Retroperitoneal hemorrhage

Background

• bleeding into retroperitoneal space
• difficult to diagnose given poor sensitivity of physical exam findings (Cullens, Grey-Turners)
• FAST and DPL do not evaluate retroperitoneal space
• can accumulate 4L blood before tamponade
• must have high clinical suspicion to make diagnosis

Etiologies

• Trauma
• Leaking/ruptured AAA
• Iatrogenic (colonoscopy, cardiac catheterization)
• Spontaneous (coagulopathy)
• Hemorrhagic pancreatitis

Clinical Features

• May present with abdominal, flank or back pain

Differential Diagnosis

• Abdominal Aortic Aneurysm (AAA)
• Abdominal Trauma
• Pancreatitis
• Iatrogenic

Abdominal Trauma

• Abdominal compartment syndrome
• Diaphragmatic trauma
• Duodenal hematoma
• Genitourinary trauma
• Liver trauma
• Pelvic fractures
  • Acetabular pelvic fractures
  • Open book pelvic fracture
  • Straddle pelvic fracture
  • Pelvic avulsion fracture
• Retroperitoneal hemorrhage
• Renal trauma
• Splenic trauma
• Trauma in pregnancy
• Ureter trauma

Diagnosis

• CT scan abdomen/pelvis

Management

• Address A, B, C's
• Resuscitation with blood products
• Reverse coagulopathy
• Treat underlying etiology

Disposition

• ICU

References

• CURRENT Diagnosis and Treatment Emergency Medicine 7th ed