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 
  • haemodialysis

Treatment and prognosis 

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

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