Spontaneous Retroperitoneal Bleeding Research Articles

Non-traumatic spontaneous retroperitoneal bleeding: treated by interventional radiology

Non-traumatic spontaneous retroperitoneal bleeding: treated by interventional radiology

A Retroperitoneal Hematoma in an Anticoagulated Patient

Aim Spontaneous retroperitoneal haemorrhage (SRH), a potentially fatal complication with an atypical presentation, is caused by anticoagulants. The present body of literature does not offer much guidance for diagnosing and treating these situations. This case report’s major goal is to give a general review of the condition’s clinical presentation and anticoagulant therapy in relation to spontaneous retroperitoneal haemorrhage. Case report In this case report, we have covered an instance of retroperitoneal bleeding brought on by anticoagulants. Due to abdominal pain, a computed tomography (CT) scan of the abdomen was performed on the patient, who was using an anticoagulant, and it diagnosed a retroperitoneal hematoma. Conclusion Spontaneous retroperitoneal bleeding is an uncommon occurrence. When patients taking anticoagulant medications appear with stomach pain and distension, retroperitoneal haemorrhage should always be considered a possibility. With this presentation, this is one such instance. An early diagnosis will aid in the proper treatment of the patient.

Abstract 13444: Acute Anemia With Mechanical Circulatory Support; Unmasking the Culprit

Introduction: Mechanical circulatory support (MCS) is known to potentiate hemolytic anemia. Nevertheless, patients are also at an increased risk of spontaneous bleeding due to anticoagulation or post-procedural complication. We present two cases of acute anemia due to spontaneous retroperitoneal bleeding following insertion of the Impella assist device. Case Presentation: Two male patients aged 65 and 74 presented with cardiogenic shock secondary to ischemic cardiomyopathy with a low ejection fraction of 10% and 15%). Both patients initially had an intra-aortic balloon pump (IABP) inserted. Because of progressively deteriorating hemodynamics, IABP was switched to the Impella 5.5 device through the axillary artery. Following insertion of the Impella, they developed anemia requiring multiple blood transfusions. Despite repositioning of Impella, hemoglobin continued to drop prompting further workup. CT abdomen/pelvis revealed left retroperitoneal hematoma. CT angiogram showed active bleeding from the left L3 lumbar artery in one patient and multiple foci of active arterial extravasation in the other patient. Coil embolization was performed, achieving hemostasis and stabilization of hemoglobin levels in both patients. Discussion: Hemolytic anemia associated with the use of the Impella that improves with repositioning or device removal is well known and documented. However, patients with MCS are also at increased risk of spontaneous bleeding due to procedural injury and the use of anticoagulation. We report 2 cases with retroperitoneal bleeding from the lumbar artery diagnosed a few days after the placement of Impella. The occurrence of retroperitoneal hemorrhage was possibly spontaneous due to anticoagulation along with Impella-induced hemolysis resulting in acute anemia. Neither patient had any vascular access through the left groin making post-procedural complications less likely. The concealed nature and non-specific symptoms of retroperitoneal bleed can lead to a delay in diagnosis. Early identification and control of bleeding can prevent fatal outcomes. Conclusion: Our cases highlight the importance of clinicians having a broad differential and low threshold to investigate other causes of anemia in patients with MCS.

Life-threatening retroperitoneal bleeding in coronavirus disease 2019 patient while on full dose anticoagulation: A case report

Introduction: Thromboembolism is one of the common complications in patients presenting with coronavirus disease 2019. Studies on coronavirus disease 2019 patients recommend the use of anticoagulation to prevent thrombotic complications in these patients and have shown to decrease mortality. However, spontaneous retroperitoneal bleeding is one of the life-threatening complications of therapeutic anticoagulation. Case Report: This case report is about an 82-year-old male who was admitted for coronavirus disease 2019 pneumonia, started on therapeutic dose anticoagulation on presentation, and developed life-threatening retroperitoneal bleeding. He was managed with conservative treatment because of the advanced age of the patient, high risk of deterioration, and guarded prognosis. Conclusion: Although anticoagulation protects against the thrombotic complications of coronavirus-19 infection, it has life-threatening bleeding complications. The use of anticoagulation in these patients should be practiced with caution while monitoring for bleeding complications. There needs to be more clinical studies and trials to assess the risk-benefit ratio of anticoagulation in coronavirus disease 2019 patients.

