Department of Surgery, University of Iowa, Iowa City, IA, USA (all authors).

ABSTRACT

Introduction: Operative intervention for retroperitoneal hematomas is rarely indicated, and treatment is usually conservative, including observation, transfusion, correction of coagulopathy, and coil embolization.

Case and Technique Description: A 75-year-old man underwent sigmoid resection and Hartmann’s procedure for sigmoid volvulus. Ten days postoperatively, he presented with a large left-sided retroperitoneal hematoma and a supratherapeutic international normalized ratio. After resuscitation and reversal of coagulopathy, he continued to bleed and required vasopressor support. He was not a candidate for procedures requiring intravenous contrast given new-onset acute renal failure. He was taken to the operating room for laparoscopic drainage of the hematoma with a total retroperitoneal approach. Several small bleeding points were identified and cauterized. The patient’s hemodynamic status and hemoglobin stabilized postoperatively. He did not experience any further bleeding complications. His renal impairment resolved.

Conclusion: Unstable patients with retroperitoneal hematoma, who are not candidates for coil embolization, can be treated successfully with laparoscopic drainage with a retroperitoneal approach.

Key Words: Postoperative hemorrhage, Laparoscopy, Retroperitoneal hematoma

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