Hematoma retroperitoneal espontáneo en pacientes con neumonía grave por SARS-CoV-2 / Spontaneous retroperitoneal hematoma in patients with severe SARS-CoV-2 pneumonia

Recientemente se han publicado varios casos de hematomas retroperitoneales espontáneos (Hre) en el contextode infección por SarS-CoV-2. este estudio presenta una revisión sistemática de la literatura con el objetivo deprofundizar en esta infrecuente asociación. Se identificaron 32 casos de Hre, el 28,1 % con enfermedad COVID-19 crítica. el 68,7 % recibió anticoagulacióncon HBpM y el 15,6 % con heparina sódica. La mediana de días hasta el diagnóstico fue de 10,5 (rango de 0-38).en el 31,2 % de los casos se optó por manejo conservador, mientras que otro 31,2 % requirió angioembolización. Se comunicaron 10 exitus (31,2 %), 6 probablemente relacionados con el Hre.existen hipótesis acerca de la relación entre la infección por SarS-CoV-2 y los fenómenos hemorrágicos. Se handescrito dos mecanismos que explicarían la coagulopatía: la unión al receptor aCe2 y la acción directa del virussobre el endotelio vascular. Por otra parte, la disfunción plaquetaria, la trombocitopenia inmune y la respuesta alSIrS, así como los microtraumas secundarios al esfuerzo tusígeno, la ventilación mecánica invasiva o los cambiosposturales, sugieren un origen multicausal del Hre.La literatura sobre esta asociación es escasa. Dado el exceso de morbimortalidad que supone, se considera nece-sario profundizar en su investigación.(AU)

Recently, cases of spontaneous retroperitoneal haematomas (SrH) in the context of SarS-CoV-2 infection havebeen published. this study presents a systematic review with the aim of further investigating this rare association. Thirty-two cases were identified, with a 28,1 % of critical patients. a total of 68,7 % received anticoagulation withLMWH, and a 15,6 % with UFH. the median number of days to diagnosis was 10,5 (0-38). Conservative manage-ment was chosen in 31,2 %, while another 31,2 % required angio-embolisation. ten exitus (31,2 %) were reported,6 related to SrH. There are hypotheses on the link between SarS-CoV-2 infection and haemorrhagic phenomena. two mechanismshave been described that would explain coagulopathy: the binding of SarS-CoV-2 to the aCe2 receptor and itsdirect action on the vascular endothelium. Furthermore, the platelet dysfunction, immune thrombocytopenia andSIrS, added to the endothelial disruption in retroperitoneal vessels, as well as microtrauma secondary to coughstress, invasive mechanical ventilation and/or postural changes, suggest a multicausal origin of SrH. The literature concerning this association is scarce. Given the excess morbidity and mortality involved, it is consid-ered necessary to investigate it further.(AU)

Massive retroperitoneal haematoma because of renal cyst rupture, report of a case / Hematoma retroperitoneal masivo por ruptura de quiste renal, reporte de caso

We report the case of an 86-year-old adult man who, as a pedestrian, is hit by a motorcycle, suffering polytrauma; in initial care, he refers to thoraco-abdominal pain and subsequently neurological deterioration. Assessed by a neurosurgeon and general surgeon, a right chest tube is placed and a laparoscopy is performed where there is little bleeding from the abdominal cavity. It shows deterioration of its general state and dies in respiratory failure. During the necropsy procedure there is subarachnoid hemorrhage and cerebral herniation, rib fractures and pneumonic consolidation, a massive retroperitoneal hematoma is observed due to rupture of simple renal cyst.

Reportamos el caso de un hombre de 86 años que, siendo peatón, es atropellado por una motocicleta, sufriendo politraumatismo. En la atención inicial refiere a dolor toracoabdominal y posteriormente deterioro neurológico. Evaluado por un neurocirujano y un cirujano general, se coloca un tubo torácico derecho y se realiza una laparoscopia y observándose poco sangrado de la cavidad abdominal. El paciente muestra deterioro de su estado general y muere por insuficiencia respiratoria. Durante el procedimiento de necropsia se determina hemorragia subaracnoidea y hernia cerebral, fracturas costales y consolidación neumónica, se observa un hematoma retroperitoneal masivo por rotura de quiste renal simple.

