Spontaneous retroperitoneal hemorrhage

Background: We evaluated patients with spontaneous retroperitoneal hemorrhage for reliable predictors of early diagnosis and improved outcomes. Methods: A retrospective chart review was done to determine patient demographic and laboratory findings, presenting symptoms, time to diagnosis, anticoagulant and/or antiplatelet agent use, transfusions, and patient outcome. Results: One hundred nineteen patients were identified; 14 (12%) died (mean age 77 9 years vs. 74 +/- 10 years for survivors [P 0.235]). All nonsurvivors were on anticoagulants: 8 of 89 (9%) were on heparin or warfarin alone, and 6 of 23 (26% [P 0.028]) were on a combined anticoagulant-antiplatelet regimen. Symptom onset to computed axial tomography (CAT) scan averaged 1.3 +/- 1.3 days for nonsurvivors versus 1.5 +/- 1.9 days for survivors (P = 0.778). Hemoglobin was 9.07 +/- 3.35 for nonsurvivors versus 9.60 +/- 2.07 for survivors (P = 0.435). Eighty-eight patients were transfused, and 10 died; 31 patients had no transfusion, and 4 of these died (P = 0.821). Conclusions: A high index of clinical suspicion is necessary for diagnosis of spontaneous retroperitoneal hemorrhage because these patients present with a variety of symptoms. Prospective studies are necessary to determine whether earlier diagnosis combined with aggressive resuscitation can impact the high mortality rate seen in these patients. (c) 2005 Excerpta Medica Inc. All rights reserved.