COVID-19 enfeksiyonu geçiren hastada böbrek pelvis rüpürünün eşlik ettiği spontan ciddi retroperitoneal kanama: Olgu sunum

Spontaneous rupture of the renal pelvis is a rarely encountered urological event that causes extravasation of urine. It often occurs as a result of increased intrapelvic pressure secondary to obstructions developed in the urinary system. Similarly spontaneous retroperitoneal hematoma is retroperitoneal hemorrhage that occurs without trauma or an underlying pathology. In this study, we present a case of spontaneous rupture of the renal pelvis that developed secondary to compression of the hematoma that occurred spontaneously in the retroperitoneum in a 63-year-old female patient who received anticoagulant therapy with the diagnosis of Covid-19 infection. In the light of this case, we would like to emphasize that widespread endothelial cell damage associated with Covid-19 infection may cause spontaneous severe retroperitenal bleeding and accompanying renal pelvis rupture. In which both the rarely encountered spontaneous rupture of the renal pelvis and spontaneous retroperitoneal bleeding are seen simultaneously in the same patient, is reporting for the first time in the literature. Keywords: anticoagulant treatment, COVID-19, renal pelvis rupture, retroperitoneal hematoma, urinary obstruction

ADRENAL HEMATOMA SECONDARY TO A SPONTANEOUS RUPTURE OF A PSEUDOANEURYSM

Spontaneous unilateral adrenal haematoma secondary to a pseudoaneurysm is a rare condition and is usually associated with anomalies of the gland. Mostly, it can be treated conservatively; but in some cases, it can progress to a progressive haemorrhage with instability. We report a case of a 74-year-old male who presented with pain and hypotension secondary to a spontaneous unilateral adrenal pseudoaneurysm and retroperitoneal bleeding associated to anticoagulation, successfully treated by embolization.

An Unusual Presentation of a Rare Tumor: Primary Renal Synovial Sarcoma

Primary renal synovial sarcomas are very rare and highly aggressive tumors. They are seen at an average age of 35 years. Common symptoms include side pain, abdominal pain, and hematuria. Imaging modalities have no specific findings indicating their presence, and the diagnosis is made based on immunohistochemical methods, which may need to be confirmed by cytogenetic analysis. Radical nephrectomy is the best treatment option currently available, with a combination of anthracyclines and ifosfamidine being administered as adjuvant chemotherapy. In this case report, we present a patient with a primary renal synovial sarcoma presenting with spontaneous massive retroperitoneal bleeding due to tumor rupture. To the best of our knowledge, this is only the second case of such clinical presentation reported in the literature.

COVID-19 İlişkili Antikoagülan Kullanımına Bağlı Hemorajiler: Üç Olgu Sunumu

In the pathogenesis of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, disseminated intravascular coagulation and venous thromboembolism are one of the causes of high morbidity and mortality. Therefore, anticoagulant drugs play an important role in treatment. One of the rare complications of anticoagulant therapy is bleeding in the retroperitoneal space. These hemorrhages require rapid diagnosis and an urgent approach. Retroperitoneal bleeding should be kept in mind among the many complications that develop in patients treated and followed-up due to coronavirus disease-2019 (COVID-19). For this purpose, we present 3 cases who developed spontaneous retroperitoneal bleeding under the treatment of COVID-19 in this article.

Spontaneous Retro Peritoneal Bleeding with COVID 19: Management Modalities and Mortality Predictors

Spontaneous Retro Peritoneal Bleeding with COVID 19: Management Modalities and Mortality Predictors

COVID-19-Associated Retroperitoneal Hemorrhage: Same Complication, Two Different Types of Treatment

One of the reasons for the high mortality in COVID-19 patients is the increased risk of disseminated intravascular coagulation (DIC) and venous thromboembolism. For this reason, the use of anticoagulant treatments has become widespread. One of the rare complications of anticoagulant therapy is retroperitoneal hemorrhage. These hemorrhagies require immediate intervention. Retroperitoneal hemorrhage should be kept in mind among the many complications that develop in the patient who was followed up during the pandemic period. For this purpose, we present 2 cases who developed spontaneous retroperitoneal bleeding while clinically recovering under COVID-19 treatment.

Embolization using warmed glue via the triaxial microballoon occlusion system for various vascular disorders.

We aimed to illustrate the benefits of using warmed glue for viscosity reduction via the triaxial microballoon system for the treatment of various vascular disorders. Seven patients who underwent 10 treatment sessions for hemoptysis, type II endoleak, post-pancreatic surgical bleeding, spontaneous retroperitoneal bleeding, or ovarian tumor bleeding were evaluated based on technical and clinical outcomes. In the procedure, the triaxial system, consisting of a 4.5-Fr guiding catheter, a 2.8-Fr microballoon catheter, and a 1.9-Fr no-taper microcatheter, was advanced into the target lesion. Glue (33% n-butyl cyanoacrylate mixed with Lipiodol) warmed to 40°C was injected under balloon occlusion. The common hepatic, right bronchial, intercostals, internal mammary, costocervical, lateral thoracic, superior thoracic, thoracoacromial, inferior thyroid, iliolumbar, lumbar, internal pudendal arteries, and branch of the inferior mesenteric artery were successfully embolized; 100% technical success and 100% clinical success were obtained after each session. Our modified balloon-occluded glue embolization may lead to better handling with more distal glue penetration capability.

