Spontaneous retroperitoneal hemorrhage or hematoma
Introduction
Introduction to spontaneous retroperitoneal hemorrhage or hematoma Spontaneous retroperitoneal hemorrhage is very rare. It was first reported in Barber (1909). It can occur at any age and can be combined with intra-abdominal hemorrhage. The pathogenesis is complicated, the clinical manifestations are atypical, and the diagnosis is difficult. The medical history needs to be traced in detail. Abdominal pain can be radiated to the lower back, accompanied by nausea and vomiting. If the peritoneum flows into the abdominal cavity after the blood is worn, it may cause peritoneal irritation. At this time, there may be abdominal tenderness, rebound tenderness, and abdominal muscle tension. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock
Cause
Spontaneous retroperitoneal hemorrhage or hematoma etiology
(1) Causes of the disease
The occurrence of spontaneous retroperitoneal hemorrhage may be related to the following factors:
1. Hypertension and arteriosclerosis According to reports in the literature, 38% to 50% of patients are associated with hypertension, so some scholars believe that hypertension and vascular sclerosis may be important pathogenic factors of this disease.
2. vascular congenital malformations or developmental defects in any part of the peritoneal blood vessels, may have congenital malformations or developmental defects, spontaneous rupture and bleeding under the influence of external or internal factors.
3. Endocrine changes Spontaneous retroperitoneal hematoma occurs during pregnancy or puerperium, which may be related to endocrine changes.
4. Hemophilia patients with hemophilia can cause hemorrhage and hematoma due to minor trauma. Occasionally, patients with hemophilia may induce retroperitoneal hemorrhage due to weight lifting or exertion.
5. Hemorrhagic tendency and renal failure have been reported in the literature. When hemodialysis is performed in renal failure, spontaneous retroperitoneal hematoma can occur. There are also reports of hemorrhagic uremia in cases of epidemic hemorrhagic fever.
6. Anticoagulant therapy and rupture of abdominal aortic aneurysm can lead to retroperitoneal hemorrhage.
7. Angiography catheter caused by trauma.
Prevention
Spontaneous retroperitoneal hemorrhage or hematoma prevention
The most important reasons for removing the cause are to control high blood pressure, soften blood vessels, eat more fresh fruits and vegetables, and eat low-salt diet. Timely examination revealed abnormal blood vessels in the abdominal cavity. Check the level of endocrine hormones in a timely manner, and check related during pregnancy. And timely detection of hemophilia, kidney disease and so on. Pay attention to the care during the puerperium and prevent the damage caused by angiography.
Complication
Spontaneous retroperitoneal hemorrhage or hematoma complications Complications
Hypovolemic shock: low blood pressure, weak pulse, cold limbs, and low urine output.
Symptom
Symptoms of spontaneous retroperitoneal hemorrhage or hematoma Common symptoms Intestinal paralysis abdominal muscle tension Abdominal tenderness Intestinal peristalsis slows down flatulence and nausea
1. Abdominal pain, abdominal pain is relatively vague, can be full abdominal pain or limited to the pain of the hematoma, abdominal pain can be radiated to the lower back, with nausea, vomiting, such as blood perforation into the abdominal cavity after perforation, can cause peritoneal irritation, at this time There are abdominal tenderness, rebound tenderness, and abdominal muscle tension.
2. Intestinal paralysis patients often have varying degrees of slowing of intestinal peristalsis, intestinal flatulence, such as blood perforation into the peritoneal cavity after perforation, can increase intestinal paralysis.
3. Rectal irritation symptoms of pelvic retroperitoneal hematoma, patients can increase the number of defecation and urgency.
4. Signs of lupus can appear in the waist, the side abdomen can be full, swelling; palpation of the whole abdomen or local tenderness, pelvic retroperitoneal hematoma, rectal examination can touch the mass; percussion can sometimes find that the waist or back does not change position with the position Voiced area.
Examine
Spontaneous retroperitoneal hemorrhage or hematoma examination
Blood routine examination, hematocrit and hemoglobin progressive decline.
1. B-ultrasound examination of the abdominal abdomen B-ultrasound, can show the accumulation of blood in the retroperitoneum, effusion.
2. CT examination helps to locate the retroperitoneal hematoma.
3. Abdominal puncture If there is no peritoneal rupture, the blood does not flow into the abdominal cavity, abdominal puncture is often negative, if the retroperitoneal hematoma extends to the abdominal wall, puncture in the right or left lower abdomen can also extract non-coagulated blood.
Diagnosis
Diagnosis and diagnosis of spontaneous retroperitoneal hemorrhage or hematoma
1. History and clinical manifestations of the diagnosis of spontaneous retroperitoneal hematoma is difficult, in patients with hypertension and vascular sclerosis, pregnancy or puerperium, hemophilia patients, renal failure or epidemic hemorrhagic fever cases of uremia, receive anti- Condensation treatment or angiography examination of abdominal pain, radiation to the lower back, with nausea, vomiting, abdominal tenderness and other symptoms and signs, and hemorrhagic shock performance, should think of the possibility of this disease.
2. Laboratory and auxiliary examination blood routine, B-ultrasound, CT and other auxiliary examinations are helpful for diagnosis.
