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

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