Contemporary management of spontaneous retroperitoneal and rectus sheath hematomas

Warren, Michael H.; Bhattacharya, Bishwajit; Maung, Adrian A.; Davis, Kimberly A.

doi:10.1016/j.amjsurg.2019.05.002

Cited by 23 publications

(50 citation statements)

References 15 publications

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“…4e6 Patients at risk are those receiving anticoagulation/antiplatelet medications or a combination of both. 4,7,8 Under these circumstances, the incidence of SRH has been reported at 0.6e6.6%. 6 The pathophysiology of SRH is unclear, although some hypotheses exist: arteriosclerosis or occult vasculopathy that lead to fragile vasculature, autoimmune microangiopathy, or unrecognised minor trauma (coughing, vomiting) with subsequent rupture of small retroperitoneal vessels.…”

Section: Introductionmentioning

confidence: 99%

“…6,9 Recent studies underline contemporary diagnosis and therapy is of utmost importance in patients with SRH to prevent a fatal outcome. 7,8,10 Because of the unspecific clinical findings, imaging is key for establishing the correct diagnosis. 5,10,11 Ultrasound can be a primary diagnostic tool to detect free fluid and a mass effect in the retroperitoneal space.…”

Section: Introductionmentioning

confidence: 99%

“…8,10,12,13 Management recommendations are rare and based on few published data. 4,7,8,14 Most patients receive conventional treatment (volume support with blood products, reverse anticoagulation, pain relief) with or without intensive care unit stay. 4,5,7,8 In case of haemodynamically unstable patients, open surgery with exploration and consecutive ligation of the bleeding vessel is an option, but this technique often fails.…”

Section: Introductionmentioning

confidence: 99%

“…4,7,8,14 Most patients receive conventional treatment (volume support with blood products, reverse anticoagulation, pain relief) with or without intensive care unit stay. 4,5,7,8 In case of haemodynamically unstable patients, open surgery with exploration and consecutive ligation of the bleeding vessel is an option, but this technique often fails. 1,15 In recent years, catheterdirected angiography and embolisation have become additional options for patients with life-threatening SRH; however, the published data consist mostly of case reports or small heterogeneous series of patients.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of transarterial embolisation in patients with life-threatening spontaneous retroperitoneal haematoma

et al. 2021

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To evaluate the technical and clinical success of embolisation in patients with lifethreatening spontaneous retroperitoneal haematoma (SRH) and to assess predictors of clinical outcome.MATERIALS AND METHODS: Thirty patients (mean age: 71.9AE9.8 years) with SRH underwent digital subtraction angiography (DSA). All patients received anticoagulant or antiplatelet medication or a combination of both at the time the SRH occurred.RESULTS: Pre-interventional computed tomography angiography (CTA) revealed active retroperitoneal bleeding in 28 of 30 (93.3%) patients. DSA identified active haemorrhage in 22 of 30 patients (73.3%). Twenty-nine of 30 (96.7%) patients underwent embolisation. n-Butyl-2cyanoacrylate (NBCA) was used in 15 patients (51.7%), coils were used in 10 patients (34.5%), and both embolic agents were used in four patients (13.8%). The technical success rate was 100%. Pre-interventional haemoglobin levels increased significantly after embolotherapy from 70.9AE16.1 g/l to 87AE11.3 g/l (p<0.001), whereas partial thromboplastin time decreased from 58AE38 to 30AE9 seconds (p<0.001) after embolotherapy. The need for transfusion of concentrated red cells decreased from 3AE2.2 to 1AE1.1 units (p<0.001) after the intervention. Clinical success was achieved in 19 of 29 (65.5%) patients. No major procedure-related complications occurred. Seven patients (24.1%) died within 30 days after the procedure.CONCLUSION: Embolotherapy in patients with life-threatening SRH leads to a high technical success rate and is a safe therapeutic option. The clinical success rate was acceptable and

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of transarterial embolisation in patients with life-threatening spontaneous retroperitoneal haematoma

et al. 2021

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“…Warren et al described that in a study of patients with non-traumatic spontaneous RP hematomas, the need for intervention by the interventional radiologist was only 17% of 99 patients, while the need for blood product transfusion was 80%, and admission to the ICU was 70%. However, most hematomas were found to be self-limiting and rarely require surgical intervention [ 5 ]. Internal iliac artery ligation (IIAL) is sometimes used in obstetrical practice for the emergent treatment of postpartum hemorrhage [ 6 ], though it is generally underutilized in obstetric and gynecologic practice [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Large Retroperitoneal Hematoma: A Rare Intraoperative Complication of Total Vaginal Hysterectomy

Fuchs¹,

Parthasarathy²,

Coots³

et al. 2021

Cureus

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Retroperitoneal (RP) hematoma is a rare complication of total vaginal hysterectomy. A 45-year-old female G4P3013 with a history of abnormal uterine bleeding refractory to treatment by endometrial ablation and stress urinary incontinence underwent total vaginal hysterectomy, bilateral salpingectomy, bilateral uterosacral ligament suspension, anterior colporrhaphy, and cystoscopy. After the hysterectomy the left uterine artery pedicle was hemostatic; however, the patient became hemodynamically unstable and anemic. Laparoscopy revealed a stable zone III RP hematoma. Intraoperative observation revealed no further expansion of the hematoma. Left iliac angiography and aortography revealed there was no extravasation from the uterine arteries and gonadal vessels. Four days post-operative abdominal CT showed a stable hematoma. Hemodynamic instability resolved over the post-operative course. RP hematoma must be included in the differential for the evaluation of acute intraoperative hemodynamic instability with an unclear source.

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Acute Hemorrhagic Myocardial Infarction

Kolhe

Zare

Vaideeswar

2022

Tropical Cardiovascular Pathology

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Contemporary management of spontaneous retroperitoneal and rectus sheath hematomas

Cited by 23 publications

References 15 publications

Efficacy of transarterial embolisation in patients with life-threatening spontaneous retroperitoneal haematoma

Efficacy of transarterial embolisation in patients with life-threatening spontaneous retroperitoneal haematoma

Large Retroperitoneal Hematoma: A Rare Intraoperative Complication of Total Vaginal Hysterectomy

Acute Hemorrhagic Myocardial Infarction

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