Contemporary Management of Spontaneous Retroperitoneal and Rectus Sheath Hematomas
*Michael Warren, Bishwajit Bhattacharya, Adrian Maung, Kimberly Davis
Yale School of Medicine, New Haven, CT
Objective: Spontaneous retroperitoneal and rectus sheath hematomas often occur in the absence of trauma or instrumentation. Although surgeons are commonly consulted, there is a paucity of literature describing whether intervention is required and outcomes. In this study we examine the current management of spontaneous hematomas at an academic center. Design: Retrospective series examining all adult patients who developed a spontaneous rectus sheath or retroperitoneal hematomas. Setting: Academic tertiary care center Patients: Adult patients (ages 18 or older) diagnosed with spontaneous rectus sheath or retroperitoneal hematomas over one-year period. Interventions: None Main Outcome Measures: Therapeutic intervention required, blood product transfusion requirements. Results: 99 patients met the inclusion criteria. Median age was 73 (IQR 61-80) with an equal gender distribution. 88 patients were anticoagulated; most commonly used agents included warfarin (42%) and heparin infusion (36.4%). 26 patients had evidence of shock and 79 patients required blood product transfusion (79.8% PRBC, 43.4% FFP, 17% platelets). Diagnosis was made by CT scan in all patients. 17 patients underwent angioembolization for contrast extravasation. One patient underwent surgery for bleeding control in anticipation of anticoagulation after a planned mesenteric angiogram. Neither anticoagulation in general nor any specific agent were associated with the need for blood product transfusion or angioembolization. ICU admission occurred in 69 patients with a median ICU LOS 4 days and median total hospital LOS 10 days. There were 13 deaths; none were attributed to the hematoma. Conclusions: Spontaneous hematomas are generally self-limiting and rarely require surgery. A small subset may require angioembolization for evidence of contrast extravasation. Surgical consultation is unnecessary as intervention is not required. Additional larger studies are required to identify risk factors for these conditions.
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