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.

Abdominal Compartment Syndrome Due to Spontaneous Retroperitoneal Hemorrhage in a Patient Undergoing Anticoagulation

Spontaneous retroperitoneal hemorrhage is one of the most serious and often lethal complications of anticoagulation therapy. The clinical symptoms vary from femoral neuropathy to abdominal compartment syndrome or fatal hypovolemic shock. Of these symptoms, abdominal compartment syndrome is the most serious of all, because it leads to anuria, worsening of renal failure, a decrease in cardiac output, respiratory failure, and intestinal ischemia. We report a case of a spontaneous retroperitoneal hemorrhage in a 48-year-old female who had been receiving warfarin and aspirin for her artificial aortic valve. She presented with a sudden onset of lower abdominal pain, dizziness and a palpable abdominal mass after prolonged straining to defecate. Computed tomography demonstrated a huge retroperitoneal hematoma and active bleeding from the right internal iliac artery. After achieving successful bleeding control with transcatheter arterial embolization, surgical decompression of the hematoma was performed for management of the femoral neuropathy and the abdominal compartment syndrome. She recovered without any complications. We suggest that initial hemostasis by transcatheter arterial embolization followed by surgical decompression of hematoma is a safe, effective treatment method for a spontaneous retroperitoneal hemorrhage complicated with intractable pain, femoral neuropathy, or abdominal compartment syndrome.

Spontaneous Retroperitoneal Hematoma due to Liver Cirrhosis: A Case Report / 대한간학회지

Spontaneous retroperitoneal hemorrhage due to liver cirhosis associated with impaired coagulopathy is very rare disease. Spontaneous retroperitoneal hemorrhage has been recorded as having originated from many retroperitoneal organs and blood vessels, and it may be due to local disease and/or systemic factors. In the majority of patients the bleeding arose from the kidney or adrenal gland. Among the systemic causes of spontaneous retroperitoneal hemorrhage are anticoagulation therapy and chronic hemodialysis during the course of which hemorrhagic complications may occur at many site, including the retroperitoneal space. Blood dyscrasias have been a rare cause of spontaneous retroperitoneal hemorrhage. Conditions reported have been included hemophilia, leukemia, polycythemia and sickle cell trait. Virtually every hemostatic function may be impaired in patients with severe hepatic disease as the result of failure of both the biosynthetic and clearence function of the liver, thrombocytopenia, platelet dysfunction, intravascular coagulation and fibrinogenolysis, and the effects of products of fibrinogen catabolism on the coagulation mechanism. We are reporting a case of spontaneous retroperitoneal hematoma in a patient with alcoholic liver cirrhosis with brief review of literature.