Wunderlich Syndrome in a patient with dengue infection – An entity to remember

Dengue infection has become a serious public health concern. Dengue management protocols and the management of common complications arebeing updated often based on understanding the Pathophysiology of dengue infection. This understanding has definitely improved dengue management resulting in reduction in dengue deaths. At times, uncommon complications may be overlooked in busy and crowded clinical settings. Spontaneous localized retro-peritoneal bleeding including bleeding into psoas muscle or Wunderlich Syndrome has been reported in few instances associated with dengue fever in this country and abroad. Thislife-threatening possibility must be born in mind when a clinician notices sudden deterioration of a dengue patient withoutsignificant thrombocytopenia, generalized bleeding manifestation or other evidence of extra vascular fluid loss. The management of this entity requires urgent restoration of the circulatory volume including urgent blood transfusion though, in general, clinicians are moreconcerned about fluid overload in the management of dengue patients. As awareness of this entity seems poor, further research and reporting of similar cases in medical literature will shed more light on this obscure entity and increase the awareness among clinicians with favorable results.

Management of Anticoagulation in Patients with Hematologic Malignancy Undergoing Autologous Hematopoietic Cell Transplantation

▪Introduction: Venous thromboembolism (VTE) is a significant cause of morbidity in patients with hematologic malignancy who undergo hematopoietic cell transplantation (HCT); however, clinically significant bleeding is not uncommon in this setting and anticoagulation is often contraindicated during prolonged periods of severe thrombocytopenia. This study aims to determine the relative risks of continuing versus temporarily withholding therapeutic anticoagulation during periods of chemotherapy-induced thrombocytopenia in patients who undergo autologous HCT.Methods: Adult patients with hematologic malignancies who underwent first autologous HCT at our institution between 2006 and 2015 were selected. Among those, patients with VTE (as identified by ICD9 code and confirmed by chart review) that occurred in the year preceding transplant were selected as the study population. Patients were allocated into two cohorts at the onset of thrombocytopenia based on whether they continued anticoagulation using a high platelet transfusion threshold (50k), or whether they temporarily withheld anticoagulation using a standard platelet transfusion threshold (10k) and restarted treatment upon platelet engraftment. Patient characteristics and VTE risk factors were captured, depicted as number (percentage) and median (interquartile range), and compared using Fisher's exact and rank sum tests.Primary outcomes included rate of VTE extension/recurrence (assessed by appropriate imaging modality) and major bleeding (defined as grade 3 or 4 bleeding by WHO criteria) by 30 days. Secondary outcomes included clinical bleeding (grade 2-4), overall mortality, median number of platelet and red blood cell (RBC) transfusion, median time to neutrophil and platelet engraftment. Pre-defined exploratory subgroup analysis was performed. Logistic regression, Cox regression, and linear regression models without adjustment were generated for outcomes where a P value of < 0.05 was considered significant (Stata 14.1).Results: Among 1,631 patients who underwent first autologous HCT between 2006 and 2015, 204 patients developed VTE (12.5%) in the year preceding transplant. The median duration of thrombocytopenia, defined as the period during which the platelet < 50k, was 12 days. The median follow-up period was 359 days and only 4% of patients were lost to follow up prior to 30 days. In addition to routine clinical assessment for VTE and bleeding, repeat imaging surveillance was done in 55% of patients prior to discharge from the transplant service. Except for the timing of prior VTE occurrence, there were no significant differences in baseline characteristics between the cohort that continued anticoagulation (N=132) and the cohort that discontinued anticoagulation (N=72) (Table 1).There were no significant differences in the rate of VTE extension/recurrence or major bleeding between the treatment groups by 30 days (Table 2). The rates of VTE in both groups were low (1 new pulmonary embolism and 2 new catheter-associated thromboses). There was 1 fatal spontaneous retroperitoneal bleeding (grade 4) in the cohort that continued anticoagulation. The number of platelet transfusions was significantly higher in the patients who continued anticoagulation. Further comparison of the 2 cohorts by different subgroups did not reveal significant interactions (Figure 1, all interaction P values > 0.300).Conclusions: In patients undergoing HCT for hematologic malignancy who also have VTE, continuation of anticoagulation (compared to temporary cessation) during chemotherapy-induced thrombocytopenia is associated with increased platelet utilization but no significant difference in the rate of VTE extension/recurrence. The low rate of recurrent thrombosis among patients who discontinued anticoagulation during pre-engraftment thrombocytopenia suggests that temporary interruption of anticoagulation may be the better option for selected patients who face this difficult clinical situation. [Display omitted] [Display omitted] [Display omitted] DisclosuresGopal:Seattle Genetics: Research Funding. Garcia:Daiichi Sankyo: Consultancy, Research Funding; Pfizer: Consultancy; Boehringer Ingelheim: Consultancy; BMS: Consultancy; Janssen: Consultancy, Research Funding.

