneurysm was noted. Through conservative management with close monitoring, he was treated and discharged on the tenth hospital day without any morbidity.ConclusionsSpontaneous retroperitoneal hematoma treatment comprises conservative management, transcatheter arterial embolization, and surgical intervention. The mortality rate of spontaneous retroperitoneal hematoma is so high that the optimal treatment timing needs to be carefully judged on the basis of detailed evaluation, and management algorithm with clear criteria.

Case Report: Spontaneous Left Inferior Epigastric Artery Injury in a COVID-19 Female Patient Undergoing Anticoagulation Therapy

Since the beginning of the pandemic, a recommendation was made for the use of anticoagulants in high-risk hospitalized patients. This therapeutic approach has positive and negative effects regarding the outcome of the disease. Anticoagulant therapy prevents thromboembolic events, but it can also lead to spontaneous hematoma formation, or be accompanied by massive active bleeding. We present a 63-year-old COVID-19-positive female patient with a massive retroperitoneal hematoma and spontaneous left inferior epigastric artery injury.

Intraoperative cell salvage in the treatment of Wunderlich syndrome caused by renal angiomyolipoma

Introduction. Wunderlich syndrome is defined as acute spontaneous hemorrhage into the subcapsular and perirenal spaces in the absence of trauma. The most common causes of Wunderlich syndrome are various renal neoplasms, polycystic and vascular kidney diseases. Wunderlich syndrome is common in patients who use anticoagulant therapy or suffer from various types of congenital coagulopathies. The clinical diagnosis is usually confirmed by computer tomography of the abdomen and requires urgent surgical treatment or renal artery embolization. Case Report. A 45-year-old woman was admitted to the Emergency Center due to acute pain in the left abdomen, associated with arterial hypotension. A computer tomography of the abdomen was performed using intravenous contrast, which showed a ruptured tumor of the left kidney with a massive retroperitoneal hematoma. The tumor was 7 cm in diameter and according to the computer tomography data it corresponded to an angiomyolipoma. The patient underwent emergency surgery. Intraoperative cell salvage was used with additional blood replacement. Nephrectomy and drainage of the massive retroperitoneal hematoma were performed. Pathohistological analysis of the surgically removed kidney confirmed a renal angiomyolipoma. Conclusion. Wunderlich syndrome caused by the rupture of angiomyolipoma is still a life-threatening condition that should be considered in the differential diagnosis of sudden abdominal pain, especially in women of reproductive age. In hypotensive patients, available radiological methods should be used to make an accurate diagnosis, before taking the patient to the operating room.

Ruptured Collateral Venous Aneurysm Associated with IVC Agenesis Resulting in a Massive Retroperitoneal Hematoma

Ruptured Collateral Venous Aneurysm Associated with IVC Agenesis Resulting in a Massive Retroperitoneal Hematoma

Hemorrhagic Shock from Massive Retroperitoneal and Pelvic Hematoma After Stapled Hemorrhoidopexy

Background: Massive retroperitoneal and pelvic hematoma leading to hemorrhagic shock following stapled hemorrhoidectomy is rare. To the best of our knowledge at the time of this publication, there are no reported cases of postoperative pelvic or retroperitoneal hematoma without intraluminal bleeding reported after stapled hemorrhoidopexy. We describe such a case in a patient with grade III internal hemorrhoid who was treated with colonoscopy and stapled hemorrhoidectomy. Case Summary: A 64-year-old female with a past medical history significant for deep vein thrombosis and pulmonary embolism for which she was anticoagulated with warfarin presented with hemorrhoids and rectal bleeding and associated iron deficiency anemia. The warfarin was held five days prior to the planned combined colonoscopy and hemorrhoidectomy procedure. While still recovering in the post-anaesthesia care unit (PACU) a few hours post-operatively, she was found to be hypotensive, tachycardic, and somnolent. A CT abdomen/pelvis was obtained, which identified a large collection of blood in the pelvis and retroperitoneum. She was taken back to the OR for an emergent exploratory laparotomy and flexible sigmoidoscopy. She was admitted to the ICU where she required placement on BiPAP for respiratory acidosis and resuscitation with a total of seven units of pRBCs and two units of FFP. She was clinically stable three days later. Conclusion: In a patient with a history of chronic anticoagulation, one should consider intraluminal, retroperitoneal, and pelvic bleeding if the patient is in hemorrhagic shock after stapled hemorrhoidectomy. Furthermore, one should not rule out the possibility of retroperitoneal or pelvic bleeding even if there is no evidence of intraluminal bleeding. Emergent laparotomy and sigmoidoscopy may be considered for unstable patients with unidentified external bleeding.