Hemoperitoneo en el post parto secundario a la rotura aneurismática de la arteria ovárica: Caso Clínico / Post partum hemoperitoneum secondary to ovarian aneurysm rupture: Case Report

Resumen El hallazgo de hemoperitoneo en el post parto secundario a la rotura aneurismática de la arteria ovárica es una situación clínica extremadamente rara que presenta un cuadro clínico inespecífico y puede poner en riesgo la vida del paciente. El ultrasonido es una modalidad segura y rápida para la detección de líquido libre intraperitoneal. (1) . La tomografía computada es la herramienta de elección para un diagnóstico rápido y seguro (2) ; y la angiografía con embolización durante el mismo procedimiento es una alternativa útil y altamente efectiva para la resolución del cuadro. (3). Presentamos el caso de una multípara puérpera de 34 años que consulta en el servicio de urgencia por intenso dolor abdominal. La paciente se encontraba hemodinámicamente estable y afebril. La tomografía computada demostró un hematoma retroperitoneal y hemoperitoneo asociado a un aneurisma de la arteria ovárica derecha. Fue evaluada por el servicio de radiología intervencional y se trasladó de emergencia al pabellón angiográfico donde se realizó la embolización de la lesión mediante la cateterización vascular supra selectiva. La paciente evolucionó de manera favorable y fue dada de alta una semana después. Es necesario tener un alto índice de sospecha en pacientes de riesgo para lograr un diagnóstico y tratamiento oportuno.

SUMMARY Spontaneous ovarian artery aneurysm rupture is a rare postpartum life-threatening event with non-specific clinical manifestations. The present article reports the case of a 34 year old multiparous post partum women who came to the emergency department with acute onset of intense abdominal right flank pain. Patient was afebrile and hemodynamically stable. A computed tomography revealed a retroperitoneal haematoma and hemoperitoneum related to an aneurysm of the right ovarian artery. The patient was taken to the interventional radiology suite and selective embolization was performed. Following the procedure, the patient symptoms subsided and 7 days later she was discharged. A high index of suspicion in patients with risk factors can lead to a prompt diagnosis and treatment. Computed tomography is the image modality for a fast and safe evaluation, although diagnostic angiography and subsequent transcatheter embolization are thought to be effective for treatment.

Pelvic fractures with associated retroperitoneal hematoma: time until angioembolization and results. / Fracturas de pelvis con hematoma retroperitoneal asociado: tiempo hasta la angioembolización y resultados.

INTRODUCTION: Two areas of controversy in the management of bleeding pelvic fractures are the need to perform angioembolization (AE) in patients with a retroperitoneal hematoma (RPH) but no contrast extravasation (CE) on Computerized Tomography (CT) and/or angiography, and the delay to AE. Our main objective was to assess whether there had been differences in the percentage and delay to AE between patients admitted on weekdays versus off-hours (weekends and admission after 3pm) at our hospital. Our hypothesis was that angiography and AE would be more frequent on weekdays, and the time delay would be longer during off-hours, with a higher mortality in this latter group for a similar overall severity. A secondary objective was to assess the correlation between CE on CT scan and angiography. METHODS: Retrospective review of two cohorts of patients with RPH from a pelvic fracture during a period of 24 years. Patients were divided depending on the time of arrival (Group A: weekdays, and Group B: off-hours). The decision to perform angiography and AE was made by the general surgeons on call, in consensus with the interventional radiologist. We analyzed demographics, mechanism of injury, associated injuries, physiologic and anatomic trauma scores, CE on CT scan, need of AE, Intensive Care Unit (ICU) stay and mortality. RESULTS: 104 patients were admitted with RPH from a pelvic fracture. We performed AE in 63 cases (61%). The groups were comparable in the variables analyzed. In 70% of patients in group A, angiography was done, vs 57% in group B, with the same median time delay. CE on CT scan was seen in 53 out of 96 patients and confirmed by angiography in 45 (85%) of them. No significant differences were found in mortality between the two groups. CONCLUSIONS: There was a short delay from admission to AE, even during off-hours, and a good correlation of CE on CT scan and angiography.

