Retroperitoneal hemorrhage

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 (renal, vascular, colon, pancreas or pelvis)
  • Leaking/ruptured AAA
  • Iatrogenic (colonoscopy, cardiac catheterization, femoral line placement)
  • Spontaneous (coagulopathy)
  • Hemorrhagic pancreatitis

Clinical Features

Differential Diagnosis

Abdominal Trauma

Evaluation

Must have high clinical suspicion to make diagnosis

  • CT scan abdomen/pelvis
  • Consider ultrasound for AAA
  • FAST and DPL do not evaluate retroperitoneal space

Classification of traumatic retroperitoneal hemorrhage[3]

Retroperitoneal zones.jpg
  • Zone 1: Central
    • Pancreaticoduodenal injuries, major vascular injury
  • Zone 2: Flank/Perinephric
  • Zone 3: Pelvic
    • Pelvic fracture or ileofemoral vascular injury

Management

Disposition

  • ICU

See Also

External Links

References

  1. Bhasin HK and Dana CL. Spontaneous retroperitoneal hemorrhage in chronically hemodialyzed patients. Nephron. 1978; 22(4-6):322-327.
  2. Ernits M, et al. A retroperitoneal bleed induced by enoxaparin therapy. Ann Surg. 2005; 71(5):430-433.
  3. FELICIANO, D. V. (1990) ‘Management of Traumatic Retroperitoneal Hematoma’, Annals of Surgery, 211(2), pp. 109–123.