Spontaneous retroperitoneal hematoma – our experience with surgical approach

Czech version

Authors: L. Mitáš ¹; T. Nevrtal ¹; L. Kunovsky ^1,2; Z. Kala ¹; J. Kamelander ³; V. Čan ¹; T. Andrašina ⁴; M. Penka ³; I. Penka ¹
Authors‘ workplace: Chirurgická klinika, Fakultní nemocnice Brno, Lékařská fakulta Masarykovy univerzity ¹; Interní gastroenterologická klinika, Fakultní nemocnice Brno, Lékařská fakulta Masarykovy univerzity ²; Oddělení klinické hematologie, Fakultní nemocnice Brno, Lékařská fakulta Masarykovy univerzity ³; Klinika radiologie a nukleární medicíny, Fakultní nemocnice Brno, Lékařská fakulta Masarykovy univerzity ⁴
Published in: Rozhl. Chir., 2019, roč. 98, č. 1, s. 23-26.
Category: Case Report

Overview

Spontaneous retroperitoneal hematoma is a serious complication of anticoagulation and antiplatelet therapy. Its incidence has increased in recent years due to an increasing number of patients on this treatment. A number of case series have been described in the literature. In the vast majority of cases, the hemodynamically stable patients were treated either conservatively or by selective radiological embolization of the bleeding source. A surgical approach is reported as a last choice in the cases where the conservative therapy fails, radiological intervention is unavailable, in patients with continuous bleeding or in patients who develop abdominal compartment syndrome.

In our case report, we present a patient on anticoagulation therapy for deep venous thrombosis complicated by massive retroperitoneal bleeding: surgery was used as the method of first choice and the treatment was successful.

Key words:

retroperitoneal hematoma − bleeding − anticoagulation treatment − surgery

Sources

Sunga KL, Bellolio MF, Gilmore RM, et al. Spontaneous retroperitoneal hematoma: Etiology, characteristics, management, and outcome. J Emerg Med 2012;43:e157–61.
Hodin E, Dass T. Spontaneous retroperitoneal hemorrhage complicating anticoagulant therapy. Ann Surg 1969;170:848–51.
Ernits M, Mohan PS, Fares LG, et al. A retroperitoneal bleed induced by enoxaparin therapy. Am Surg 2005;71:430–3.
Chan YC, Morales JP, Reidy JF, et al. Management of spontaneous and iatrogenic retroperitoneal haemorrhage: conservative management, endovascular intervention or open surgery? Int J Clin Pract 2008;62:1604–13.
Chan-Tack KM. Fatal spontaneous retroperitoneal hematoma secondary to enoxaparin. South Med J 2003;96:58–60.
Won DY, Kim SD, Park SC, et al. Abdominal compartment syndrome due to spontaneous retroperitoneal hemorrhage in a patient undergoing anticoagulation. Yonsei Med J 2011;52:358–61.
Besir FH, Gul M, Ornek T, et al. Enoxaparin-associated giant retroperitoneal hematoma in pulmonary embolism treatment. N Am J Med Sci 2011;3:524–6.
Vayá A, Mira Y, Aznar J, et al. Enoxaparin-related fatal spontaneous retroperitoneal hematoma in the elderly. Thromb Res 2003;110:69–71.
Quartey B, Nelson J. Massive spontaneous retroperitoneal hemorrhage induced by enoxaparin and subsequent abdominal compartment syndrome requiring surgical decompression: A case report and literature review. Int J Case Rep Imag 2011;2:14–8.
Fernández-Ruiz M, Guerra-Vales JM. Enoxaparin-induced retroperitoneal haematoma in patients with renal insufficiency. Swiss Med Wkly 2010;140:122–3.
Butt MU, Buzsaki LA, Smyth SS, et al. Deep vein thrombosis complicated by spontaneous iliopsoas hematoma in patient with septic shock. Am J Case Rep 2017;18:1148–52.
Dohan A, Darnige L, Sapoval M, et al. Spontaneous soft tissue hematomas. Diagn Interv Imaging 2015;96:789–96.
Dondelinger RF, Trotteur G, Ghaye B, et al. Traumatic injuries: radiological hemostatic intervention at admission. Eur Radiol 2002;12: 979–93.
Triscott J, Mercer S, Tian PG, et al. Retroperitoneal haematoma associated with enoxaparin use in an elderly woman with chronic kidney disease. BMJ Case Rep 2015. Available from: doi:10.1136/bcr-2015-211699.
Hunter JD, Damani Z. Intra-abdominal hypertension and the abdominal compartment syndrome. Anaesthesia 2004; 59: 899–907.
Moore AF, Hargest R, Martin M, et al. Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 2004;91:1102–10.

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Article was published in

Perspectives in Surgery

2019 Issue 1