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. 2021 Jul:84:106101.
doi: 10.1016/j.ijscr.2021.106101. Epub 2021 Jun 11.

A spontaneous retroperitoneal haemorrhage resulting in abdominal compartment syndrome requiring laparotomy: A case report and proposed management algorithm

Patrick Tully  1 , James Moshinsky  1 , Manfred Spanger  2 , Anoop N Koshy  3 , Michael Yii  4 , Laurence Weinberg  5
Affiliations

A spontaneous retroperitoneal haemorrhage resulting in abdominal compartment syndrome requiring laparotomy: A case report and proposed management algorithm

Patrick Tully et al. Int J Surg Case Rep. 2021 Jul.

Abstract

Introduction and importance: Spontaneous Retroperitoneal Haemorrhage (SRH) is a rare condition, which in its extreme state can result in Abdominal Compartment Syndrome (ACS). The aim of this case report is to provide an overview of the diagnosis and management of SRH and to present an algorithm to inform and guide clinical decision-making in the context of ACS.

Case presentation: A 74-year-old woman with multiple risk factors for SRH developed a tense abdomen in ICU post-cardiac graft study. Radiological imaging confirmed multiple bleeding points to the contralateral side of the graft access site. She underwent endovascular treatment for her condition, however, developed ACS necessitating surgical evacuation of the haematoma.

Clinical discussion: SRH is a rare condition that may be difficult to diagnose on physical exam. Medical, endovascular and surgical approaches are recognised treatments. ACS is an extreme variant of SRH and although endovascular management can specifically address the acute bleed, surgical evacuation of the haematoma is the only treatment that can effectively reduce abdominal compartment pressures.

Conclusion: SRH can cause abdominal compartment syndrome with subsequent multiorgan failure. Ultimately, as outlined in this case, surgical evacuation of the haematoma was the only treatment able to reduce abdominal compartment pressures.

Keywords: Abdominal compartment; Case report; Endovascular; Intraabdominal pressure; Spontaneous retroperitoneal haemorrhage; Surgery; Syndrome.

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Conflict of interest statement

Nothing to declare.

Figures

Fig. 1
Fig. 1
Axial computed tomography demonstrating a massive right retroperitoneal haematoma.
Fig. 2
Fig. 2
Coronal computed tomography demonstrating a massive right retroperitoneal bleed.
Fig. 3
Fig. 3
Microcatheter angiogram of iliolumbar artery shows extravasation.
Fig. 4
Fig. 4
Catheter angiogram of left common iliac artery showing two bleeding points and coils in iliolumbar artery with cessation of extravasation.
Fig. 5
Fig. 5
Management algorithm for spontaneous retroperitoneal haemorrhage in the context of abdominal compartment syndrome.
See this image and copyright information in PMC

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