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Retroperitoneal Hematoma – a Case Report

Ralica Ruseva, Anton Tonev, Alexander Zlatarov, Mehmed Hadzhiveli, Georgi Ivanov, Boris Andonov, Georgi Valentinov, Nikola Kolev, Valentin Ignatov, Krasimir Ivanov

Abstract

Introduction: The acute hemorrhage of the adrenal glands is a rare condition. Trauma is the most common cause, but non-traumatic etiology has been reported.

Materials and Methods: We present a case of a 67-year-old patient, who came to our clinic with complaints of strong, unbearable pain in the upper part of abdomen, pale skin and cyanosis on the face. The CT results showed a retroperitoneal hematoma or a highly vascularized tumor formation, as well as intraperitoneal free fluid. The unstable hemodynamics, the shock and the temporary cardiac arrest could not be controlled with a conservative treatment. The patient’s condition, the increased quantity of the retroperitoneal hematoma and the intraperitoneal free fluid required emergency surgery. During the operation we found a rupture of the left adrenal gland and a crossing of the hematoma in the right part of the retroperitoneal space. We performed left adrenalectomy.

Results: In the early postoperative period, the condition of the patient remained critical despite the postoperative intensive care and the compensation of the blood loss and that led to a lethal outcome.

Conclusion: The formations of the adrenal glands may present a diagnostic challenge and difficulty in choosing a treatment approach. This is due to the a wide range of differential diagnoses (adenoma, cysts, pheochromocytoma, myelolipoma, metastases or primary carcinoma), the evaluation of hormonal activity and differentiation between benign and malignant formations. Surgical treatment is indicated in those cases with potentially malignant formations and with a risk of spontaneous rupture.


Keywords

hematoma, adrenal gland, adrenalectomy, retroperitoneal


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