Spontaneous Retroperitoneal Hematoma: A Single Center Experience

Abstract

INTRODUCTION: Spontaneous retroperitoneal hematoma (SRH) is a rare and potentially fatal entity usually described as a complication of anticoagulant therapy. It can be a diagnostic challenge, given the heterogeneity of clinical manifestations. The objective of this study is to characterize a population of patients with SRH and to identify predictors of mortality.
METHODS: A retrospective study including all patients admitted to our hospital over a 10-year period (2010-2019) with diagnosis of SRH. Patients with a history of trauma, invasive procedures or surgeries in the previous 14 days were excluded.
RESULTS: Eleven patients were included; 63.6% were men. The median age was 81 years. Nine patients were anticoagulated: 5 with vitamin K antagonists, 4 with enoxaparin. SRH was the primary reason for admission in 45.5% of cases. The others developed SRH during inpatient admission. The most common clinical presentation was abdominal pain (45.5%), followed by symptoms of low output (36.4%). Three patients had a supratherapeutic INR. All patients were treated conservatively. The overall mortality at 30 days was 36.4%; in-hospital mortality was 54.5%. SRH was considered the direct cause of death in only 18.2%. The only factor we found to be associated with higher mortality was a decline in renal function (p=0.029).
CONCLUSION: SRH occurs mainly in elderly and hypocoagulated patients. It is associated with high mortality, but typically is not the direct cause of death. It is difficult to identify predictors of mortality, however, it seems that a decline in renal function is associated with a higher risk.