Traumatic retroperitoneal injuries rsna publications online. It should be recognized as a possible site of massive blood loss. On arrival, the patient had hypotension, tachycardia, tachypnea, lowgrade fever, and glasgow coma scale score of 12. 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. Multiple myeloma, a plasma cell neoplasm, presents most commonly with anemia, hypercalcemia, renal failure, and bone pain. The management of retroperitoneal hematomas remains confusing to many surgeons because the available literature frequently groups patients with blunt and penetrating etiologies together. For spontaneous hematomas, it is important to keep a high index of suspicion in patients with. Retro peritoneum contains a number of visceral and vascular.
Other than these existing diseases, heparin is one of the reported risk factors for srb 36. Retroperitoneal hemorrhage is a lesion which is commonly associated with abdominal trauma. Report of one case spontaneous retroperitoneal hematoma is a rare condition. Because the underlying injuries and their treatment may differ. Dalteparinsodium associated retroperitoneal hematoma in a patient with diabetic nephropathy. Approach and management of traumatic retroperitoneal injuries.
Background in the early 1980s, sheldon introduced a treatment principle founded on a locationbased classification of traumatic rh as 1. Spontaneous retroperitoneal hematoma causing abdominal pain and hemorrhagic shock. Despite all the advances in the fi elds of technology and. Duodenal injuries caused by blunt abdominal trauma. The clinical features are varied depending on the amount of hemorrhage present, rate of onset and ability of the surrounding structures to contain the hemostatic system. Spontaneous retroperitoneal hematoma associated with enoxaparin and aspirin treatment. 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 reported cases included gastrointestinal bleeding and cardiac tamponade. Enoxaparin in unstable angina patients who would have been excluded from randomized. Hemodynamically unstable patients with retroperitoneal hematoma represent an intraoperative diagnostic challenge.
For a broader discussion, including other etiologies, please refer to the parental article on retroperitoneal hemorrhage. Carlos alvarez z 1,3, cesar cerda c a, andres jadue t b, francisco rojas r b, millarai abelleira p c, carlos hermansen t 2,3, francisco gatica j 1,3. Hemoperitoneum attributable to a retroperitoneal hematoma has previously been described 6. Retroperitoneal bleeding refers to an accumulation of blood found in the retroperitoneal space.
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. Retroperitoneal hematoma, induces paralytic ileus which causes colonic distension. The diagnosis and treatment of traumatic retroperitoneal hematoma. Spontaneous retroperitoneal hemorrhage in chronically hemodialyzed patients. T olga muftuoglu 1, umit t opaloglu 1, ali aktekin 1, mehmet odabasi 1, mehmet ates 2, abdullah saglam 1. The spontaneous form is the most infrequent retroperitoneal hemorrhage. The diagnosis and treatment of traumatic retroperitoneal. Traumatic duodenal perforation requires emergent surgical intervention, whereas duodenal hematoma is frequently managed conservatively. T olga muftuoglu 1, umit t opaloglu 1, ali aktekin 1, mehmet odabasi 1, mehmet ates 2, abdullah saglam 1 scand j trauma resusc emer g med 2004. Hemoperitoneum in a peritoneal dialysis patient from a. Retroperitoneal hemorrhage is most commonly seen as a complication of anticoagulation, either with low molecular weight heparin e. Spontaneous retroperitoneal hemorrhage radiology reference. Retroperitoneal rp hematoma or hemorrhage is a rare but potentially lifethreatening diagnosis.
Traumatic retroperitoneal hematoma linkedin slideshare. Spontaneous retroperitoneal hematoma after warfarin therapy is an extremely rare event. Only few cases of clinical aggressive presentation associated with bleeding were reported in the medical literature. Pdf the diagnosis and treatment of traumatic retroperitoneal. Gigantic retroperitoneal hematoma as a complication of. Get a printable copy pdf file of the complete article 4. Lematoma retroperitoneale posttraumatico cnr solar. Spontaneous retroperitoneal bleeding srb is a rare disease. Retro peritoneum contains a number of visceral and vascular structures in the gastrointestinal, genitourinary, vascular, musculoskeletal and nervous systems. 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. Rph localized to the upper central area zone 1 after penetrating trauma. The centremedial hematoma was observed in 24 25% patients, lateral hematoma in 46 47. Most retroperitoneal bleeding is associated with trauma, tumor, hematologic disease, thrombotic thrombocytopenic purpura, or evans syndrome.
Jeong tk, jeong gh, park bs, ma sk, kim sw, kim nh, et al. Surgeons specialized in trauma frequently meet blood and hematoma in the retroperitoneal space. Tumors were malignant in 83% of patients and benign. An overview of the injury mechanisms, recognition, and management of traumatic injury to the retroperitoneum is provided. Retroperitoneal hemorrhage an overview sciencedirect topics. Diagnosis and treatment of retroperitoneal hematoma in. Traumatic retroperitoneal haematoma article pdf available in il giornale di chirurgia 2810. To analyze our experiences in patients with traumatic retroperitoneal hematoma, and highlight the problems in diagnosis and. A high clinical suspicion is needed to recognize and appropriately manage retroperitoneal injuries. Retroperitoneal hemorrhage radiology reference article. Etiologia y diagnostico del hematoma retroperitoneal. Nontraumatic retroperitoneal hematoma after warfarin.
Traumatic retroperitoneal hematoma rph may arise from injury to bony structures. Nine patients survived multiple trauma index grade iii, hanover polytrauma index, three patients with very severe injuries died immediately. Retroperitoneal hematoma surgery medical art works. Computed tomography ct was the imaging technique used most often and the most accurate. In operation, a retroperitoneal hematoma discovered, no significant pathology seen. Retroperitoneal hemorrhage an overview sciencedirect.
Retroperitoneal hemorrhage definition of retroperitoneal. In addition to retroperitoneal hematoma, other retroperito neal sources of hemoperitoneum have been reported tablei, including an iliopsoas hematoma, rupture of a retroperitoneal varix into the peritoneal cavity. The differential diagnosis between intra and extraperitoneal hemorrhage was impossible in many patients, particularly in the severely injured patient or the patient with multiple injuries. 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. After blunt trauma, selected retroperitoneal hematomas in the lateral perirenal and pelvic areas do not require operation and should not be opened if discovered at operation.
Collet jp, montalescot g, fine e, golmard jl, dalby m, choussat r, et al. Pdf the management of retroperitoneal hematomas researchgate. Here, we report a 25yearold man who was brought in to the emergency service with confusion. A retroperitoneal bleed induced by enoxaparin therapy. The clinical characteristics of srb have not been elucidated yet. Haemorrhage within the retroperitoneal area may be massive and may exceed 2000 ml of blood. Traumatic retroperitoneal hematoma rph may arise from injury to bony structures, major blood vessels, and intestinal or retroperitoneal viscera. Nine patients survived multiple trauma index grade iii, hanover polytrauma index, three patients with very severe injuries died immediately multiple trauma index grade iv. Traumatic retroperitoneal hematoma spreads through the interfascial planes volume 593, september 2005, pp 595608 2. However, presentation is often nonspecific with a lack of. It can be traumatic or nontraumatic spontaneous with signs and symptoms of flank or abdominal pain, hematuria and shock. Midline, lateral paraduodenal, lateral pericolonic not associated with pelvic. Because the underlying injuries and their treatment may differ considerably, the nonoperative or operative approach to the common hematomas is based on. Hematoma retroperitoneal traumatico traumatic retroperitoneal hematoma fonte.
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