Retroperitoneal hemorrhage: Difference between revisions
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==Background== | ==Background== | ||
* | *Bleeding into retroperitoneal space | ||
* | *Difficult to diagnose given poor sensitivity of physical exam findings (Cullens, Grey-Turners) | ||
* | *Can accumulate 4L blood before tamponade | ||
===Etiologies=== | ===Etiologies=== | ||
*Trauma | *Trauma | ||
*Leaking/ruptured [[AAA]] | *Leaking/ruptured [[AAA]] | ||
*Iatrogenic (colonoscopy, cardiac catheterization) | *Iatrogenic (colonoscopy, cardiac catheterization, femoral line placement) | ||
*Spontaneous ([[coagulopathy]]) | *Spontaneous ([[coagulopathy]]) | ||
*Hemorrhagic [[pancreatitis]] | *Hemorrhagic [[pancreatitis]] | ||
==Clinical Features== | ==Clinical Features== | ||
*May present with | *Most common in patients with bleeding disorders, on anticoagulants, and on HD<ref>Bhasin HK and Dana CL. Spontaneous retroperitoneal hemorrhage in chronically hemodialyzed patients. Nephron. 1978; 22(4-6):322-327.</ref><ref>Ernits M, et al. A retroperitoneal bleed induced by enoxaparin therapy. Ann Surg. 2005; 71(5):430-433.</ref> | ||
*May present with: | |||
**Abdominal pain | |||
**Flank pain | |||
**Back pain | |||
**Hypotension | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Abdominal trauma DDX}} | {{Abdominal trauma DDX}} | ||
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''Must have high clinical suspicion to make diagnosis'' | ''Must have high clinical suspicion to make diagnosis'' | ||
*CT scan abdomen/pelvis | *CT scan abdomen/pelvis | ||
**FAST and DPL do not evaluate retroperitoneal space | *Consider [[Ultrasound: Aorta| ultrasound for AAA]] | ||
*FAST and DPL do not evaluate retroperitoneal space | |||
==Management== | ==Management== | ||
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*Resuscitation with blood products | *Resuscitation with blood products | ||
*Reverse [[coagulopathy]] | *Reverse [[coagulopathy]] | ||
**[[Warfarin (Coumadin) Reversal]] | |||
**[[Dabigatran (Pradaxa) Reversal]] | |||
**[[Unfractionated heparin reversal]] | |||
*Treat underlying etiology | *Treat underlying etiology | ||
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==See Also== | ==See Also== | ||
*[[Abdominal trauma]] | |||
*[[coagulopathy]] | |||
*[[Warfarin (Coumadin) Reversal]] | |||
*[[Dabigatran (Pradaxa) Reversal]] | |||
*[[Unfractionated heparin reversal]] | |||
*[[Ultrasound: Aorta]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 15:09, 13 June 2015
Background
- Bleeding into retroperitoneal space
- Difficult to diagnose given poor sensitivity of physical exam findings (Cullens, Grey-Turners)
- Can accumulate 4L blood before tamponade
Etiologies
- Trauma
- Leaking/ruptured AAA
- Iatrogenic (colonoscopy, cardiac catheterization, femoral line placement)
- Spontaneous (coagulopathy)
- Hemorrhagic pancreatitis
Clinical Features
- Most common in patients with bleeding disorders, on anticoagulants, and on HD[1][2]
- May present with:
- Abdominal pain
- Flank pain
- Back pain
- Hypotension
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma
Diagnosis
Must have high clinical suspicion to make diagnosis
- CT scan abdomen/pelvis
- Consider ultrasound for AAA
- FAST and DPL do not evaluate retroperitoneal space
Management
- Address A, B, C's
- Resuscitation with blood products
- Reverse coagulopathy
- Treat underlying etiology
Disposition
- ICU
See Also
- Abdominal trauma
- coagulopathy
- Warfarin (Coumadin) Reversal
- Dabigatran (Pradaxa) Reversal
- Unfractionated heparin reversal
- Ultrasound: Aorta