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retroperitoneal haemorrhage


  • retroperitoneal bleeding can be life threatening and often diagnosis is delayed

Clinical features

  • flank pain - often of sudden onset
  • if forms a large psoas haematoma, may present with:
    • constipation
    • urinary frequency
    • femoral neuropathy
    • fever
  • haematuria if aetiology is renal
  • late, Cullen's sign (umbilical bruising), Gray-Turner's sign (flank ecchymosis), the shocked hypotensive patient


Spontaneous (Wunderlich syndrome)



  • CT abdomen
    • plain first to assess for other causes and should demonstrate the haemorrhage
    • THEN, if positive, contrast angiography to determine site of bleeding


  • IV access
  • send bloods for FBE, U&E, lipase, group and hold +/- X-match, coagulation profile
  • resuscitate with iv fluids if haemodynamic compromise
  • treat any underlying coagulopathy
  • careful observation to detect deterioration early
  • analgesia
  • treat underlying cause as indicated
    • interventional radiology with intra-arterial embolisation or stent-grafting
retroperitoneal_haemorrhage.txt · Last modified: 2018/01/27 14:57 by

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