Retroperitoneal hematoma

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... 

Matsuyama H, Nagao K, Yamakawa GI, Akahoshi K, Naito K. Retroperitoneal hematoma due to rupture of a pseudoaneurysm caused by acupuncture therapy. J Urol 1998 159(6) 2087-8. 

A 40-year-old woman had multiple bone injuries, severe sepsis, and coma after a car accident a retroperitoneal hematoma caused by lumbar fractures was drained, but she continued to be pyrexial (23). She had prominent accumulation of Ga, which had been used for bone scanning, in her multiple recent fractures and an area of accumulation in the soft tissue related to a fractured vertebra. Post-traumatic paravertebral calcifications had accumulated Ga and simulated the presence of an infected hematoma. 

Retroperitoneal hematoma has been reported as a complication of pudendal block, probably due to pudendal artery perforation (SEDA-21,134). 

Morita N, Kashihara K, Tagashira H, Otsuka H, Yoneda K, Murase T, Tsujikawa T, Furutani S, Furutani K, Minato M, Nishitani H. Two cases of retroperitoneal hematoma caused by combination of anticoagulant therapy and 5-flu(xourBcil. J Med Invest (2005) 52,114-17. 

Melde SL, Enoxaparin-induced retroperitoneal hematoma. Ann Pharmacother (2003) 37, 822, ... 

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-... 

Previous experience with translumbar puncture of the aorta for diagnostic angiography showed that this puncture carries only minor risks, with a retroperitoneal hematoma rate of about 3% [45]. The aorta can be punctured under CT or fluoroscopic guidance. 

Fig. 23.6. Rupture of an infrarenal aortic aneurysm (arrow), with an extensive retroperitoneal hematoma (arrowhead). Coronary MPR of a CTA of the abdominal aorta...

Methylsalicylate Topical methylsalicylate 50% has been reported to have enhanced the action of warfarin in a 53-year-old man, resulting in a large right retroperitoneal hematoma and right iliac intramuscular hematoma after trauma [47 ]. 

Testerman GM, Shilad S, George KJ. Rapid warfarin reversal with factor Vila in an elderly trauma patient with retroperitoneal hematoma. Tenn Med 2009 102 (3) 37-9. 

Vascular access Hemodynamic/arrhythmic Groin hematoma Femoral artey pseudoaneurysm Hypotension Transient bradycardia Retroperitoneal hemorrhage... 

Although rare, dissection or perforation of the renal arteries and their branches can occur. Rupture may lead to rapid development of retroperitoneal hemorrhage. Both dissection flaps and rupture can be immediately controlled with balloon tamponade. Although dissection flaps can often be tacked down, rupture typically requires emergent surgery. Even perforation of smaller branch vessels can occur if a guidewire is passed too far into the periphery. Hematoma and abscess can develop. 

Fig. 24.10a,b. Retroperitoneal Wilms tumor rupture in a 9-year-old girl presenting with acute abdominal pain. Unenhanced CT scan (a) shows a perirenal hematoma (H). Enhanced CT (b) shows a subcapsular effusion related to tumor rupture (asterisk). Wilm s tumor (M)... 

Because of the retroperitoneal location of the duodenum and its close proximity to the pancreatic head, secondary inflammatory changes with oedema and mural thickening of the duodenal loop may result from adjacent acute pancreatitis (Fig. 9.11). Severe pancreatitis can also cause intramural duodenal hematoma (Abbas et al. 2002), and indeed in this situation thickening of the duodenal wall may lead to symptoms of bowel obstruction. Pancreatic pseudocyst following acute pancreatitis may also cause... 

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