Simultaneous retroperitoneal haematoma and rectus sheath haematoma in a COVID-19 patient

A 67-year-old woman was admitted to hospital with shortness of breath and acute cough for two days. Computed tomography (CT) results indicated COVID-19 pneumonia. Prophylactic anticoagulant treatment was begun using enoxaparin sodium on service. On the 10th day of her follow-up, increased respiratory distress occurred, and she was taken to the intensive care unit (ICU). Her haemoglobin level decreased to 7.5 g/dL in the intensive care follow-up (16th day). On CT scan, a massive retroperitoneal haematoma, 150 mm in diameter, was detected with a right inferior rectus sheath haematoma, 60 mm in diameter. Anticoagulant therapy was stopped, and eight units of erythrocyte suspension (ES) administered. Kidney and liver failure was added to the clinical picture, and patient died on the 18th day after admission.

Retroperitoneal Ectopic Pregnancy Presenting as a Massive Retroperitoneal Hematoma.

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Endovascular Repair for Abdominal Aortic Rupture Caused by Periaortic Mantle Cell Lymphoma.

A 72-year-old man was referred to our hospital for the suspicion of ruptured abdominal aortic aneurysm. Before admission, he was suspected of having a malignant lymphoma and underwent excisional biopsy in his right groin. A contrast enhanced computed tomography scan revealed a massive retroperitoneal hematoma with an extravasation arising from the infrarenal abdominal aorta coexisting with an extensive retroperitoneal mass surrounding the aorta. An emergency endovascular aneurysm repair was performed and the postoperative course was uneventful. After the treatment, histological examination of the previous biopsy confirmed the diagnosis of mantle cell lymphoma.

Massive retroperitoneal haematoma because of renal cyst rupture, report of a case

An exhaustive investigation is carried out on the cause of death of this pedestrian, carrying out an extensive bibliographic search taking into account the pathophysiology of trauma for this type of accident, and then making a clinical-pathological correlation of the series of events that concluded with the death of this person and its applicability in trauma services.

Postpartum Spontaneous Rupture of an Ovarian Artery Aneurysm: A Case Report and Review

This study reported a case of spontaneous rupture of an ovarian artery aneurysm 4 days following cesarean section. The patient mainly presented with a consistent low-grade fever and did not have symptoms, such as severe abdominal or flank pain, as is common in other similar cases. Enhanced magnetic resonance imaging revealed a massive retroperitoneal hematoma; angiography confirmed that there was a rupture in an ovarian artery aneurysm. A selective embolization was performed successfully.

Spontaneous lumbar artery rupture and massive retroperitoneal hematoma, successfully treated with arteriographic embolization.

Background and Objective:Massive retroperitoneal hematoma caused by lumbar artery rupture is generally associated with trauma or retroperitoneal malignancy. However, despite recent advances in technologies and tools, spontaneous lumbar artery rupture is a very rare disease entity but remains a challenging problem because it is frequently associated with significantly high mortality and morbidity and is very difficult to make a correct diagnosis.Methods:We evaluated the databases of the PubMed, Embase, Cochrane Central Register of Controlled Trial, Google Scholar, the KoreaMed and the Research Information Sharing Service databases, and a detailed systematic review was performed by searching in PubMed. The initial search was performed on 3 February 2018 and a second search conducted in 29 January 2019.Results:A total of 10 case reports on massive hemoperitoneum caused by spontaneous lumbar artery rupture were identified. Of the 10 case reports involving 14 patients, eight were male and six were female under 62.71 ± 13.93. Of the 14 patients, 9 (64.3%) surviving with transcatheter arterial embolization, three (21.4%) died of multi-organ failure or hypovolemia, and two (14.3%) had no definite records on survival or death.Conclusions:A massive retroperitoneal hematoma caused by lumbar artery rupture should be considered in patients with late-onset shock accompanied by blunt abdominal/pelvic trauma. Furthermore, early detection and urgent embolization would prevent further complications and eliminate the need for surgical interventions.