[Wünderlich syndrome due to a ruptured iliac vein secondary to deep venous thrombosis]. / Síndrome de Wünderlich por rotura de vena iliaca, secundario a trombosis venosa profunda.

Wünderlich syndrome, or spontaneous retroperitoneal hematoma, secondary to spontaneous rupture of the iliac vein is a rare clinical entity and a medical emergency. Often the aetiology is difficult to identify and different hypotheses have been proposed, such as the presence of hormonal, inflammatory and/or mechanical factors. It may be important to assess the presence of a factor that triggered the deep vein thrombosis and secondary rupture of the iliac vein and retroperitoneal hematoma. We present a case where venous thrombosis could have caused rupture of the iliac vein and we discuss the entity in light of the current literature.

Hematoma retroperitoneal espontáneo concurrente con una atonía uterina poscesárea / Concurrent Spontaneous Retroperitoneal Hematoma with Uterine Atony Post Cesarean

El hematoma retroperitoneal espontáneo durante el embarazo es una complicación infrecuente definido como el sangrado en el espacio retroperitoneal que ocurre sin historia de trauma reciente, tratamiento anticoagulante o enfermedad vascular. El objetivo del trabajo es presentar un caso grave poco usual en que el hematoma retroperitoneal coexistió en una paciente con atonía uterina. Se presenta una gestante de 21 años y 39 semanas que acudió al Cuerpo de Guardia del Hospital Ginecobstétrico de Guanabacoa en noviembre 2016 por presentar dolor abdominal. Se ingresa en Cuidados perinatales. Los exámenes complementarios, físico y la cardiotocografía fueron normales. Cuatro horas después aqueja dolor lumbar y se detectó dolor a la palpación en región intercostal posterior derecha sin otro hallazgo ni alteraciones hemodinámicas. No hay dinámica uterina y frecuencia fetal 140 latidos/minuto. Dos horas después, presentó un cuadro que el familiar informa como una "convulsión", no observada por personal médico o de enfermería. No hay toma de conciencia y los signos vitales normales, se comprueba una bradicardia fetal que motiva la indicación de cesárea de urgencia. La hemoglobina descendió a 70 g/L. Se repone volumen y se extrae un neonato con Apgar 1-3. Se produce atonía uterina que no cedió al tratamiento medicamentoso y/o masaje. Se realiza técnica de B- Lynch para la hemostasia que se logra. Se comprueba hematoma retroperitoneal no activo desde borde superior hepático hasta flanco derecho. Se estabiliza hemodinámicamente. El neonato fallece a las 72 horas. El diagnóstico y tratamiento precoz del hematoma retroperitoneal contribuye a disminuir la morbilidad y mortalidad materna.

Spontaneous retroperitoneal hematoma during pregnancy is an uncommon complication defined as bleeding in the retroperitoneal space that occurs without a history of recent trauma, anticoagulant treatment or vascular disease. The objective of this study is to present an unusual case in which the retroperitoneal hematoma coexisted in a patient with uterine atony. A 21 year old pregnant woman of 39 weeks who went to the Emergency Room at Guanabacoa Gynecobstetric Hospital in November 2016, due to abdominal pain. The patient is admitted to perinatal care. Complementary studies and physical examination were normal, including cardiotocography. Four hours later, she suffered back pain, which was detected on palpation in the right posterior intercostal region without any other finding or hemodynamic changes. There were no uterine dynamics and fetal frequency was 140 beats / minute. Two hours later, this patient presented a "seizure," according to her family member that was not observed by medical or nursing staff. There was no loss of consciousness and her vital signs were normal. A fetal bradycardia is verified that motivates the indication of emergency caesarean section. Hemoglobin decreased to 70 g / L. Volume was replaced and an Apgar 1-3 neonate was extracted. There was uterine atony that did not yield to drug treatment and massage. The B-Lynch technique was performed for the hemostasis that was achieved. A non-active retroperitoneal hematoma was found from the superior border of the liver to the right flank. The patient was hemodynamically stabilized. The neonate died at 72 hours. The diagnosis and early treatment of retroperitoneal hematoma help to reduce maternal morbidity and mortality.

