Ver el código de «Retroperitoneal hemorrhage»

==Background==
[[File:PMC5265200 13244 2016 536 Fig1 HTML.png|thumb|Perinephric space with exaggerated pararenal space to show retroperitoneal structures. Perinephric bridging septa are seen between the left kidney and the adjacent renal fascia.]]
[[File:Blausen 0592 KidneyAnatomy 01.png|thumb|Renal anatomy.]]
*Bleeding into retroperitoneal space 
*Difficult to diagnose given poor sensitivity of physical exam findings (Cullens, Grey-Turners)
*Can accumulate 4L blood before tamponade

===Etiologies===
*Trauma (renal, vascular, colon, pancreas or pelvis)
*Leaking/ruptured [[AAA]]
*Iatrogenic (colonoscopy, cardiac catheterization, femoral line placement)
*Spontaneous ([[coagulopathy]])
*Hemorrhagic [[pancreatitis]]

==Clinical Features==
*Most common in patients with bleeding disorders, on anticoagulants, and on HD<ref>Bhasin HK and Dana CL. Spontaneous retroperitoneal hemorrhage in chronically hemodialyzed patients. Nephron. 1978; 22(4-6):322-327.</ref><ref>Ernits M, et al. A retroperitoneal bleed induced by enoxaparin therapy. Ann Surg. 2005; 71(5):430-433.</ref>
*May present with:
**[[Abdominal pain]]
**[[Flank pain]]
**[[Back pain]]
**[[Hypotension]]
**Bryant's sign (unilateral scrotal ecchymosis from tracking blood)

==Differential Diagnosis==
{{Abdominal trauma DDX}}

==Evaluation==
===Workup===
[[File:Abdotrauma.png|thumb|Right kidney contusion (open arrow) and blood surrounding the kidney (closed arrow).]]
[[File:Kidneyhematoma.png|thumb|Left kidney injury (open arrow) with retropeitoneal hematoma (closed arrow).]]
''Must have high clinical suspicion to make diagnosis''
*CT scan abdomen/pelvis
*Consider [[Aortic ultrasound| ultrasound for AAA]]
*FAST and DPL do not evaluate retroperitoneal space

===Classification of traumatic retroperitoneal hemorrhage<ref>FELICIANO, D. V. (1990) ‘Management of Traumatic Retroperitoneal Hematoma’, Annals of Surgery, 211(2), pp. 109–123. </ref>===
[[File:Retroperitoneal zones.jpg|thumb|Retroperitoneal zones]]
*Zone 1: Central
**Pancreaticoduodenal injuries, major vascular injury
*Zone 2: Flank/Perinephric
**[[Renal trauma]], ureteric or colonic injury
*Zone 3: Pelvic
**Pelvic fracture or ileofemoral vascular injury

==Management==
*Address A, B, C's
*Resuscitation with [[blood products]]
*Reverse [[coagulopathy]]
**[[Warfarin (Coumadin) Reversal]]
**[[Dabigatran (Pradaxa) Reversal]]
**[[Unfractionated heparin reversal]]
*Treat underlying etiology

==Disposition==
*ICU

==See Also==
*[[Abdominal trauma]]
*[[coagulopathy]]
*[[Warfarin (Coumadin) Reversal]]
*[[Dabigatran (Pradaxa) Reversal]]
*[[Unfractionated heparin reversal]]
*[[Aortic ultrasound]]

==External Links==


==References==
<references/>

[[Category:Trauma]]