Wunderlich’s syndrome associated with anticoa­ gulant treatment, heart failure, and post-radiation vasculopathy (RCD code: I-O)

Background: Wunderlich’s syndrome (WS) is an extremely rare condition, characterised by spontaneous haemorrhage into the subcapsular, perirenal, and retroperitoneal spaces. The most common cause is renal angiomyolipoma. Classic symptoms, such as acute flank pain, flank mass, and hypovolemic shock, known as Lenk’s triad, have limited sensitivity and specificity for detecting WS. High mortality may be related to the difficulties in diagnosis, poor disease recognition, and non‐specific symptoms and signs. Computed tomography (CT) is the method of choice for the diagnosis of WS. Depending on the severity of symptoms, a conservative or invasive approach is reasonable. Methods and results: We report the case of a 58‐year‐old male with multivalvular heart defect, atrial fibrillation, and exacerbation of chronic heart failure complicated with nontraumatic bleeding into the retroperitoneal space. CT revealed a massive (14x11x26 cm) retroperitoneal and perirenal haematoma. The patient was successfully treated with transfusion of red blood cells, fresh frozen plasma, and intravenous fluids. Simultaneously, heart failure treatment was initiated. In view of the chronic and idiopathic character of the haematoma and successful conservative treatment, there was no indication for surgery. Discussion: Several factors might have contributed to the bleeding. First, the patient was receiving anticoagulant treatment to reduce the risk of arterial thromboembolism in atrial fibrillation. Another possible cause is post‐radiation vasculopathy, an adverse effect of previous radiation therapy for malignant granuloma. The third factor which could have contributed to bleeding was the exacerbation of chronic heart failure and pulmonary hypertension. JRCD 2019; 4 (2): 51-55.

IVC filter resulting in IVC Perforation and Massive Retroperitoneal Hematoma Presenting as Acute Onset of Lower Extremity Weakness

IVC filter resulting in IVC Perforation and Massive Retroperitoneal Hematoma Presenting as Acute Onset of Lower Extremity Weakness

Radiological classification of retroperitoneal hematoma resulting from lumbar vertebral fracture.

Lumbar vertebral fracture (LVF) infrequently produces massive retroperitoneal hematoma (RPH). This study aimed to systematically review the clinical and radiographic characteristics of RPH resulting from LVF. For 193 consecutive patients having LVF who underwent computed tomography (CT), demographic data, physiological conditions, and outcomes were reviewed from their medical records. Presence or absence of RPH, other bone fractures, or organ/vessel injury was evaluated in their CT images, and LVF or RPH, if present, was classified according to either the Orthopaedic Trauma Association classification or the concept of interfascial planes. RPH resulting only or dominantly from LVF was found in 66 (34.2%) patients, whereas among the others, 64 (33.2%) had no RPH, 38 (19.7%) had RPH from other injuries, and 25 (13.0%) had RPH partly attributable to LVF. The 66 RPHs resulting only or dominantly from LVF were radiologically classified into mild subtype of minor median (n = 35), moderate subtype of lateral (n = 11), and severe subtypes of central pushing-up (n = 13) and combined (n = 7). Of the 20 patients with severe subtypes, 18 (90.0%) were in hemorrhagic shock on admission, and 6 (30.0%) were clinically diagnosed as dying due to uncontrollable RPH resulting from vertebral body fractures despite no anticoagulant medication. LVF can directly produce massive RPH leading to hemorrhagic death. A major survey of such pathology should be conducted to establish appropriate diagnosis and treatment.

Spontaneous Rupture of an Ovarian Artery Aneurysm: A Rare Postpartum Complication.

Background. Spontaneous rupture of an ovarian artery aneurysm is a rare but usually life-threatening event. It is most often associated with pregnancy or fibroids. Our case followed a normal vaginal delivery and then a delayed presentation with features similar to other less life-threatening postpartum conditions. The diagnosis could have been missed but for the meticulous and timely interventions which avoided catastrophic outcome. Case. This is a case of a multiparous woman with rupture of a left ovarian artery aneurysm, causing massive retroperitoneal hemorrhage and hematoma that required a combination of arterial embolization, percutaneous CT scan guided drainage, and surgical evacuation of the hematoma. Conclusion. Spontaneous rupture of ovarian artery should be considered as one of the differential diagnoses in the immediate postpartum period especially when the clinical symptoms do not correlate with the amount of blood loss. A high index of suspicion, prompt diagnosis, intervention, and a multidisciplinary approach in the management were the elements of a successful outcome in this case.