What is Abdominal Bleeding?

Retroperitoneal hemorrhage refers to bleeding from retroperitoneal organs or blood vessels caused by trauma or other lesions. Most of them are acute progressive hemorrhage, and the blood loss is large. The blood easily spreads widely in the retroperitoneal space, forms a huge hematoma, and can penetrate into the mesentery. Most of this disease is caused by damage to the retroperitoneal organs, and a few are caused by other diseases. Clinical manifestations vary depending on the location, extent, extent, and speed of bleeding, especially when combined with injuries in other locations, and the symptoms of retroperitoneal bleeding are often masked and are easily confused with intra-abdominal bleeding.

Basic Information

Visiting department: Gastroenterology
Common causes: trauma.

Common symptoms: Abdominal pain or low back pain, hematoma compresses nerves, etc.
Contagious: no

Causes of retroperitoneal hemorrhage

1. Trauma Trauma is the most common cause. Trauma can cause pelvic and / or lumbar fractures, rupture and bleeding of kidneys, pancreas and other organs, as well as rupture and bleeding of large blood vessels behind the peritoneum.
2. The disease is rare, mainly seen in abdominal aortic aneurysms, iliac aneurysms and other retroperitoneal macrovascular lesions, spontaneous rupture of kidneys and retroperitoneal tumors, etc .; elderly patients may have spontaneous retroperitoneal bleeding; severe acute pancreatitis may also have hemorrhagic necrosis Causes retroperitoneal bleeding.
3 Other anticoagulant therapies and catheters cause peritoneal tissue damage during angiography.

Clinical manifestations of retroperitoneal hemorrhage

Varies by location, range, extent, and speed. Symptoms such as those associated with injury to other areas are often masked. Most patients have abdominal pain or low back pain. Hematomas that compress nerves and internal organs can cause neuropathic pain, gastrointestinal and urinary dysfunction, intestinal paralysis such as abdominal flatulence and disappearance of bowel sounds. Peritoneal irritation can occur and intestinal paralysis can be aggravated. . Pelvic retroperitoneal hematoma can have symptoms of rectal irritation, digital rectal examination can touch the sense of fluctuation, most patients with hematoma area swelling and swelling, tenderness, high bleeding may appear corresponding symptoms such as hypotension or shock. The blood penetrated through the retroperitoneal space to the subcutaneous tissue of the abdominal wall, and the plaques appeared subcutaneously or in the umbilicus of the lateral abdomen.

Retroperitoneal hemorrhage

1. Laboratory tests (1) Blood routine showed anemia, increased reticulocyte and white blood cell counts.
(2) Blood biochemical examination shows renal failure and hematuria in perrenal hematoma. In hemorrhagic pancreatitis, amylase and lipase activities in blood and urine increase.
2. Imaging (1) X-ray examination: visible fractures, non-development of one side of the kidney or psoas muscle, localized or diffuse intestinal paralysis.
(2) CT, magnetic resonance, ultrasound: help to identify and localize retroperitoneal hematoma.
(3) Intravenous pyelography: seeing the contrast agent passing through the kidney, suggesting renal trauma.
3 Abdominal puncture, such as peritoneal rupture, blood flows into the abdominal cavity, and the abdominal puncture fluid is bloody ascites.

Diagnosis of retroperitoneal bleeding

Combined with the primary disease and symptoms and signs, and with the help of laboratory tests, abdominal X-rays, intravenous pyelography, ultrasound and CT scans, the diagnosis of retroperitoneal bleeding and the cause of bleeding can be diagnosed. Spontaneous blood without a history of trauma should be searched for the cause, non-coagulation problems and unknown causes, and angiography should be performed as soon as possible to determine the bleeding site. If retroperitoneal bleeding is found with gas accumulation and jaundice, the possibility of duodenal injury should be considered.

Treatment of retroperitoneal bleeding

1. General treatments such as small amount of retroperitoneal bleeding, blood can be absorbed by itself, generally only symptomatic treatment, until it heals itself.
2. Drug treatment (1) In cases of moderate bleeding, anti-infection and hemostatic drugs should be actively used.
(2) Patients with hemophilia should be intravenously administered with anti-hemophilia factors.
(3) For bleeding caused by anticoagulation therapy, anticoagulant drugs should be suspended.
3 Surgical treatment (1) Hemorrhagic shock is caused by pelvic fracture with massive retroperitoneal hemorrhage, and those with poor conservative treatment are sometimes ligated to control bleeding.
(2) For those with visceral injury, a laparotomy should be performed, and attention should be paid to the presence of multiple organ damage in the abdominal and retroperitoneal organs.
(3) If hemorrhagic shock cannot be corrected, surgery should be performed as soon as possible, and effective hemostatic treatment should be performed according to the cause.