Clinical spectrum, risk factors, management and outcome of patients with retroperitoneal hematoma: a retrospective analysis of 3-year experience

ABSTRACT

Objective

Retroperitoneal Hematoma (RPH) is an underdiagnosed and overlooked disease entity and has a high mortality rate if not diagnosed in a timely manner. This study aims to analyze the clinical characteristics, risk factors, treatment and the outcome of RPH cases at our medical center.

Methods

In this retrospective study, all cases who presented to the emergency room (ER) and/or admitted to our center with the diagnosis of RPH from Jan 2016 to Dec 2018 were included (3-year data).

Results

A total number of 78 RPH cases were included including both the traumatic and spontaneous bleed. The most common setting was spontaneous bleeding with no concurrent use of anti-thrombotic agents. Zone 3 (pelvic hematoma) bleed was the most common type of RPH. Most patients were successfully managed medically alone (59%). Others required surgical intervention, either laparoscopy, laparotomy or through the interventional radiological approach. There was a significant association between the need for vasopressors (OR-5.65, P-value of 0.039), spontaneous bleed (P-value of 0.001), bleed without antithrombotic agents (P-value of 0.002) with prolonged hospital stay (> 5 days). On follow-up, 83% of cases were reported to be alive. Only 2 patients died secondary to hemorrhagic shock.

Conclusion

Most cases of RPH had an excellent outcome with conservative management alone.

KEYWORDS:

• Retroperitoneum
• bleeding
• antithrombotic agents
• CT abdomen
• hematoma

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Author contributions

Kamal Kant Sahu- KKS; Amos lal- AL; Ajay Kumar Mishra-AKM; Susan V George-SVG; Ahmad Daniyal Siddiqui- ADS.

AKM, KKS, AL, ADS were instrumental in data collection. AKM, KKS, ADS, SVG were involved with data analysis and manuscript writing. AKM, KKS were involved with formatting of the manuscript. AKM, SVG, AL, ADS were involved with editing and finalizing.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.