Hematoma retroperitoneal espontáneo concurrente con una atonía uterina poscesárea / Concurrent Spontaneous Retroperitoneal Hematoma with Uterine Atony Post Cesarean

El hematoma retroperitoneal espontáneo durante el embarazo es una complicación infrecuente definido como el sangrado en el espacio retroperitoneal que ocurre sin historia de trauma reciente, tratamiento anticoagulante o enfermedad vascular. El objetivo del trabajo es presentar un caso grave poco usual en que el hematoma retroperitoneal coexistió en una paciente con atonía uterina. Se presenta una gestante de 21 años y 39 semanas que acudió al Cuerpo de Guardia del Hospital Ginecobstétrico de Guanabacoa en noviembre 2016 por presentar dolor abdominal. Se ingresa en Cuidados perinatales. Los exámenes complementarios, físico y la cardiotocografía fueron normales. Cuatro horas después aqueja dolor lumbar y se detectó dolor a la palpación en región intercostal posterior derecha sin otro hallazgo ni alteraciones hemodinámicas. No hay dinámica uterina y frecuencia fetal 140 latidos/minuto. Dos horas después, presentó un cuadro que el familiar informa como una "convulsión", no observada por personal médico o de enfermería. No hay toma de conciencia y los signos vitales normales, se comprueba una bradicardia fetal que motiva la indicación de cesárea de urgencia. La hemoglobina descendió a 70 g/L. Se repone volumen y se extrae un neonato con Apgar 1-3. Se produce atonía uterina que no cedió al tratamiento medicamentoso y/o masaje. Se realiza técnica de B- Lynch para la hemostasia que se logra. Se comprueba hematoma retroperitoneal no activo desde borde superior hepático hasta flanco derecho. Se estabiliza hemodinámicamente. El neonato fallece a las 72 horas. El diagnóstico y tratamiento precoz del hematoma retroperitoneal contribuye a disminuir la morbilidad y mortalidad materna(AU)

Spontaneous retroperitoneal hematoma during pregnancy is an uncommon complication defined as bleeding in the retroperitoneal space that occurs without a history of recent trauma, anticoagulant treatment or vascular disease. The objective of this study is to present an unusual case in which the retroperitoneal hematoma coexisted in a patient with uterine atony. A 21 year old pregnant woman of 39 weeks who went to the Emergency Room at Guanabacoa Gynecobstetric Hospital in November 2016, due to abdominal pain. The patient is admitted to perinatal care. Complementary studies and physical examination were normal, including cardiotocography. Four hours later, she suffered back pain, which was detected on palpation in the right posterior intercostal region without any other finding or hemodynamic changes. There were no uterine dynamics and fetal frequency was 140 beats / minute. Two hours later, this patient presented a "seizure," according to her family member that was not observed by medical or nursing staff. There was no loss of consciousness and her vital signs were normal. A fetal bradycardia is verified that motivates the indication of emergency caesarean section. Hemoglobin decreased to 70 g / L. Volume was replaced and an Apgar 1-3 neonate was extracted. There was uterine atony that did not yield to drug treatment and massage. The B-Lynch technique was performed for the hemostasis that was achieved. A non-active retroperitoneal hematoma was found from the superior border of the liver to the right flank. The patient was hemodynamically stabilized. The neonate died at 72 hours. The diagnosis and early treatment of retroperitoneal hematoma help to reduce maternal morbidity and mortality(AU)

Retroperitoneal hematoma after using the extreme lateral interbody fusion (XLIF) approach: Presentation of a case and a review of the literature. / Hematoma retroperitoneal tras fusión lumbar intersomática mediante abordaje lateral transpsoas (XLIF): revisión de literatura a propósito de un caso.

