Retroperitoneal bleeding

Assess skin for ecchymosis and petechiae also, assess for Gl, GU, and retroperitoneal bleeding and for bleeding at all puncture sites... 

Muscle 30%-50% for most sites 70%-100% for thigh, iliopsoas, or nerve compression Risk of significant blood loss with femoral/retroperitoneal bleed bed rest for iliopsoas or other retroperitoneal bleeding... 

Emits M, Mohan PS, Fares LG, Hardy H. A retroperitoneal bleed induced by enoxaparin therapy. Am Surg (2005) 71, 430-3. 

Serious retroperitoneal bleeding occurred in a patient with aeute eoronary syndrome reeeiving enoxaparin, elopidogrel and aspirin. ... 

Chan TY. Life-threatening retroperitoneal bleeding due to warfarin-drug interactions. Pharmacoepidemiol Drug Saf 2009 f8(5) 420-2. 

An open surgical approach to retroperitoneal bleeding is not a treatment for retroperitoneal pelvic bleeding. Dissection into the retroperitoneum and pelvis results in the loss of the internal compression effect provided by adjacent anatomic structures, resulting in increased bleeding. The rich collateral... 

The number of percutaneous femoral arterial catheterizations has increased exponentially in recent years with several million procedures performed worldwide annually. A direct consequence of that explosion in number of percutaneous diagnostic and interventional catheterizations is the increasing number of vascular complications due to the percutaneous creation of that vascular access mainly using the femoral artery. Potential complications are pseudoaneurysm, arteriovenous fistula, uncontrollable groin and/or retroperitoneal bleeding, in situ arterial thrombosis, and peripheral embolization. In order to deal with these complications, there is an increasing need for quick and optimal diagnosis and for efficient and, by preference, minimally invasive treatment. 

Cases of bleeding with fatal outcome (especially intracranial, Gl, and retroperitoneal hemorrhage) have been reported. 

Bleeding (intrathoracic, retroperitoneal, Gl, GU, intra-abdominal, intracranial) occurs in about 2% of patients. 

Superficial or surface bleeding at puncture sites (venous cutdowns, arterial punctures, surgical sites, IM sites, retroperitoneal/intracerebral sites) internal bleeding (GI/GU tract, vaginal). 

A 73-year-old woman taking metformin 1000 mg bd and warfarin 5 mg/day developed epistaxis, hematuria, gingival bleeding, a retroperitoneal hematoma, and bilateral perinephric blood with obstruction of both collecting systems (152). She received fresh frozen plasma, vitamin K, 10 mg, and packed erythrocytes. In the next 8 hours she developed a metabolic acidosis... 

In lower gastrointestinal haemorrhage, the bleeding site is distal to the duodenojejunal ligament (Treitz s ligament) or the duodenojejunal recessus (i.e. the passage of the duodenum retroperitoneally and its transition to the intraperitoneal jejunum). 

Bleeding at internal sites (intracranial, retroperitoneal GI, GU, or respiratory) occurs occasionally. Lysis or coronary thrombi may produce atrial or ventricular dysrhythmias, stroke. 

Heparin, one of the complex carbohydrates known as mucopolysaccharides or glycosaminoglycan is currently used to prevent formation of clots. In general, heparin is well tolerated and devoid of serious consequences. However, it allows platelet adhesion to foreign surfaces and may cause hemorrhagic complications such as subdural hematoma, retroperitoneal hematoma, gastrointestinal bleeding, hemorrage... 

If there is an acute indication for embolization therapy, but if the patient is hemodynamic stable, a spiral CT can be very beneficial to help planning the intervention. A pseudoaneurysm of a visceral vessel certainly will target the intervention. A retroperitoneal hematoma will suggest potential bleeding sites. Active extravasation can also sometimes be visual-... 

The interventional radiologist has become the central figure in treating traumatic pelvic and retroperitoneal arterial hemorrhage, and with impressive results. Angiographic embolization has a success rate between 85% and 100% when bleeding sites can be identified [33,34], The first-line therapy for an unstable patient with a pelvic fracture should be immediate angiographic evaluation and embolization. 

Endovascular therapy is now established as the treatment modality of choice for retroperitoneal and pelvic bleeding secondary to trauma. Despite evidence to support earlier involvement of the interventional radiologist, some trauma centers still fail to consider angiographic study until much later into the resuscitative process. The adoption of an evidence-based trauma algorithm (Table 5.2) is vital to ensure rapid and decisive treatment. 

Fig. 25.6a-c. Six-meter fall in a 10-year-old boy. Liver and right kidney injury. Enhanced CT (a) performed on admission showed intra- and retroperitoneal effusions. Active bleeding of the right renal artery was demonstrated by CT, then confirmed by angiography (b). Selective embolization of the injured artery was carried out with immediate satisfactory result. Loss of renal function on the right side was detected 1 year later by DMSA scintigraphy (c)... 

Frank rectal bleeding or melaena is common and is associated with the presence of intramural haemorrhages. Constant diffuse abdominal pain is common, and pain in the back raises the possibility of retroperitoneal haematoma. Colicky abdominal pain is also frequent and may last for several months following the initial injury. It is an indication for repeated re-examination. 

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