Retroperitoneal bleeding

Signs and symptoms

Signs and symptoms may include:

• abdominal pain.
• upper leg pain.
• hematuria.
• shock.

Causes

Retroperitoneal bleeds are most often caused by major trauma, such as from a traffic collisions or a fall. Less common non-traumatic causes including:

• anticoagulation.
• a ruptured aortic aneurysm.
• a ruptured renal aneurysm.
• acute pancreatitis.
• malignancy. Retroperitoneal bleeds may also be iatrogenic, caused accidentally during medical procedures. Such procedures include cannulating the femoral artery for cardiac catheterization or for interventional radiology, and the administration of a psoas compartment nerve block.

Diagnosis

Neurology

As well as initial symptoms, the accumulation of blood in the retroperitoneal space also compresses the femoral nerve. This may lead to weakness in extending the knee (with reduced patellar reflex) and weakness in flexing the hip.

Radiology

A magnetic resonance imaging (MRI) scan may be used to identify the collection of blood, although this is often not performed if bleeding is a medical emergency.

Management

The management will depend on the location of the bleeding, the stability of the patient and the cause. Thus, the patient needs to be closely monitored and the etiology investigated. The initial management must include adequate fluid resuscitation. Treatment options for a retroperitoneal bleed may range from angiographic embolization to surgery in severe cases.

References

References

1. (2006). "Spontaneous Retroperitoneal Hemorrhage Caused by Segmental Arterial Mediolysis". Reviews in Urology.
2. (April 2013). "The diagnosis and treatment of traumatic retroperitoneal hematoma". Pakistan Journal of Medical Sciences.
3. (2005-01-01). "Chapter 6 - MRI of the Retroperitoneum and Peritoneum". W.B. Saunders.
4. (January 2008). "Diagnostic ultrasound". Informa Health Care.
5. Weller, Robert S.. (2007-01-01). "Chapter 64 - Psoas Compartment Block: Potential Complications". W.B. Saunders.
6. (2013). "A Cough Deteriorating Gross Hematuria: A Clinical Sign of a Forthcoming Life-Threatening Rupture of an Intraparenchymal Aneurysm of Renal Artery (Wunderlich's Syndrome)". Case Reports in Vascular Medicine.
7. Marilyn J. Siegel. (1 November 2007). "Pediatric Body CT". Lippincott Williams & Wilkins.
8. (2013-01-01). "32 - Lumbosacral Plexopathy". W.B. Saunders.
9. (2022). "Retroperitoneal Bleeding". StatPearls.