What is Retroperitoneal Bleeding

Retroperitoneal bleeding happens when the blood vessels behind your abdomen bleed into the space between your abdomen and your back (retroperitoneal space). This space contains:

• Your kidneys.
• The glands that are on top of your kidneys (adrenal glands).
• The tubes that drain urine from your kidneys (ureters).
• The large blood vessel that carries blood to your lower body (aorta).
• Some parts of your digestive tract.

The bleeding can be slow or fast. Bleeding into the retroperitoneal space is a rare but life-threatening condition. Get help right away for any signs of retroperitoneal bleeding.

What are the causes?

This condition may be caused by:

• Injury (trauma) to your pelvic area, abdomen, or back.
• Surgery or procedures in the retroperitoneal space.

Other causes include:

• Tumors.
• Swelling through a weakened wall of a blood vessel (aneurysm). This can rupture and cause bleeding.
• Ovarian cysts.
• Bleeding from your spleen.
• Inflammation of the pancreas (pancreatitis).

Sometimes, the cause is not known (idiopathic).

What increases the risk?

Retroperitoneal bleeding is more likely to develop in people:

• Who take medicines to prevent blood clots (anticoagulants).
• Have a blood clotting disorder.
• Who have high blood pressure.
• Who are on a machine that cleans blood because the kidneys have failed (dialysis).

What are the signs or symptoms?

Signs and symptoms usually occur suddenly and include:

• Pain in the abdomen, back, groin or side (flank).
• Pain when pressing on the abdomen, back, or flank.
• Bruising in the abdomen, side or back.
• Pain, numbness or tingling in your leg (neuropathy).
• Blood in the urine.
• Dizziness or lightheadedness from low blood pressure.
• Rapid heartbeat (tachycardia).
• Very low blood pressure, which can cause shock. Symptoms of shock include:
  • Fainting.
  • Trouble breathing.
  • Cold, clammy skin.

How is this diagnosed?

This condition may be diagnosed based on your symptoms and your medical history. It is important to find the cause of the bleeding. Your health care provider will do a physical exam. You may also have other tests, including:

• X-rays of the abdomen to check for signs of bleeding or aneurysm.
• Blood tests to check for low blood counts (anemia) or blood loss.
• Imaging studies, such as:
  • CT scan. You may have dye injected into a blood vessel to help locate the source of the bleeding (CT angiography).
  • Ultrasound.
  • MRI.

How is this treated?

The goal of treatment is to stop the bleeding. Treatment may include:

• Giving you fluids through an IV to get your blood pressure back into a normal range.
• Medicines or blood products to reverse anticoagulant medicines, if you take them.
• Giving you blood from a donor (transfusion).
• Observation to see if the bleeding stops on its own.
• Blocking the bleeding with a small plug (embolization). This is done by placing a long tube (catheter) through your blood vessel and into the site of the bleeding.
• Doing exploratory surgery to find the bleeding and stop it. This may be done using an operating scope (laparoscopy) or as an open surgery (laparotomy).

Follow these instructions at home:

Activity

• Rest as told by your health care provider.
• Do not participate in any activity that takes a lot of effort until your health care provider says that it is safe.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These may delay healing after an injury. If you need help quitting, ask your health care provider.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

Get help right away if you have:

• A fever.
• New or worsening pain in your abdomen, back, or side (flank).
• Chest pain.
• Difficulty breathing.
• Dizziness or passing out.

Summary

• Retroperitoneal bleeding happens when the blood vessels behind your abdomen bleed into the space between your abdomen and your back (retroperitoneal space).
• Symptoms of this condition may include pain in the abdomen, back, or side, dizziness or light-headedness, a rapid heart rate, blood in the urine, or low blood pressure.
• The goal of treatment is to stop the bleeding.
• Rest as told by your health care provider.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.