Retroperitoneal hemorrhage is a somewhat uncommon but potentially life-threatening event. It can develop after an external injury to the abdomen, or as a result of various intrinsic conditions of neoplastic, iatrogenic, or autoimmune origin, in which case the term spontaneous retroperitoneal hemorrhage is used. The severity of symptoms depends on the extent of bleeding, but abdominal pain, shock, and a poor general condition are usually noted. Imaging studies are necessary to confirm the diagnosis.
A rare complication of numerous diseases and external factors, retroperitoneal hemorrhage is defined as sudden bleeding into the retroperitoneal space  and must be recognized early because of its life-threatening nature. In general, conditions that can induce bleeding in the retroperitoneum are broadly divided into two categories - traumatic and spontaneous . Mechanical damage to the visceral structures (both solid and hollow organs), major blood vessels, or musculoskeletal tissues is readily observed in severe trauma (crush injuries, motor vehicle accidents, falls, severe fractures, etc.), and up to 12% of blunt-trauma patients were diagnosed with retroperitoneal hemorrhage in isolated case series  . On the other hand, several authors have documented the appearance of spontaneous retroperitoneal hemorrhage due to an array of intrinsic diseases     . Neoplastic processes (primarily of renal origin, such as renal cell carcinoma, angiomyolipoma, but also pheochromocytoma, hemangioma, paragangliomas, etc.), drugs (anticoagulants - coumadin, low molecular dose heparin), nephritis, polyarteritis nodosa (PAN) and vascular malformations have been confirmed as underlying causes of spontaneous retroperitoneal hemorrhage   . The clinical presentation depends on the severity and rate of blood loss and accumulation in the peritoneum and on the presence of additional injuries . The most common symptoms are an abdominal pain (particularly flank pain), hematuria, and a state of shock  , as blood loss universally leads to hypotension and hypovolemia.
Entire Body System
However, there may be complications related to the endoscopic procedure including mucosal laceration, bleeding, fever, and perforation. [ncbi.nlm.nih.gov]
A computed tomography (CT) PE/DVT scan was obtained due to sudden increasing oxygen requirement, and low grade fever which showed sub-segmental pulmonary emboli. Enoxaparin (weight based) 80 mg, subcutaneous every 12-hours was initiated. [ijcasereportsandimages.com]
[…] abdominal compartment syndrome (e.g. intra-abdominal hypertension, renal failure) history of risk factors (often no significant history if spontaneous) Psoas haematomas can present with constipation, urinary frequency, compressive femoral neuropathy or fever [lifeinthefastlane.com]
She denied shortness of breath, chest pain, fever, chills, nausea, and vomiting. The patient initially reported having diarrhea, but further inquiry revealed that her stools had been softer than usual but not watery or more frequent. [mdedge.com]
The pain was associated with sweating, dizziness, pallor, and dyspnoea. He has no history of trauma, drug use, or other chronic diseases. Finally, this patient was referred to our department by the orthopedist. [omicsonline.org]
She was in hypotension with severe pallor. Patient was initially resuscitated with intravenous (IV) fluids, and then two units of blood as her hemoglobin (Hb) was 6 g%. [jscisociety.com]
RESULTS: Four patients had abdominal pain, two patients had hematuria, and one patient had abdominal pain and hematuria. There was retroperitoneal hemorrhage in three patients on abdominal CT. [ncbi.nlm.nih.gov]
The most common symptoms are an abdominal pain (particularly flank pain), hematuria, and a state of shock, as blood loss universally leads to hypotension and hypovolemia. [symptoma.com]
Spontaneous retroperitoneal hemorrhage is a lethal cause of acute abdomen that is most frequently related to drugs, coagulopathy and intra-abdominal tumors. [ncbi.nlm.nih.gov]
Robert Gore (co-editor of Textbook of Gastrointestinal Radiology) has assembled an expert panel of authors on the topic of The Acute Abdomen. [books.google.com]
Severe Abdominal Pain
A patient with end-stage renal disease on maintenance hemodialysis developed sudden severe abdominal pain and distension. [ncbi.nlm.nih.gov]
However, the presentation in a middle-aged female with sudden onset hypotension with anemia with severe abdominal pain (left iliac and lumbar region) following defecation (increased abdominal pressure) with a preexisting thrombus in the left iliac vein [jscisociety.com]
Abdominal compartment syndrome is a rare but serious complication of severe RPH often presenting as acute renal failure with severe abdominal pain distention causing respiratory distress and cardiovascular collapse. [benthamopen.com]
’s sign (umbilical ecchynosis) and Gray-Turner’s sign (flank ecchymosis) /- palpable swelling haematuria haemodynamic instability and shock evidence of abdominal compartment syndrome (e.g. intra-abdominal hypertension, renal failure) history of risk factors [lifeinthefastlane.com]
’s sign (periumbilical ecchymosis) – late finding Grey-Turner’s sign (ecchymosis of the flanks) – late finding *History of risk factors as above Evaluation and Diagnosis 1,3,4,5 Complete Blood Count for anemia Lipase – suggests pancreatic or duodenal [emdocs.net]
Left Flank Pain
She consulted the emergency room of the Nagano Red Cross Hospital with a complaint of sudden left flank pain. A computerized tomography (CT) scan revealed a tumor with areas of fat density and hematoma in the left retroperitoneal space. [ncbi.nlm.nih.gov]
