Life Threatening Retroperitoneal Haemorrhage in COVID-19 Patient -Surgical Treatment: A Case Report

@#Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus that emerged in late 2019. The COVID-19 pandemic has affected millions of people worldwide, causing severe respiratory distress, multi-organ failure, and death. Nevertheless, there are records of unusual presentations of COVID-19, which includes hemorrhagic complications. Retroperitoneal hemorrhage (RPH) is a rare but life-threatening complication that can occur in COVID-19 patients. In this paper, we present a case of a life-threatening spontaneous retroperitoneal haemorrhage who has successfully undergone an exploratory laparotomy and made a full recovery. We would like to highlight the importance of close monitoring and prompt recognition in patients with increased risk of bleeding.

Ruptured Tubal Pregnancy with Massive Retroperitoneal Hemorrhage

Ectopic pregnancy is an implantation of the fertilized ovum on a place except the endometrium. Most of the ectopic pregnancies are located at the fallopian tube. Few cases of retroperitoneal hematoma associated with ectopic pregnancy have been reported on previously; in each the retroperitoneal space had been the site of implantation. In contrast, we treated a patient with an ectopic pregnancy that implanted in the tube and then perforated through into the retroperitoneal space. To our knowledge this is very rare case of retroperitoneal hematoma caused by a ruptured tubal pregnancy.

Hematoma renal subcapsular espontáneo secundario al empleo de antiagregantes plaquetarios / Spontaneous renal sub-capsular hematoma after the use of antiplatelet

Paciente masculino de 65 años de edad, con antecedentes de habérsele colocado stent coronario y tratamiento antiagregante plaquetario con Aspirina® y Clopidogrel®. A los 21 días comenzó a presentar dolor en el flanco y la fosa ilíaca derechos, náuseas y vómitos. En el examen físico inicial se detectó dolor y aumento de volumen en las zonas referidas y los signos vitales normales. El ultrasonido abdominal reveló colección perirrenal derecha bien delimitada y riñones de tamaño y ecoestructura normal. La tomografía axial computarizada evidenció la presencia de una imagen renal subcapsular derecha, con densidades de líquido, con compresión extrínseca de un riñón estructuralmente normal. Al día siguiente del ingreso comenzó a presentar fiebre de 38 ºC. Se suspendió el tratamiento antiagregante plaquetario y a los 7 días se realizó lumbotomía y drenaje del hematoma; se obtuvo alrededor de 400 mL de sangre carmelitosa. El paciente evolucionó satisfactoriamente. Se concluye que el hematoma renal subcapsular espontáneo es una complicación inusual del uso de antiagregantes plaquetarios que necesita manejo multidisciplinario. La tomografía axial computarizada es indispensable para el diagnóstico imagenológico de certeza. La compresión renal por su gran tamaño, así como el dolor y la aparición de fiebre, justifican su drenaje quirúrgico.

A case of a 65 year-old male patient with a history of having received a coronary stent and antiplatelet therapy with Aspirin® and Clopidogrel® is presented here. He complained of pain in the right flank and iliac fossa nausea and vomiting 21 days after the procedure. At initial physical examination, normal vital signs but pain and increased volume in the aforementioned areas were detected. Abdominal ultrasound revealed well defined right perirenal collection and normal size kidneys and echotexture. Computed tomography showed the presence of a right subcapsular renal image with liquid density and extrinsic compression of a structurally normal kidney. The day after admission the patient ran a fever of 38 ºC. Antiplatelet therapy was discontinued and lumbotomy and drainage of the hematoma was performed 7 days latter; about 400 mL of brownish blood was obtained. The patient progressed satisfactorily. It is concluded that spontaneous subcapsular renal hematoma is a rare complication of antiplatelet requiring multidisciplinary management.Computed tomography imaging is required for diagnosis. The renal compression due to its large size as well as pain and fever, justify their surgical drainage.

Ruptura espontánea de aneurisma de arteria renal duranteel embarazo: reporte de caso / Spontaneous rupture of renal arterial aneurism during pregnancy: case report

Se presenta un caso de ruptura espontánea del aneurisma de la arteria renal. Paciente de 30 años con embarazo de 30 semanas y dolor de fuerte intensidad, de aparición súbita y de carácter punzante en cuadranteinferior izquierdo. La exploración del útero y los anexos no se observaron anomalías macroscópicas. Se observó sangre en el espacio retroperitoneal izquierdo. La arteria renal izquierda mostraba una apertura que se comunicaba con un saco aneurismático, por lo que se realizó la nefrectomía

A case of spontaneous rupture of renal artery aneurysm is described in a 30 years-old patient with a 30 weeks pregnancy who consulted for presenting severe and acute pain in left inferior quadrant. Uterus and both adnexa examination did not show macroscopical anomalies. There was observed blood in left retroperitoneal space. Left renal artery showed and opening that comuncate to secular aneurysm, nephrectomy was done

Retroperitoneal Hemorrhage after Thrombolysis in ST Elevation Myocardial Infarction / 영남의대학술지

Bleeding is the most common and serious complication of thrombolysis in ST elevation myocardial infarction. Most bleeding cases are associated with an intervention or operation, but spontaneous bleeding such as gastro-intestinal bleeding or intracranial hemorrhage can happen. This is a report on the case of a 76-year-old female patient with retroperitoneal hemorrhage due to spontaneous right colic artery branch bleeding after thrombolysis in ST elevation myocardial infarction.

