自發性後腹腔出血：病例報告

徐志豪、賴宗豪

臺北市立萬芳醫院泌尿科‑委託臺北醫學大學辦理

Spontaneous Retroperitoneal Hemorrhage: A Case Report

Chih-Hao, Hsu、Zong-Hao, Lai

Department of urology, Taipei Medical University Wan Fang Hospital

Introduction:

Spontaneous retroperitoneal hemorrhage is a rare but life-threatening condition, which is defined as bleeding into the retroperitoneal space without trauma or iatrogenic manipulation.

Case description:

A 69-year-old male with past history of hypertension, type 2 diabetes mellitus, hyperlipidemia and end-stage renal disease under hemodialysis. He was suffered from progressive left abdominal pain for several hours after hemodialysis. Severe hypotension and decreased hemoglobin was noted, the contrast-enhanced computed tomography revealed encapsulated hematoma at left perirenal region up to 15.12cm with contrast extravasation. The diagnosis of spontaneous retroperitoneal hemorrhage was impressed and transcatheter arterial embolization was done first. Blood transfusion and close monitoring was then given. After eight days of treatment, he was discharged without any morbidity.

Discussion and conclusions:

Spontaneous retroperitoneal hematoma treatment including conservative management, transcatheter arterial embolization, and surgical intervention. Most patients will respond to medical therapy alone, which includes volume support with intravenous fluids and/or blood products and reversal of anticoagulation, often in the intensive care setting. For patients with refractory hypovolemic shock, ongoing transfusion requirement, expanding hematoma, or active contrast extravasation on CT, we suggest angiographic rather than surgical intervention. The mortality rate of spontaneous retroperitoneal hematoma is so high that the optimal treatment timing needs to be carefully judged on the basis of detailed evaluation, and management algorithm with clear criteria.