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Spontaneous Retroperitoneal and Rectus Sheath Hemorrhage—Management, Risk Factors and Outcomes

  • Josefine S. BaekgaardEmail author
  • Trine G. Eskesen
  • Jae Moo Lee
  • D. Dante Yeh
  • Haytham M. A. Kaafarani
  • Peter J. Fagenholz
  • Laura Avery
  • Noelle Saillant
  • David R. King
  • George C. Velmahos
Original Scientific Report
  • 16 Downloads

Abstract

Background

Spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH) is associated with high mortality in the literature, but studies on the subject are lacking. The objective of this study was to identify early predictors of the need for angiographic or surgical intervention (ASI) in patients with SRRSH and define risk factors for mortality.

Methods

We conducted a retrospective cohort study at a tertiary academic hospital. All patients with computed tomography-identified SRRSH between 2012 to 2017 were included. Exclusion criteria were age below 18 years, possible mechanical cause of SRRSH, aortic aneurysm rupture or dissection, and traumatic or iatrogenic sources of SRRSH. The primary outcome was the incidence of ASI and/or mortality.

Results

Of 100 patients included (median age 70 years, 52% males), 33% were transferred from another hospital, 82% patients were on therapeutic anticoagulation, and 90% had serious comorbidities. Overall mortality was 22%, but SRRSH-related mortality was only 6%. Sixteen patients underwent angiographic intervention (n = 10), surgical intervention (n = 5), or both (n = 1). Flank pain (OR 4.15, 95% CI 1.21–14.16, p = 0.023) and intravenous contrast extravasation (OR 3.89, 95% CI 1.23–12.27, p = 0.020) were independent predictors of ASI. Transfer from another hospital (OR 3.72, 95% CI 1.30–10.70, p = 0.015), age above 70 years (OR 4.24, 95% CI 1.25–14.32, p = 0.020), and systolic blood pressure below 110 mmHg at the time of diagnosis (OR 4.59, 95% CI 1.19–17.68, p = 0.027) were independent predictors of mortality.

Conclusions

SRRSH is associated with high mortality but is typically not the direct cause. Most SRRSHs are self-limited and require no intervention. Pattern identification of ASI is hard.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Josefine S. Baekgaard
    • 1
    • 2
    Email author
  • Trine G. Eskesen
    • 1
    • 2
  • Jae Moo Lee
    • 1
  • D. Dante Yeh
    • 3
  • Haytham M. A. Kaafarani
    • 1
  • Peter J. Fagenholz
    • 1
  • Laura Avery
    • 4
  • Noelle Saillant
    • 1
  • David R. King
    • 1
  • George C. Velmahos
    • 1
  1. 1.Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Anesthesia, Center of Head and Orthopedics, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
  3. 3.Ryder Trauma Center, DeWitt Daughtry Family Department of SurgeryUniversity of Miami Miller School of MedicineMiamiUSA
  4. 4.Department of Radiology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

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