Detecting spontaneous retroperitoneal hemorrhage using a modified RUSH protocol: a case report

Zouheir Ibrahim Bitar 1, Ragab Desouky Elshabasy 2, Mohamed Jaber Mohsen 3, Ossama Sajeh Maadarani 4, Mahmoud Mostafa Elzoueiry 5, Mohamed Refaat Gohar 6

Affiliations

01 March 2022

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doi: 10.1016/j.ijscr.2022.106830

Abstract

Introduction: Bleeding in the retroperitoneal space is a serious complication. Hypovolemia and shock develop late after losing a large volume of blood. However, point of care ultrasound (POCUS) examinations in adult patients with shock do not include the retroperitoneal space.

Case presentation: We present the case of a 74-year-old male with ischemic heart disease on dual antiplatelet. He developed vague abdominal pain and hemoglobin drop without overt bleeding source until he developed shock. Modified POCUS examination that included the retroperitoneal space detected the bleeding source and confirmed later by computerized tomography of the abdomen. The case was managed conservatively.

Clinical discussion: The risk factors associated with the formation of spontaneous retroperitoneal hematomas are age above 70 years and dual antiplatelet therapy. The initial integration of point-of-care ultrasound into the assessment of shocked patients leads to an earlier and accurate initial diagnosis with a clear patient care plan. POCUS should include the retroperitoneal space examination in every patient presenting with shock.

Conclusion: In patients with unexplained hemorrhagic shock, a modified POCUS protocol could help by including an examination of the retroperitoneal space in the assessment.

Keywords: Case report; Point of care ultrasound; Retroperitoneal hemorrhage.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1 Ultrasound of the posterolateral thoraco-abdominal junction zone Large acute hematoma in the left psoas muscle, adjacent left posterior abdominal wall and left posterior pararenal retroperitoneal space.

Fig. 1 Ultrasound of the posterolateral thoraco-abdominal junction zone Large acute hematoma in the left psoas muscle, adjacent left posterior abdominal wall and left posterior pararenal retroperitoneal space.

Fig. 2 Abdominal CT Left psoas hematoma (P) and hematoma seen in the adjacent left posterior abdominal wall (H).

Fig. 2 Abdominal CT Left psoas hematoma (P) and hematoma seen in the adjacent left posterior abdominal wall (H).

Fig. 3 Abdominal CT Hemorrhage can also be seen in the left retroperitoneal posterior pararenal space (H) with involvement of the posterior Gerota's fascia.

Fig. 3 Abdominal CT Hemorrhage can also be seen in the left retroperitoneal posterior pararenal space (H) with involvement of the posterior Gerota's fascia.

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