Spontaneous Retroperitoneal Hemorrhage

Dolapsakis, Christodoulos; Giannopoulou, Vasiliki; Grivakou, Evgenia

doi:10.1016/j.jemermed.2019.01.037

Cited by 6 publications

(6 citation statements)

References 5 publications

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“…Generally, the target population includes elderly population. Usually, retroperitoneal hematomas present with abdominal and back pain, less frequently with fatigue, nausea, headache, and dyspnea (Baekgaard et al 2019;Dolapsakis et al 2019).…”

Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of vascular access-site complications: a ten years’ experience in two centres

et al. 2020

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Background The spread of percutaneous arterial catheterization in diagnostic and therapeutic procedures has led to a parallel increase of vascular access site complications. The incidence of these events is between 0.2–1%. A detailed analysis of injuries by type of procedure shows a higher incidence of injuries after therapeutic procedures (3%) than those observed for diagnostic ones (1%), due to the greater size of the vascular devices used and the necessity to frequently administer anticoagulant and antiplatelet therapy during procedures. The iatrogenic arterial injuries requiring treatment are the pseudoaneurysm, arteriovenous fistula, arterial rupture and dissection. Less frequent complications include distal embolization of the limbs, nerve damage, abscess and lymphocele. Moreover, the use of percutaneous vascular closure devices (VCD) has further expanded the types of complications, with an increased risk of stenosis, thrombosis, distal embolism and infection. Our work aims to bring the personal 10 years’ experience in the percutaneous treatment of vascular access-site complications. Results Ninety-two pseudoaneurysms (PSA), 12 arteriovenous fistulas (AVF), 15 retrograde dissections (RD) and 11 retroperitoneal bleedings (RB) have been selected and treated. In 120/130 cases there were no periprocedural complications with immediate technical success (92.3%). Nine femoral PSA, treated with percutaneous ultrasound-guided thrombin injection, showed a failure to close the sac and therefore they were treated by PTA balloon inflation with a contralateral approach and cross-over technique. Only one case of brachial dissection, in which the prolonged inflation of the balloon has not led to a full reimbursement of the dissection flap, was then surgically repaired. At the 7 days follow-up, complications were two abscesses in retroperitoneal bleedings, treated by percutaneous drainage. At 3 months, acute occlusion of 3 covered femoral stents occurred, then treated by loco-regional thrombolysis and PTA. A total of 18 major complications was recorded at 2 years, with a complication rate at 2 years of 13.8%. Conclusions The percutaneous treatment of vascular access-site complications is the first-choice treatment. It represents a safe and effective option, validated by a high technical success rate and a low long-term complication rate, that allows avoiding the surgical approach in most cases.

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Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of vascular access-site complications: a ten years’ experience in two centres

et al. 2020

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“…This approach was taken, given the evidence of ongoing bleeding from the CT scan and haemodynamic instability of the patient. Prior studies have reported the usage of transarterial embolisation to halt such bleeding 1 3 4 6. However, this method is suitable when the mother and baby do not show signs of distress.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of renal angiomyolipoma in pregnancy mimicking preterm labour

Basri,

Dasrilsyah

2024

BMJ Case Rep

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Ruptured renal angiomyolipoma in pregnancy is uncommon. Pregnant women may present with nonspecific symptoms such as flank or abdominal pain, contraction pain and haematuria. A thorough assessment is needed to reach the correct diagnosis. Management varies between conservative measures, radiological intervention or surgery depending on the patient’s haemodynamic status and foetal condition. We present a case of a woman in her 30s, gravida 5 para 3+1 at 28 weeks of gestation, who presented with pain. The pain worsened, and she went into hypovolaemic shock. An exploratory laparotomy and emergency caesarean section were done. Retroperitoneal haematoma was found intraoperatively, but the source of bleeding was difficult to determine. An abdominal CT angiogram subsequently revealed an ongoing bleeding from a ruptured angiomyolipoma. An emergency nephrectomy was performed, and the bleeding was secured.

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“…Therefore, rapid and accurate diagnosis is critical for the prognosis of SRH. Emergency abdominal ultrasound is usually the first examination method, with low sensitivity in retroperitoneal diseases [ 11 ]. In the 2 patients in this report, free peritoneal effusion could be detected by ultrasound, but due to the interference of gas in the gastrointestinal tract, it is difficult to detect pancreatic lesions.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Pancreatic Hemorrhage: Successful Conservative Management in Two Cases

Xiao,

Liu,

et al. 2023

Am J Case Rep

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Case series Patients: Male, 39-year-old • Male, 44-year-old Final Diagnosis: Spontaneous pancreatic hemorrhage Symptoms: Abdominal pain Clinical Procedure: — Specialty: Critical Care Medicine • Surgery • Traditional Medicine Objective: Rare disease Background: Spontaneous pancreatic and peripancreatic hemorrhage (SPH) is a rare subtype of spontaneous retroperitoneal hemorrhage. With diverse clinical manifestations and no specific presentations, early diagnosis of SPH becomes challenging. Patient-specific underlying causes and vital signs guide the SPH treatment approach. Case Reports: Case 1: A 39-year-old man reported unexplained hypogastralgia at the emergency department (ED). An abdominal MRI revealed a mixed hematoma and cystic lesions between the pancreatic head and descending duodenum, attributed to ruptured mucinous cystic neoplasms. Extensive hematoceles were identified around the liver and abdominal pelvis on an enhanced CT scan. After undergoing fasting, rehydration, proton pump inhibitor and somatostatin intravenous injections, and peritoneal puncture, his condition improved. He was discharged nine days post-admission. Case 2: A 44-year-old man arrived at the ED with back pain and right upper quadrant pain. Enhanced CT indicated peritoneal fluid and a hematoma between the pancreatic head and descending duodenum. He initially received conservative treatment. However, on the eighth day, he reported recurrent abdominal pain. Follow-up CT showed an enlarged hematoma and gastric content accumulation. The patient was fasted and put on parenteral nutrition, and by the 37 th day of hospitalization, he had fully recovered and was discharged. Both patients, having stable hemodynamics, fully recovered following conservative management, with no surgical intervention required. Conclusions: Given its varied clinical presentations, SPH can easily be misdiagnosed. However, successful conservative management can lead to full recovery, as demonstrated in these case reports.

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Spontaneous Retroperitoneal Hemorrhage

Cited by 6 publications

References 5 publications

Percutaneous treatment of vascular access-site complications: a ten years’ experience in two centres

Percutaneous treatment of vascular access-site complications: a ten years’ experience in two centres

Spontaneous rupture of renal angiomyolipoma in pregnancy mimicking preterm labour

Spontaneous Pancreatic Hemorrhage: Successful Conservative Management in Two Cases

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