A case of spontaneous retroperitoneal hemorrhage complicated with abdominal compartment syndrome

DOI 2 Citations Open Access
  • Miyamoto Kyohei
    Department of Emergency and Critical Care Medicine, Wakayama Medical University
  • Kawazoe Yu
    Department of Emergency and Critical Care Medicine, Wakayama Medical University
  • Shibata Naoaki
    Department of Emergency and Critical Care Medicine, Wakayama Medical University
  • Tanaka Masaou
    Department of Emergency and Critical Care Medicine, Wakayama Medical University
  • Nakashima Tsuyoshi
    Department of Emergency and Critical Care Medicine, Wakayama Medical University
  • Yonemitsu Takafumi
    Department of Emergency and Critical Care Medicine, Wakayama Medical University
  • Kida Maki
    Department of Emergency and Critical Care Medicine, Wakayama Medical University
  • Kato Seiya
    Department of Emergency and Critical Care Medicine, Wakayama Medical University

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Other Title
  • 特発性後腹膜出血により腹部コンパートメント症候群を来した一例

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A 61-year-old woman developed spontaneous retroperitoneal hemorrhage during hospitalization for adrenal failure and secondary coagulopathy. She slipped into a state of shock, and therefore, we began coagulopathy correction and performed a transcatheter arterial embolization to repair the retroperitoneal hemorrhage. Concurrently, we confirmed elevated intracystic pressure (19 mmHg), but did not detect any progressive organ dysfunction. At this stage, we decided to not perform surgical decompression because disturbance of the tamponade effect could result in rebleeding. Subsequently, the bleeding stopped and the patient achieved hemodynamic stability. Two days later, however, she developed acute kidney injury and hemodynamic instability. We performed emergency surgical decompression for abdominal compartment syndrome and hemostatic retroperitoneal packing. After the surgery, we performed open abdomen management, and her general condition stabilized. On the next day, we performed abdominal closure. Therefore, in cases of spontaneous retroperitoneal hemorrhage with intraabdominal hypertension, early definitive therapy can be safely achieved with hemostatic retroperitoneal packing and open abdomen management.

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