RESUMO
El hematoma retroperitoneal es una entidad poco frecuente cuya repercusión clínica varía en función de la velocidad y la cuantía de la hemorragia: desde asintomático, que suele diagnosticarse casualmente en pruebas de imágenes, hasta complicado, cuyo síntomas característicos son el dolor y el shock hipovolémico. Presentamos 3 casos clínicos de hematoma retroperitoneal complicado. Si bien la bibliografía describe múltiples causas, en nuestros pacientes el origen fue siempre tumoral: 1 mielolipoma suprarrenal, 1 adenocarcinoma renal y 1 metástasis suprarrenal de adenocarcinoma broncogénico. La tomografía computarizada fue la prueba de imagen utilizada, no sólo para definir la naturaleza del proceso (hematoma, absceso, tumor), sino también para valorar la compresión de estructuras adyacentes y la existencia de hemorragia activa. Aunque se intentó el tratamiento conservador mediante reposición de la volemia y corrección de la coagulación, en todos los casos fue necesaria intervención quirúrgica urgente, 2 por inestabilidad hemodinámica y 1 por compresión de la vena cava (AU)
Retroperitoneal hematoma is a rare entity with clinical consequences that vary according to the speed and amount of bleeding. Thus, it may be asymptomatic, in which case it is usually diagnosed incidentally through imaging tests, or severe, in which case the most common symptoms are pain and hypovolemic shock. We report three cases of severe retroperitoneal hematoma. Although the literature on the subject describes a wide variety of causes, in all three patients the etiology was tumoral, consisting of one suprarenal myelolipoma, one renal adenocarcinoma and one suprarenal metastasis from bronchogenic adenocarcinoma. Computed tomography was the imaging test employed not only to determine the nature of the process (hematoma, abscess, tumor) but also to assess compression of adjacent structures and the occurrence of active bleeding. Conservative treatment consisting of volemic replacement and correction of coagulation was initially attempted. However, all three patients required emergency surgery due to hemodynamic instability in two patients and compression of the vena cava in the other (AU)
Assuntos
Masculino , Feminino , Pessoa de Meia-Idade , Humanos , Hematoma/complicações , Hematoma/diagnóstico , Espaço Retroperitoneal/cirurgia , Hematoma/etiologia , Tomografia Computadorizada de Emissão/métodos , Choque/complicações , Hemorragia/complicações , Hemorragia/diagnóstico , Angiolipoma/complicações , Angiolipoma/cirurgia , Espaço Retroperitoneal/patologia , Espaço Retroperitoneal , Mielolipoma/complicações , Carcinoma de Células Renais/complicações , Abdome/patologia , Abdome , Adenoma Adrenocortical/patologia , Adenoma Adrenocortical/cirurgia , Metástase Neoplásica/patologia , Metástase NeoplásicaRESUMO
Retroperitoneal hematoma is a rare entity with clinical consequences that vary according to the speed and amount of bleeding. Thus, it may be asymptomatic, in which case it is usually diagnosed incidentally through imaging tests, or severe, in which case the most common symptoms are pain and hypovolemic shock. We report three cases of severe retroperitoneal hematoma. Although the literature on the subject describes a wide variety of causes, in all three patients the etiology was tumoral, consisting of one suprarenal myelolipoma, one renal adenocarcinoma and one suprarenal metastasis from bronchogenic adenocarcinoma. Computed tomography was the imaging test employed not only to determine the nature of the process (hematoma, abscess, tumor) but also to assess compression of adjacent structures and the occurrence of active bleeding. Conservative treatment consisting of volemic replacement and correction of coagulation was initially attempted. However, all three patients required emergency surgery due to hemodynamic instability in two patients and compression of the vena cava in the other.