The transpsoas approach, also known as extreme lateral interbody fusion (XLIF), to the lumbar spine is a novel minimally invasive technique with positive clinical outcomes and a low complication rate. There is a low risk of bleeding, due to this approach causing less soft tissue disruption than traditional spine surgery, but segmental arteries and great vessels can be damaged. Retroperitoneal haematoma is a major complication, with few cases reported. This is the first case reported in a Stand-alone XLIF and also the first case reported with haemorrhagic shock. Non-specific symptoms such tachycardia, hypotension, and anaemia are the most prevalent in this complication. With this case, our aim is to describe serious complications related to XLIF.

Morbimortalidad de hematoma retroperitoneal traumático en el Hospital Nacional Daniel Alcides Carrión Enero del 2007 a Diciembre del 2011 / Morbidity and mortality of traumatic retroperitoneal hematoma at the National Hospital Daniel Alcides Carrion from January 2007 to December 2011

El hematoma retroperitoneal traumático (HRP) es una entidad poco frecuente cuya repercusión clínica varía, de acuerdo a los órganos retroperitoneales que sean lesionados, en función del agente causal, la velocidad y la cuantía de la hemorragia; se asocia con altas tasas de complicaciones y letalidad. En el Perú, no se tiene registro de la epidemiologia de esta patología, lo que dificulta la toma de decisiones precisas en su manejo. METODOS: Se realizó un estudio descriptivo, transversal y retrospectivo en pacientes mayores de 15 años con diagnóstico de HRP, que ingresaron a la emergencia de cirugía del Hospital Nacional Daniel Alcides Carrión, por trauma abdominal (Enero del 2007 - Diciembre del 2011). Se revisaron las historias clínicas y libro de reporte operatorio. OBJETIVO PRINCIPAL: Identificar la morbimortalidad que causa el Hematoma Retroperitoneal Traumático en pacientes mayores de 15 años atendidos en el servicio de Cirugía en el Hospital Nacional Daniel Alcides Carrión, en el periodo Enero 2007 a Diciembre del 2011. RESULTADOS: Se obtuvo una muestra de 81 pacientes con los criterios de inclusión; 95 por ciento fueron de sexo masculino. El rango de edad más frecuente fue de 15 a 34 años. La incidencia de trauma abierto fue de 77 por ciento; y de trauma cerrado, de 23 por ciento, siendo el principal mecanismo de lesión el producido por proyectil de arma de fuego (61.7 por ciento). El diagnóstico se realizó en el intraoperatorio en un 77 por ciento y por tomografía en 15 por ciento. Se realizó tratamiento quirúrgico en el 83 por ciento. El hematoma retroperitoneal se localizó con mayor frecuencia en la Zona II (70 por ciento), las estructuras lesionadas que predominaron fueron la vena cava en la Zona I (50 por ciento), los riñones en la Zona II (40 por ciento) y los vasos de mediano calibre en la Zona III (22 por ciento). La principal lesión asociada fue el trauma yeyunal. Se determinó una mortalidad de 3,7 por ciento. CONCLUSIÓN: El hematoma...

