Life-Threatening Retroperitoneal Hematoma in a Patient with COVID-19

Abstract

COVID-19 is a respiratory illness that affects the human body in many different ways. The disease carries both thrombotic and hemorrhagic complications, especially in those patients who are anticoagulated to prevent the thromboembolic manifestations. In this report, we discuss a case of retroperitoneal hemorrhage in a patient treated with therapeutic anticoagulation which ultimately led to the patient’s death. The literature highlights the importance of anticoagulation because it reduces mortality in patients hospitalized with COVID-19. Although, more recent studies suggest that patients treated with therapeutic anticoagulation are at a higher risk of hemorrhage and increased mortality. Therefore, our case stresses the importance of active monitoring of these patients to detect any suspected case of hemorrhage early to reduce mortality. Overall, more research should be conducted to determine the optimal dosing of anticoagulation that balances safety and efficacy.

Multiple Surgical Treatments for Recurrent Retroperitoneal Hemorrhage in a COVID-19 Patient with Respiratory Failure on Extracorporeal Membrane Oxygenation

“…Recently, RPHs have been reported in patients with COVID-19 where an anticoagulant has been used. Most patients were treated using embolization where there was a clear bleeding focus [6][7][8][14][15][16]. In this study, no obvious bleeding focus was observed on the CT scan, and the ECMO flow was not properly maintained due to external compression by a huge RPH.…”

“…With the accumulation of data for severely ill patients with COVID-19, case reports of bleeding complications from the use of anticoagulant are being reported more frequently. Typically, these reports advise caution regarding the risk of bleeding [6][7][8][14][15][16], but despite the acknowledged risk of bleeding, the use of an anticoagulant for the stable use of ECMO is inevitable.…”

A Pictorial Essay Describing the CT Imaging Features of COVID-19 Cases throughout the Pandemic with a Special Focus on Lung Manifestations and Extrapulmonary Vascular Abdominal Complications

“…The most frequent locations were the retroperitoneum and the muscular abdominal walls [152][153][154][191][192][193][194][195] (Figure 27). The muscles most commonly affected were the iliopsoas and the rectus abdominis [152][153][154][191][192][193][194][195]. In most cases, patients were older, receiving a prophylactic dose of subcutaneous enoxaparin, and showed moderate-to-severe COVID-19 pneumonia.…”

Spontaneous Hematomas and Deep Vein Thrombosis during the Recovery from a SARS-CoV-2 Infection: Case Report and Literature Review

“…Nevertheless, data over hemostasis disturbances related to COVID-19 are scarce in the medical literature [3,[9][10][11]. Except for the severe examples of disseminated intravascular coagulopathy observed in severe cases hospitalized in the intensive care units, further hemorrhages with diverse locations have been reported [12,13]. In the same vein, spontaneous hematomas developed in patients suffering or recovering from COVID-19 were rarely described [7,14], being mostly associated with the treatment with LMWH [1,9,11].…”