spontaneous retroperitoneal hematoma

28 Nov

HIGHLIGHTS from J Emerg Med article:

 

its RARE: 89 patients over 8 year period at Mayo Clinic with spontaneous retroperitoneal hematoma

Median age was 72 years

Overall, 66.3% were anticoagulated:

  • 41.6% on warfarin,
  • 30.3% heparin,
  • 11.2% low-molecular-weight heparin;
  • 30.3% were on antiplatelet therapy;
  • 16.5% were taking both anticoagulant and antiplatelet medications
  • 15.3% were taking neither anticoagulant and antiplatelet medications

36% presented to ED, 64% developed SRH during inpatient anticoagulation therapy.

most common symptom was pain:

  • abdominal (67.5%),
  • leg (23.8%),
  • hip (22.5%),
  • back (21.3%)

10.1% were misdiagnosed upon their initial encounter.

Management:

  • 40.4% were managed in an intensive care unit;
  • 24.7% underwent interventional radiology (IR) procedures
  • 6.7% surgical evacuation
  • 75.3% receivedblood transfusion.

Mortality:

  • 5.6% within 7 days,
  • 10.1% within 30 days,
  • 19.1% within 6 months.

 

BOTTOM LINE:

spontaneous retroperitoneal hematoma:

  • rare
  • 2/3rds on anticoagulation, but don’t have to be
  • commonly present with pain (abdominal, leg, hip, back)
  • treatment options include IR, surgical, transfusions
  • good luck

 

References: article; picture

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