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Retroperitoneal and rectus sheath hematomas.

George Kasotakis1

  • 1Section of Trauma & Acute Care Surgery, Boston Medical Center, Boston University School of Medicine, 840 Harrison Avenue, Dowling 2 South, #2414, Boston, MA 02118, USA.

The Surgical Clinics of North America
|November 26, 2013
PubMed
Summary
This summary is machine-generated.

Retroperitoneal and rectus sheath hematomas are collections of blood in the abdomen. Management depends on the cause and severity, often involving supportive care, anticoagulation reversal, or angioembolization.

Keywords:
HematomasRectus sheathRetroperitonealRetroperitoneum

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Area of Science:

  • Vascular Surgery
  • Abdominal Imaging
  • Trauma Management

Background:

  • The retroperitoneum contains numerous vascular structures, making it susceptible to large hematomas from trauma or spontaneous bleeding.
  • Rectus sheath hematomas, though uncommon, arise from injury to the epigastric arteries within the rectus abdominis muscle.
  • Risk factors for these hematomas include anticoagulation therapy, strenuous physical activity, forceful coughing, bleeding disorders, and abdominal procedures.

Purpose of the Study:

  • To review the etiology, risk factors, and current management strategies for retroperitoneal and rectus sheath hematomas.
  • To highlight the importance of differentiating between traumatic and spontaneous hematomas and assessing for pulsatile or expanding characteristics.
  • To discuss the role of conservative management versus interventional procedures like angioembolization.

Main Methods:

  • Literature review of retroperitoneal and rectus sheath hematomas.
  • Analysis of clinical presentation, diagnostic findings, and treatment outcomes.
  • Synthesis of management guidelines based on hematoma characteristics and patient factors.

Main Results:

  • Retroperitoneal hematomas require management tailored to injury mechanism and hematoma expansion status.
  • Rectus sheath hematomas are associated with specific risk factors and typically managed supportively.
  • Angioembolization is a potential intervention for selected cases requiring more aggressive treatment.

Conclusions:

  • Effective management of abdominal wall and retroperitoneal hematomas necessitates a thorough understanding of their causes and clinical behavior.
  • Supportive care, including reversal of anticoagulation and blood transfusions, forms the cornerstone of treatment for many hematomas.
  • Interventional radiology, specifically angioembolization, plays a crucial role in managing hemodynamically significant or expanding hematomas.