Massive internal bleeding resulting in infected retroperitoneal hematoma

Informaticus · #1 (**permalink**) 11-09-2008, 05:21 PM

I have been asked by another member to post this request for assistance.
The patient had an operation three weeks ago for a prolapsed bladder and uterus which the surgeon said was 100% successful. Because of her stand on blood she was proactively managed by injection of factor VIIA, erythropoiten and iron. A few hours later it was discovered that she was bleeding internally and had lost a large amount of blood which had accumulated in the surgical cavity, creating a 20 x 8 cm diameter retroperitoneal haematoma that became infected and is currently being drained by tubes inserted with the guidance of a CT scan.
However, the stagnant hematoma is not draining freely and the concern is how to dissolve or break this up without resorting to surgery due to her weakened condition.
They are reluctant to use streptokinase, for fear it could cause her to bleed again.

I think what is needed is for one of the doctors here to talk directly to a colleague who has wider experience in treating patients with a similar problem. Can anyone help?

jmalak · #2 (**permalink**) 11-12-2008, 07:33 PM

Nonsurgical management of a retroperitoneal hematoma may involve a number of specialties. Much may depend on their availability at the institution or the feasibility of transfer. Perhaps the family could request consultations with:
- an interventional radiologist (to perform CT-guided evacuation)
- a urologist (some may also perform a ct-guided aspiration)
- an intensivist (to manage watchful waiting)
- a hematologist (to manage hemostasis and rbc production)

Jonathan Steele · #3 (**permalink**) 11-19-2008, 01:02 PM

I know this is late so perhaps it can help someone for future reference.

Surgeons at one of the Cleveland Ohio hospitals on two occasions were able to lise (in this case, suck up) massive hematomas with a suction catheter on the end of the cell saver intake tube. Not only that, it turned back into frank blood and was viable, bringing up the patient RBC count from a low of around 4-5. In one case the hematoma was estimated to be a few days old. It was not in literature at that time. Have not heard of it since.

Informaticus · #4 (**permalink**) 11-19-2008, 05:06 PM

The last report I received about this case was that the doctors were managing the patient proactively with judicious use of CT drainage and rFviia on hand in case of another big bleed. The treatment was working well and the doctors were expecting an uneventful recovery. I thank the above two members for their input and I will pass on this helpful information to those who have been caring for this patient.

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Massive internal bleeding resulting in infected retroperitoneal hematoma

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