Usability of Esophageal Doppler for Monitoring of Concealed Retroperitoneal Hemorrhage during Laparoscopy Assisted Subtotal Gastrectomy / 대한구급학회지

Hemodynamic monitoring is an essential element in the management of perioperative patients. In addition, anesthesiologists routinely used blood pressure (invasive or non invasive), heart rate, urinary output and central venous pressure as monitoring modalities. Esophageal doppler monitoring, as a minimally invasive hemodynamic assessment tool, has a good correlation with pulmonary artery catheterization in measuring cardiac output. We experienced a case of concealed retroperitoneal hemorrhage in a patient who underwent a laparoscopic subtotal gastrectomy. When surgeons tried to close trocar sites, the patient's blood pressure dropped rapidly. At laparoscopy, we could not find gross bleeding. However, we could detect hypovolemia by esophageal doppler monitoring (CardioQ, Deltex(TM), UK). The procedure was converted to open laparotomy. Thereafter, we could find retroperitoneal hemorrhage, and vascular repair was done successfully. The patient recovered without any other complications.

Spontaneous Retroperitoneal Hemorrhage from Ruptured Suprarenal Artery Aneurysm

Retroperitoneal hemorrhage from a ruptured suprarenal artery aneurysm is very rare. We report on a 34-year-old man who underwent selective angiography for diagnosis and treatment of retroperitoneal hemorrhage for suprarenal artery aneurysm. The patient made a full recovery with no evidence of further hemorrhage.

Transcatheter Arterial Embolization as Treatment for a Life-Threatening Retroperitoneal Hemorrhage Complicating Heparin Therapy

Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present in the absence of specific underlying pathology or trauma and is typically associated with anticoagulation therapy. We report a case of a 74-year-old female patient with a cerebral infarction related to atrial fibrillation who developed a spontaneous lumbar arterial hemorrhage complicating heparin therapy. The diagnosis was suggested by a computed tomography scan and confirmed by angiography. She was treated successfully with transcatheter embolization.

Retroperitoneal hematoma after coil embolization of cerebral aneurysm: A case report / 대한마취과학회지

We present the case of a 57-year-old man who developed retroperitoneal hemorrhage due to unintentional arterial puncture during femoral artery cannulation for Guglielmi detachable coil embolization. On emergence from anesthesia, he developed severe hypotension. Computed tomographic angiogram of the abdomen showed retroperitoneal hematomas around the urinary bladder, liver, and spleen. Because femoral artery cannulation is a common procedure for intravascular embolization in neuroradiologic procedures, Clinicians should be aware of the development of severe hematomas as a consequence of femoral artery puncture.

A Case of Spontaneous Rupture of Left Lumbar Artery Aneurysm on the Fifth day of Vaginal Delivery / 대한주산의학회잡지

Retroperitoneal hemorrhage caused by intra-abdominal vascular injury during pregnancy or puerperium is rare, but a very fatal complication. Massive retroperitoneal hemorrhage causes the high mortality rate of mother and fetus. But the difficulty of diagnosis and rarity may delay prompt treatment. We experienced a case of massive retroperitoneal hemorrhage, which was caused by a suspected left lumbar artery aneurysm rupture on the fifth day of vaginal delivery. The patient was successfully treated by surgery and arterial embolization. We reported this case with a brief review of literature.

Vascular injuries associated with lumbar disk surgery: medicolegal implications / 대한법의학회지

Symptomatic perforation of the anterior annulus fibrosus/anterior longitudinal ligament during surgery for herniated lumbar disc disease is one of the more solemn and sobering complications experienced by neurosurgeons or orthopedic surgeons. Iatrogenic vascular injuries are unusual complications of lumbar disk surgery. The incidence of such injuries is very low but probably underestimated because clinical manifestations may be extremely variable depending on the extension of trauma. Diagnosis is suspected when early signs or retroperitoneal hemorrhage appear, but may often be delayed. I experienced 5 autopsied cases of acute hemorrhage due to vascular trauma in disk surgery. A review of the literature is present and the medicolegal implications of symptomatic ventral perforations of the annulus fibrosus/anterior longitudinal ligament are discussed.

A Case of Spontaneous Retroperitoneal Hemorrhage due to Iliopsoas Muscle Hematoma in Patient with Myocardial Infarction Receiving Intravenous Heparin

The most common adverse effect of intravenous heparin is hemorrhage. Of the these, retroperitoneal hemorrhage and femoral neuropathy secondary to heparin anticoagulation has reported in 1966 for the first time by DeBolt and Jordan. We experienced a case of spontaneous retroperitoneal hemorrhage due to iliopsoas muscle hematoma in patient with myocardial infarction receiving intravenous heparin for a 3 days in therapeutic doses. The pathophysiology of iliopsoas muscle hematoma has not yet been cleared. But because of the possibility of large amount in volume, retroperitoneal hemorrhage has been known as a serious adverse effect that leads to the hypovolemic shock and death. In this article, we described the clinical manifestation, the importance of the early diagnosis and diagnostic clues and associated factors of the retroperitoneal hemorrhage in patient receiving intravenous heparin.