Spontaneous retroperitoneal hemorrhage or hematoma

　　The pathogenic factors of spontaneous retroperitoneal hemorrhage are complex and can occur at any age, and may coexist with intraperitoneal hemorrhage. The occurrence of this disease may be related to the following factors:

　　1. Hypertension and vascular sclerosis: According to literature reports, 38% to 50% of patients have hypertension, so some scholars believe that hypertension and vascular sclerosis may be important pathogenic factors for this disease.

　　2. Congenital vascular malformation or developmental defect: Any part of the retroperitoneal blood vessels may have congenital malformation or developmental defect, and spontaneous rupture and hemorrhage may occur under the influence of external or internal factors.

　　3. Endocrine changes: Spontaneous retroperitoneal hematoma during pregnancy or puerperium may be related to endocrine changes.

　　4. Hemophilia: Even a minor injury can cause bleeding and hematoma in hemophilia patients, and occasionally, hemophilia patients may develop retroperitoneal hemorrhage due to lifting heavy objects or straining.

　　5. Hemorrhagic tendency and renal failure: Some literature reports that when renal failure is treated with hemodialysis, spontaneous retroperitoneal hematoma can occur, and there are also reports of massive hemorrhage in cases of epidemic hemorrhagic fever when uremia occurs.

　　6. Anticoagulant therapy and rupture of abdominal aortic aneurysm can both lead to retroperitoneal hemorrhage.

　　7. Trauma caused by angiography catheter.

　　Patients with spontaneous retroperitoneal hemorrhage or hematoma may develop hypovolemic shock due to hemorrhage, which is a relatively serious complication. The clinical manifestations include low blood pressure, weak pulse, cold extremities, and decreased urine output.

　　The abdominal pain in patients with spontaneous retroperitoneal hemorrhage or hematoma is relatively unclear, which can be generalized abdominal pain or localized pain in the hematoma area. The pain can radiate to the lower back and waist, accompanied by nausea and vomiting. If the blood breaks through the peritoneum and flows into the peritoneal cavity, it can cause peritoneal irritation symptoms, at this time, there may be abdominal tenderness, rebound pain, and muscle tension in the abdominal muscles. Patients often have varying degrees of decreased intestinal peristalsis and intestinal bloating. If the blood breaks through the peritoneum and flows into the peritoneal cavity, it can exacerbate intestinal paralysis. Patients with retroperitoneal hematoma in the pelvis may have increased defecation frequency and a sense of urgency. Bruises may appear on the waist, and the lateral abdomen may be full and swollen. Palpation may show tenderness in the entire abdomen or locally. Retroperitoneal hematoma in the pelvis can be palpated by rectal examination. Sometimes, dullness in the lumbar or back area that does not change with body position can be found by percussion.

　　In terms of prevention of spontaneous retroperitoneal hemorrhage or hematoma, eliminating the cause is the most critical, such as controlling hypertension, softening blood vessels, eating more fresh fruits and vegetables, and low-salt diet. Timely examination to detect abnormal blood vessels in the abdominal cavity. Endocrine hormone levels, related examinations during pregnancy, and timely detection of hemophilia, kidney disease, and other diseases. Pay attention to postpartum care, and prevent damage caused by angiography, etc.

　　Blood routine examination in patients with spontaneous retroperitoneal hemorrhage or hematoma shows progressive decrease in hematocrit and hemoglobin. In addition, patients can undergo the following auxiliary examinations.

　　1. Ultrasound examinationEmergency abdominal ultrasound examination can show the condition of retroperitoneal blood and fluid accumulation.

　　2. CT examinationIt helps locate retroperitoneal hematoma.

　　3. Abdominal punctureIf there is no posterior peritoneal rupture and blood does not flow into the peritoneal cavity, peritoneal puncture is often negative. If the retroperitoneal hematoma extends to the abdominal wall, non-coagulated blood can also be aspirated by puncture in the right or left lower abdomen.

　　In addition to conventional treatment, dietary attention is needed for spontaneous retroperitoneal hemorrhage or hematoma: patients should eat foods rich in selenium, high in fiber and protein, and avoid spicy,刺激性, fried, and cold foods.

　　For spontaneous retroperitoneal hemorrhage or hematoma with good overall condition, stable hemodynamics, and a small estimated amount of retroperitoneal hemorrhage after clinical examination, non-surgical treatment is advisable. Specific measures include:

　　1. Active treatment of the primary disease.

　　2. Hemostasis: If hemostatic drugs are used, discontinue the use of anticoagulant drugs, and hemophiliacs should be given antihemophilic factor intravenously, etc.

　　3. Blood transfusion and fluid replacement to prevent hemorrhagic shock.

　　4. Timely detection of blood pressure, pulse, and other vital signs changes, dynamic detection of changes in hemoglobin and hematocrit, dynamic ultrasound or CT examination of changes in the size of retroperitoneal hematoma, etc.

　　During the treatment and observation period of patients, if hemodynamics is unstable or there is a significant increase in retroperitoneal hematoma, surgical treatment should be considered.