Non-traumatic spontaneous retroperitoneal bleeding: The effect of an early and accurate diagnosis

Spontaneous sub-capsular or peri-renal haemorrhage (Wunderlich syndrome) is a rare condition that involves a diagnostic challenge. In many cases, bleeding leads to haemodynamic instability that may be life threatening. Therefore, it is important to have a high clinical suspicion for timely action. This paper highlights the experience of the Urology Department of the Centro Médico Nacional de Occidente del Instituto Mexicano del Seguro Social. Retrospective study of consecutive non-randomized sampling. The Emergency Service Registry was reviewed for all admissions from 1 January 2010 to 31 December 2013 to identify patients with non-traumatic spontaneous retroperitoneal haemorrhage. Patient charts were reviewed to determine sex, age, vital signs, laboratory and imaging results, associated diseases, management, and outcomes. A total of 11 patients met the inclusion criteria for the study. All patients were received in the Emergency Department referred from secondary care hospitals. None of them were referred with a diagnosis of spontaneous retroperitoneal haemorrhage. The diagnosis was made in 100% of patients with abdominal CT scan. All patients received urgent surgical management on the day of admission due to haemodynamic instability. Ten patients underwent nephrectomy. Histopathological findings included, among others, angiomyolipoma, renal carcinoma, and metastatic hepatocellular injury. Spontaneous retroperitoneal haemorrhage is a lethal condition if not detected on time. The abdominal CT scan is the most accurate diagnostic method for detection. Surgical management is necessary in patients with haemodynamic instability. La hemorragia subcapsular o perirrenal espontánea (síndrome de Wunderlich) puede condicionar inestabilidad hemodinámica con riesgo para la vida. Es una enfermedad rara que implica un reto diagnóstico; por lo que debe sospecharse su diagnóstico para actuar a tiempo. Presentar la experiencia adquirida del servicio de Urología de la Unidad Médica de Alta Especialidad del Hospital de Especialidades del Centro Médico Nacional de Occidente del Instituto Mexicano del Seguro Social. Estudio retrospectivo con muestreo consecutivo no aleatorizado. Se revisaron los ingresos en el servicio de Urgencias de enero de 2010 a diciembre de 2013 para identificar los casos con diagnóstico de hemorragia retroperitoneal espontánea no traumática. De los expedientes se recabaron los siguientes datos: edad, sexo, signos vitales, resultados de laboratorio, métodos de diagnóstico por imagen, enfermedades asociadas, tratamiento y pronóstico. Un total de 11 pacientes cumplieron los criterios de inclusión. Todos los pacientes fueron recibidos en el servicio de Urgencias, y referidos de hospitales de segundo nivel. El diagnóstico se realizó en el 100% de los pacientes con tomografía computada abdominal. Todos los pacientes recibieron tratamiento quirúrgico urgente el día de la admisión debido a la inestabilidad hemodinámica; a 10 se les realizó nefrectomía; los hallazgos histopatológicos incluyeron angiomiolipomas, carcinoma renal y lesión metastásica de hepatocarcinoma, entre otras. La hemorragia retroperitoneal espontánea es una entidad patológica letal si no se detecta a tiempo. La tomografía computada es el método diagnóstico más preciso para su detección. El tratamiento quirúrgico es indispensable en pacientes con inestabilidad hemodinámica.

Spontaneous retroperitoneal bleeding: a case series.

BackgroundWe experienced four Japanese patients with spontaneous retroperitoneal bleeding, a rare disease. 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.Case presentationThree of the 4 patients did not have a bleeding tendency as indicated by laboratory data obtained at the time of retroperitoneal bleeding. The causative blood vessels were the lumbar and superior gluteal arteries and the internal iliac artery. All patients were receiving an anticoagulant, heparin in one and nafamostat mesilate in the other three patients. Three patients were being treated with hemodialysis or continuous hemodiafiltration when the spontaneous retroperitoneal bleeding occurred. We achieved hemostasis with transcatheter arterial embolization in 3 patients and with surgical hemostasis in 1 patient.ConclusionsWe suggest that in patients receiving anticoagulant therapy in whom progressive anemia and unstable vital signs are present, spontaneous retroperitoneal bleeding should be considered as a possible cause. Nafamostat mesilate may be one of the risk factors for spontaneous retroperitoneal bleeding.