A 55-year-old man with ESRD presented with acute abdominal pain and hypotension caused by a spontaneous retroperitoneal hemorrhage. This case report demonstrates the necessity of having broad differential diagnoses when evaluating patients with ESRD. [ncbi.nlm.nih.gov]
Signs The patient may develop tachycardia and hypotension if the rate of hemorrhage is rapid. Rarely, later in the course, the patient may develop a Grey-Turner’s sign with bulging flanks, and a bluish discoloration in the region of the flank. [medicalopedia.org]
On admission, the patient was in shock state, having tachycardia and tachypnea. [omicsonline.org]
We recognized hemorrhage in our patients on the basis of progressive anemia, tachycardia with low blood pressure, and abdominal distension. [bmcresnotes.biomedcentral.com]
Grey Turner's Sign
It can present with Grey Turner's sign (flank bruising). [en.wikipedia.org]
Rarely, later in the course, the patient may develop a Grey-Turner’s sign with bulging flanks, and a bluish discoloration in the region of the flank. [medicalopedia.org]
Wunderlich Triad Pain: Back, groin, flank, abdomen (most common presenting symptom) Palpable mass Shock Leg paresis and/or anterior thigh hypoesthesia Secondary to hematoma compressing the femoral nerve Cullen’s sign (periumbilical ecchymosis) – late finding Grey-Turner’s [emdocs.net]
The nonspecific symptomatology of a retroperitoneal hemorrhage may present as a challenge for the physician, which is why a proper diagnostic workup must be conducted. A detailed patient history should define the onset and progression of symptoms, detect if any underlying disorders are present, and confirm if any drugs were recently used (especially anticoagulants). A comprehensive clinical examination is the next step, with an emphasis on abdominal palpation and vital sign assessment. As soon as clinical suspicion toward a bleeding disorder is raised, imaging studies, the key step in recognizing retroperitoneal hemorrhage, should be employed. Plain radiography is of limited benefit in evaluating bleeding disorders (although a degree of haziness in the lower abdomen that can be detected by this method might suggest bleeding), which is why ultrasonography (US) is a preferred first-line method . Ascites, organ contusions and hyperechoic masses in the retroperitoneum are signs of retroperitoneal hemorrhage on US . The use of contrast-enhanced computed tomography (CT) is recommended when ultrasonography and clinical findings point toward retroperitoneal bleeding, as it can delineate the exact location of bleeding, but also confirm damage to the viscera and major blood vessels   .
Her hemoglobin decreased to 46 g/L. An abdominal ultrasound showed a hematoma in the left retroperitoneal space, and computed tomography (CT) findings revealed a 6 cm 8 cm 10 cm hematoma in the left psoas muscle. [ncbi.nlm.nih.gov]
Complications include cystic hemorrhage or infection, erythrocytosis, and renal cell carcinoma. [ncbi.nlm.nih.gov]
Abstract The purpose of this study was to report a single hospital's experience of endovascular treatment of patients with retroperitoneal hemorrhage (RPH) secondary to anticoagulant treatment. [ncbi.nlm.nih.gov]
Conservative treatment is the first choice, and prognosis is good when diagnosed early. [ncbi.nlm.nih.gov]
It has a better prognosis compared to that of the acute type. Surgery Inappropriate surgical evacuation can exacerbate hemorrhage by relieving hematoma induced tamponade. [radiopaedia.org]
ﾋﾄ, human(primates), 012150, human, 外傷, ｶﾞｲｼｮｳ, injury, 023276, *, 出血, ｼｭｯｹﾂ, hemorrhage, 011323, 腹膜疾患, ﾌｸﾏｸｼｯｶﾝ, peritoneal disease, 054354, ショック症状, ｼｮｯｸｼｮｳｼﾞｮｳ, shock(symptom), 040187, shock, X線CT, XｾﾝCT, X-ray computed tomography, 055741, 予後, ﾖｺﾞ, prognosis [togodb.biosciencedbc.jp]
To review the etiology, diagnosis and treatment of spontaneous retroperitoneal hemorrhage. [ncbi.nlm.nih.gov]
Etiology pelvic, abdominal or lumbar trauma (e.g. pelvic fractures ) blood dyscrasia rupture arterial aneurysm (e.g. abdominal aortic aneurysm ) interventional or surgical procedures bleeding from underlying renal or adrenal pathology (e.g. renal AML [radiopaedia.org]
He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]
Wight J, Paisley S (2003) The epidemiology of inhibitors in haemophilia A: a systematic review. Haemophilia 9: 418-435. White GC 2nd, Rosendaal F, Aledort LM, Lusher JM, Rothschild C, et al. (2001) Definitions in hemophilia. [omicsonline.org]
Femoral nerve dysfunction after retroperitoneal hemorrhage: pathophysiology revealed by computed tomography. Arch Phys Med Rehabil 1984;65:37–40 PubMed Google Scholar 2. Fealy S, Paletta GA Jr. [link.springer.com]
Pathophysiology of abdominal aortic aneurysms: insights from the elastase-induced model in mice with different genetic backgrounds. Ann N Y Acad Sci 2006;1085:59–7 13. Pearce William H, Christopher K. Zarins, J. Michael Bacharach. [mds.marshall.edu]
The pathophysiology of the spontaneous RPHs is unclear. [omicsonline.org]
We considered that the filter should be removed to control retroperitoneal hemorrhage and prevent secondary infection of the hematoma. Removal of the retrievable filter was effective in managing these complications. [ncbi.nlm.nih.gov]
There have been defined the typical complications and preventive measures. Implementation of the scientific results. [cnaa.md]
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