spontaneous retroperitoneal hemorrhage

Spontaneous retroperitoneal hemorrhage (SRH) is a distinctive clinical pathology of retroperitoneal bleeding without a preceding history of trauma.

For a broader discussion, including other etiologies, please refer to the parental article on retroperitoneal hemorrhage.

Clinical presentation

Clinical presentation may be vague and varied:

• no inciting history
• no evidence of cutaneous bruising
• back, lower abdominal or groin pain
• hemodynamic instability
• fall in hemoglobin

Pathology

The pathophysiology and pathogenesis of spontaneous retroperitoneal bleeding are unclear. Many hypotheses have been put forth:

• diffuse vasculopathy and arteriosclerosis of small retroperitoneal vessels renders them friable and prone to rupture
• anticoagulation induced immune microangiopathy may cause an unrecognised minor trauma in the microcirculation to cause a hemorrhage

Etiology

Spontaneous retroperitoneal hemorrhage is uncommon and is almost exclusively seen in association with:

• rupture of aortic or visceral artery aneurysm
• rupture of a pathological lesion in a retroperitoneal organ (renal and adrenal)
• anticoagulation states
• coagulopathies 
  • factor IX deficiency
  • factor X deficiency
  • von Willebrand disease
  • antiphospholipid syndrome
• haemodialysis

Treatment and prognosis 

Based on the clinical scenario and cause, the management can be endovascular repair or open surgery.

Siehe auch:

• retroperitoneales Hämatom
• Wunderlich-Syndrom
• spontane Einblutung
• rupture of renal angiomyolipoma
• Hämatom im Musculus psoas

und weiter:

• retroperitoneale Tumoren
• Marcumar
• traumatic retroperitoneal hemorrhage
• Komplikationen bei Antikoagulanzientherapie