Contemporary Management Of Spontaneous Retroperitoneal And Rectus Sheath Hematomas

Retroperitoneal and rectus sheath hematomas can occur spontaneously in the absence of trauma may be potentially life-threatening. Although surgical consults are often called for these patients, there is a lack of research about the disease progression, optimal treatment strategies and the need for surgical intervention. Our study aimed to investigate the outcomes and management of spontaneous retroperitoneal and rectus sheath hematomas. Adult patients admitted during a one-year period with a diagnosis of non-traumatic retroperitoneal or rectus sheath hematomas were identified from the electronic medical record of a quaternary care center. Biographical, hospital-course, and outcome data were extracted. 99 patients met the inclusion criteria, with a median age of 73 years (IQR 61-80). 88 patients were on an anticoagulant or antiplatelet agent with warfarin and intravenous heparin being the most commonly utilized agents (42% and 36.4%, respectively). All 99 patients were diagnosed by CT scan. 79 patients received some sort of blood product (79.8% PRBC, 43.4% FFP, 17% platelets), and 26 patients were in hemorrhagic shock. 17 patients underwent angiography and/or angioembolization. Neither anticoagulation in general nor any specific agent was associated with the need for blood product transfusion or angiography. 13 patients died but none were attributable to the hematoma. We conclude that spontaneous retroperitoneal and rectus sheath hematomas are usually self-limiting and rarely require surgical intervention. A subset may require angioembolization