The traumatic retroperitoneal hematoma (RPH) is an uncommon clinical disease whose effect varies depending on the retroperitoneal organs that are injured, according to the causal agent, the velocity and amount of bleeding; it's associated with high rates of complications and mortality. In Peru, there is no register of the epidemiology of this disease, which difficulties the decision of an adequate management. METHODS: It has made a descriptive, cross-sectional and retrospective study in patients older than 15 years diagnosed with RPH, admitted to the emergency of surgery of Daniel Alcides Carrion National Hospital with diagnosis of abdominal trauma (January 2007 - December 2011). Medical histories and book of surgery report were reviewed. PRINCIPAL OBJECTIVE: To identify the morbidity and mortality that causes Traumatic Retroperitoneal hematoma in patients older than 15 years treated in the Surgery Service of the National Hospital Daniel Alcides Carrion in the period January 2007 to December 2011. RESULTS: A sample of 81 patients was obtained with the inclusion criteria; 95 per cent were male gender. The most common age range was 15 to 34 years. The incidence of open trauma was 77 per cent; whereas closed trauma, 23 per cent, being the main mechanism of injury produced by projectile gun (61.7 per cent). The diagnosis was made intraoperative in 77 per cent and 15 per cent for tomography. Surgical treatment was made in 83 per cent. The retroperitoneal hematoma was located more frequently in Zone II (70 per cent), the principal structures that were injured were vena cava in Zone I (50 per cent), kidney in Zone II (40 per cent) and medium caliber vessels in Zone III (22 per cent). The principal associated lesion was jejunal trauma. A mortality of 3.7 per cent was determined. CONCLUSION: Traumatic retroperitoneal hematoma has its highest incidence in adolescents and young adult male patients with a history of drug dependence. The diagnosis was mainly done by...

Retroperitoneal hematoma: an unexpected complication during intervention on an occluded superficial femoral artery via a retrograde popliteal artery approach.

Peripheral arterial disease involvement of the superficial femoral artery (SFA) is common. Different endovascular techniques are used successfully for revascularization of this artery. A retrograde approach to chronic total occlusion (CTO) of the SFA through the ipsilateral popliteal artery has been used occasionally if an antegrade approach is not feasible or has failed. Some of the known complications encountered during this approach are arteriovenous fistula formation at the access site, occlusion of the popliteal artery if closure devices are used, and bleeding. There are no reports of perforation or bleeding of the SFA or the external iliac artery (EIA) during a popliteal approach, probably due to lack of flow in the occluded segment of the SFA. We report a case in which a retroperitoneal hematoma occurred due to retrograde blood flow through the established true channel in the proximal SFA and subsequently to the dissection plane with a wire tip perforation in the EIA, which was treated by stopping retrograde filling with prolonged balloon inflation in the distal SFA before the CTO.

Hematoma retroperitoneal de causa infrecuente: a propósito de un caso / Retroperitoneal hematoma of unusual cause: a case report

The spontaneous retroperitoneal hematoma (SRH) is defined as a spontaneous hematic collection located in any of the retroperitoneal compartments. The most frequently encountered cause of retroperitoneal hemorrhage is a ruptured abdominal aortic aneurysm, followed by renal and adrenal tumors, along with some other less common causes. Performing accurate diagnosis of patients at admission has proven to be difficult, given that the clinical presentation is ample and variable and may mimic other pictures of abdominal or lower back pain. Imaging techniques, mainly angiography, computed tomography, and MR Imaging, represent a fundamental tool for both timely diagnosis and proper management of the condition. We report the case of a 56-year-old male patient with diagnosis of HIV, who presented with a history of abdominal pain and palpable abdominal mass. After a thorough imaging evaluation, patient was diagnosed with retroperitoneal hematoma, whose histological analysis revealed a Burkitt lymphoma.

El hematoma retroperitoneal espontáneo (HRE) se define como una colección hemática espontánea, situada en cualquiera de los compartimentos retroperitoneales. Dentro de las causas más frecuentes se encuentran las roturas de aneurisma de aorta abdominal, tumores renales y suprarrenales, entre otras. Habitualmente es difícil realizar el diagnóstico al ingreso del paciente, ya que la presentación clínica es variable y puede simular otros cuadros de dolor abdominal o lumbar. Las técnicas de imagen, especialmente la angiografía, tomografía computada y resonancia magnética, son una herramienta fundamental en el diagnóstico y manejo oportuno del cuadro. Presentamos el caso de un varón de 56 años de edad con diagnóstico de VIH en tratamiento, que debutó como un cuadro de dolor y masa abdominal palpable. Luego de un acabado estudio de imágenes, se diagnosticó un HRE cuyo estudio histológico reveló un Linfoma de Burkitt.