clinic disscusion 6540

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Apr 3, 2024

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Hello Barbara Excellent response: more information about Spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH) typically occurs in elderly patients with significant comorbidities. It may cause exsanguination or abdominal compartment syndrome with associated devastating complications. The diagnosis may be delayed due to the variability and vagueness of the symptoms. Approximately two-thirds of SRRSHs are associated with therapeutic anticoagulation, and the remaining third is often related to hemodialysis, hemophilia, or abnormal retroperitoneal formations (cysts, lipomas, aneurysms, and tumors) ( Beakgarrd et al., 2019). Bleeding in the retroperitoneal space is a severe complication. Hypovolemia and shock develop late after losing a large volume of blood. Using a point of care ultrasound (POCUS), the examination can detect the bleeding source and confirm by computerized tomography of the abdomen (Bitar et al.,2022). References Baekgaard, J. S., Eskesen, T. G., Lee, J. M., Yeh, D. D., Kaafarani, H. M. A., Fagenholz, P. J., Avery, L., Saillant, N., King, D. R., & Velmahos, G. C. (2019). Spontaneous Retroperitoneal and Rectus Sheath Hemorrhage-Management, Risk Factors and Outcomes. World Journal of Surgery , 43 (8), 1890–1897. https://doi.org/10.1007/s00268-019-04988-y Bitar, Z. I., Elshabasy, R. D., Mohsen, M. J., Maadarani, O. S., Elzoueiry, M. M., & Gohar, M. R. (2022). Detecting spontaneous retroperitoneal Hemorrhage using a modified RUSH protocol: a case report—International Journal of Surgery Case Reports , 92 , 106830. https://doi.org/10.1016/j.ijscr.2022.106830

Hello Janna Thank you for the response. In most cases, retroperitoneal bleeding can be managed conservatively by aggressive fluid resuscitation , correction of coagulopathy , and transfusion of packer red blood cells to maintain hematocrit. Open surgery is used when the bleeding cannot be controlled. Surgical interventions include hemodynamic instability, continuous hematocrit drops, and intractable pain and neuropathy . Hypotensive patients unresponsive to fluid resuscitation should undergo emergent surgical intervention (Yacoub, 2022). The selection of treatment mode in blunt injury depends on the anatomical position of the hematoma, visceral injury, and patients' hemodynamic status. The management will depend on the location of the bleeding, the stability of the patient, and the cause. Specific therapy includes observation and serial examination, conservative management for patients who are stable and Interventional radiology with intra-arterial embolization. Seek and treat underlying causes and complications(Nickson, 2020). References Durak, Hüseyin Mert, Berk Yasin Ekenci, Hilmi Sarı, Onur Ergun, Hayriye Şahinli, and Ahmet Nihat Karakoyunlu. 2023. "Endovascular Treatment and Follow-up of Retroperitoneal Hemorrhage Caused by Bilateral Giant Renal Angiomyolipoma." Üroonkoloji Bülteni 22 (2): 84–88. doi: 10.4274/uob.galenos.2023.2023.3.2. Nickson, C. (2020, November 3). Retroperitoneal Hemorrhage . Life in the Fast Lane • LITFL. https://litfl.com/retroperitoneal-haemorrhage/ Yacoub, M. (2022). Retroperitoneal Hemorrhage . Retroperitoneal Hemorrhage - an overview | ScienceDirect Topics.

https://www.sciencedirect.com/topics/medicine-and-dentistry/retroperitoneal- hemorrhage#:~:text=Retroperitoneal%20hemorrhage%20can%20be%20managed,blood%20cells %20to%20maintain%20hematocrit.

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