Massive spontaneous retroperitoneal hemorrhage
Updates to Case Attributes
PatientThe patient was emergently transferred to a tertiary centre for endovascular embolisation. Endovascular angiography revealed the above primary bleeding sources. Each artery received Onyx embolisation. Immediate post embolisation images showed satisfactory control however her time in ICU continued to be turbulent with dependency on vasoactive medications and continued transfusion of blood products. Repeat abdominal CT angiogram confirmed an increase in the size of her retroperitoneal haematoma. The patient continued to deteriorate falling into multiorgan dysfunction syndrome thought to be contributed by abdominal compartment syndrome. An emergency midline laparotomy was performed. The massive haematoma was evacuated with a rough calculated volume of 10L10 L. No active arterial bleeding was identified, perhaps from the massive haematoma achieving tamponade. Fortunately, the patient made a full recovery.
-<p>Patient was emergently transferred to a tertiary centre for endovascular embolisation. Endovascular angiography revealed the above primary bleeding sources. Each artery received Onyx embolisation. Immediate post embolisation images showed satisfactory control however her time in ICU continued to be turbulent with dependency on vasoactive medications and continued transfusion of blood products. Repeat abdominal CT angiogram confirmed an increase in the size of her retroperitoneal haematoma. The patient continued to deteriorate falling into multiorgan dysfunction syndrome thought to be contributed by abdominal compartment syndrome. An emergency midline laparotomy was performed. The massive haematoma was evacuated with a rough calculated volume of 10L. No active arterial bleeding was identified perhaps from the massive haematoma achieving tamponade. Fortunately, the patient made a full recovery.</p>- +<p>The patient was emergently transferred to a tertiary centre for endovascular embolisation. Endovascular angiography revealed the above primary bleeding sources. Each artery received Onyx embolisation. Immediate post embolisation images showed satisfactory control however her time in ICU continued to be turbulent with dependency on vasoactive medications and continued transfusion of blood products. Repeat abdominal CT angiogram confirmed an increase in the size of her retroperitoneal haematoma. The patient continued to deteriorate falling into multiorgan dysfunction syndrome thought to be contributed by abdominal compartment syndrome. An emergency midline laparotomy was performed. The massive haematoma was evacuated with a rough calculated volume of 10 L. No active arterial bleeding was identified, perhaps from the massive haematoma achieving tamponade. Fortunately, the patient made a full recovery.</p>
References changed:
- 1. Saeed Kilani M, Izaaryene J, Cohen F, Varoquaux A, Gaubert JY, Louis G, Jacquier A, Bartoli JM, Moulin G, Vidal V. Ethylene vinyl alcohol copolymer (Onyx®) in peripheral interventional radiology: indications, advantages and limitations. (2015) Diagnostic and interventional imaging. 96 (4): 319-26. <a href="https://doi.org/10.1016/j.diii.2014.11.030">doi:10.1016/j.diii.2014.11.030</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25704146">Pubmed</a> <span class="ref_v4"></span> 2. Daliakopoulos SI. Spontaneous retroperitoneal hematoma: a rare devastating clinical entity of a pleiada of less common origins. (2011) Journal of surgical technique and case report. 3 (1): 8-9. <a href="https://doi.org/10.4103/2006-8808.78462">doi:10.4103/2006-8808.78462</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22022645">Pubmed</a> <span class="ref_v4"></span> 3. Daliakopoulos SI, Bairaktaris A, Papadimitriou D, Pappas P. Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report. (2008) Journal of medical case reports. 2: 162. <a href="https://doi.org/10.1186/1752-1947-2-162">doi:10.1186/1752-1947-2-162</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18485233">Pubmed</a> <span class="ref_v4"></span>
- 1. Saeed Kilani M, Izaaryene J, Cohen F, Varoquaux A, Gaubert JY, Louis G, Jacquier A, Bartoli JM, Moulin G, Vidal V. Ethylene vinyl alcohol copolymer (Onyx®) in peripheral interventional radiology: indications, advantages and limitations. (2015) Diagnostic and interventional imaging. 96 (4): 319-26. <a href="https://doi.org/10.1016/j.diii.2014.11.030">doi:10.1016/j.diii.2014.11.030</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25704146">Pubmed</a> <span class="ref_v4"></span> 2. Daliakopoulos SI. Spontaneous retroperitoneal hematoma: a rare devastating clinical entity of a pleiada of less common origins. (2011) Journal of surgical technique and case report. 3 (1): 8-9. <a href="https://doi.org/10.4103/2006-8808.78462">doi:10.4103/2006-8808.78462</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22022645">Pubmed</a> <span class="ref_v4"></span> 3. Daliakopoulos SI, Bairaktaris A, Papadimitriou D, Pappas P. Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report. (2008) Journal of medical case reports. 2: 162. <a href="https://doi.org/10.1186/1752-1947-2-162">doi:10.1186/1752-1947-2-162</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18485233">Pubmed</a> <span class="ref_v4"></span>
Updates to Study Attributes
Abdominal CT angiogram confirmed an increase in the size of herdemonstrates a massive retroperitoneal haematoma measuring 183x221x350mm183 x 221 x 350 mm and multiple sites of contrast blushes indicating active blushesbleeding.
Updates to Study Attributes
Interventional angiogram identified her primary bleeding source from the Leftleft circumflex iliac artery a branch of the external iliac artery and also to a lesser degree from the left L4 and L5 lumbar arteries.
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