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Inicio Medicina Clínica (English Edition) Clinical spectrum of patients with spontaneous retroperitoneal hematomas
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Vol. 145. Issue 7.
Pages 301-304 (October 2015)
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Vol. 145. Issue 7.
Pages 301-304 (October 2015)
Clinical report
Clinical spectrum of patients with spontaneous retroperitoneal hematomas
Perfil clínico de los pacientes con hematomas retroperitoneales espontáneos
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7
Amada Sánchez-González, Leyre Riancho-Zarrabeitia, Zaida Salmón-González, José Antonio Riancho, Carmen Valero
Corresponding author
mirvdc@humv.es

Corresponding author.
Departamento de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de Investigación Sanitaria Marqués de Valdecilla (IDIVAL), Santander, Spain
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Tables (2)
Table 1. Clinical characteristics of anticoagulated and non-anticoagulated spontaneous retroperitoneal hematomas.
Table 2. Comparing anticoagulated spontaneous retroperitoneal hematoma in both series.
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Abstract
Introduction and objective

Spontaneous retroperitoneal hematoma (SRH) is a potentially fatal clinical entity requiring immediate recognition and intervention.

Material and methods

The clinical records of 18-year-old and older patients admitted to the University Hospital Marqués de Valdecilla from 2003 to 2013 were reviewed. “Spontaneous” was defined as unrelated to trauma, invasive procedures or bleeding due to aortic aneurysm rupture.

Results

Thirty-four patients with SRH (44% were on anticoagulant drugs). One-third of cases had chronic renal insufficiency. Abdominal pain was the most common symptom both in anticoagulated and non-anticoagulated patients (80% in anticoagulated and 89% in non-anticoagulated patients). About one half of the patients developed shock. A CT scan was the most commonly performed diagnostic test, followed by abdominal ultrasound. Most cases were managed conservatively (80%). More than half of the patients (66%) restarted anticoagulation therapy after the acute event with a mean delay of 19 days (range 2–90 days). None of them suffered a new bleeding episode.

Conclusion

Restarting the anticoagulation treatment after hematoma resolution seems to be a safe practice. There is an increasing frequency of SRH in non-anticoagulated patients.

Keywords:
Hematoma
Retroperitoneal
Anticoagulation
Resumen
Introducción y objetivo

Los hematomas retroperitoneales espontáneos (HRE)son una complicación del tratamiento anticoagulante.

Material y métodos

Revisión retrospectiva de los HRE en el Hospital Universitario Marqués de Valdecilla (Santander, España) desde el año 2003 al 2013. Se excluyen los traumatismos, los procedimientos invasivos o las roturas de un aneurisma aórtico. Comparamos esta serie con la descrita previamente en nuestro hospital.

Resultados

Identificamos 34 HRE (64% mujeres) con una media de edad de 65 años (23-88 años). El 44% estaban anticoagulados por enfermedad cardiaca (81%). Un tercio tenía insuficiencia renal, y el 15%, cáncer. El dolor abdominal se describe en el 85%. La TC se realiza en el 82%. El 32% ingresa en UCI y solo el 20% requiere cirugía. La mortalidad relacionada fue del 21% (media de supervivencia de 5 días; 1-15 días). El 66% reinicia la anticoagulación a los 19 días (2-90 días), sin complicaciones posteriores. Se incrementan los casos no anticoagulados en un 47%.

Conclusión

En los casos anticoagulados, la reintroducción del tratamiento, tras la resolución del hematoma, parece una práctica relativamente segura. Se incrementan los casos en pacientes no anticoagulados.

Palabras clave:
Hematoma
Retroperitoneal
Anticoagulación

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