Hemorragia retroperitoneal espontánea durante sesión de hemodiálisis

Abstract

Spontaneous retroperitoneal haemorrhage (SRH) includes any extravasation of blood into the retroperitoneal space without prior external trauma, endourological or endovascular manipulation. It has multiple aetiologies, highlighting the rupture of an abdominal aortic aneurysm as the most frequent cause in adults⁽¹⁾. Greater frequency of haemorrhages has been observed in patients with anticoagulation therapy and in patients undergoing long term haemodialysis (possibly due to the anticoagulation involved in their intradialytic treatment)⁽²⁾, as is the case described below. It is a rare pathology in which, despite reaching a diagnosis in a relatively simple manner with image studies, determining the aetiology is a challenge and is the reason for multiple studies and invasive procedures, sometimes without being able to clarify the cause⁽³⁾. Retroperitoneal haemorrhage of renal origin was first observed in 1700 by Bonet, being Wünderlich who defined it as "spontaneous apoplexy of the renal capsule" in 1856. Later, in 1910, Coenene designated it as "Wünderlich's syndrome"⁽⁴⁾. The basic clinical picture is marked by the so-called Lenk triad: lumbo-abdominal pain of abrupt onset, palpable mass and hypovolaemic shock. Lumbar or abdominal pain is the predominant symptom. The most relevant analytical parameters are the drop in haemoglobin and haematocrit and leukocytosis^(1,5).