Bilateral spontaneous retroperitoneal bleeding in a patient on nimesulide: a case report

IntroductionSpontaneous retroperitoneal bleeding is a rare but potentially life-threatening event of varied etiology. Herein we report a case of bilateral non-traumatic retroperitoneal hemorrhage.Case presentationA 50-year-old Greek man, who was on a non-steroidal anti-inflammatory agent (nimesulide) for ankylosing spondylitis, presented with a right retroperitoneal hematoma combined with contralateral subcapsular renal hematoma. Bleeding on his right side was successfully controlled by arterial embolization with coils, whereas the left renal hematoma was treated conservatively. His recovery period was uneventful.ConclusionThis is the first reported case of bilateral retroperitoneal bleeding in a patient receiving nimesulide for ankylosing spondylitis. The application of minimally invasive techniques resulted in the desired positive outcome with preservation of both renal units.

Spontaneous major bleeding in acquired factor X deficiency secondary to AL-amyloidosis

Abnormal bleeding may be seen in up to a third of patients with amyloidosis. Factor X deficiency is the commonest acquired coagulopathy in amyloidosis. While mild intracutaneous bleeding is common, spontaneous life-threatening haemorrhage is rare. We report a case of acquired FX deficiency due to amyloid light chain (AL)-amyloidosis presenting with spontaneous retroperitoneal bleeding. The diagnostic and management issues in this patient are discussed.

A Retroperitoneal Bleed Induced by Enoxaparin Therapy

Retroperitoneal bleeding is one of the most serious, potentially lethal complications of anticoagulation therapy. Although well documented in fully heparinized and coumadinized patients, there are only few reports of life-threatening hemorrhages in low-molecular-weight heparin (LMWH)-treated patients. We present a case of almost fatal spontaneous retroperitoneal bleeding in a 71-year-old woman with pneumonia and acute coronary syndrome. After receiving combination therapy with Lovenox (enoxaparin), aspirin, and Plavix for 5 days, she developed acute hemorrhagic shock and possible intra-abdominal compartment syndrome. Urgent computed tomography scan of the abdomen and pelvis was performed and showed a left retroperitoneal hematoma. The patient's condition continued to deteriorate, which prompted emergent exploration. After evacuating 3 L of free blood from the peritoneal cavity, we managed to stabilize the patient. Our case of spontaneous retroperitoneal bleeding adds to the growing number of cases in which enoxaparin has been associated with severe bleeding. A high index of suspicion is necessary if the patient displays any of the signs and symptoms that suggest major hemorrhage. It appears that those at highest risk receive doses approaching 1 mg/kg subcutaneously every 12 hours, have renal impairment, are of advanced age, and receive concomitant medications that can affect hemostasis. On average, a retroperitoneal hematoma occurs within 5 days of therapy with enoxaparin. In high-risk patients, enoxaparin activity (anti-factor Xa) should be carefully monitored.

Abdominal Compartment Syndrome(ACS) and Obstructive Uropathy responding to ureteral stents from Retroperitoneal Bleeding secondary to Lovenox(LMWH)

INTRODUCTION: ACS exists when Intra-abdominal Hypertension(IAH) is associated with clinically observed organ dysfunction. ACS adversely affects multiple organ systems. Normal Intraabdominal pressure(IAP) is atmospheric or subatmospheric. Subclincial organ effects progress to overt clinically manifest organ dysfunction beginning with IAH > 10 mm Hg. Pre-renal effects and Direct Renal Parencymal compression are the mechanism of renal failure. Direct ureteral compression is not implicated in renal dysfunction even with IAP∼40mm Hg.(5) Lovenox(LMWH) is infrequently reported (<1%) to cause spontaneous retroperitoneal bleeding and rarely caused ACS(3).

Spontaneous retroperitoneal hemorrhage: Unusual presentation of renal cancer

Spontaneous retroperitoneal hemorrhage as the presenting sign of renal cancer is rare. A case of spontaneous retroperitoneal hemorrhage from a renal carcinoma is described and management possibilities presented. While it is true that renal angiomyolipomas are the main cause of spontaneous retroperitoneal renal bleeding, the possibility of renal cancer should be entertained more often in the differential diagnosis.