Gynecological retroperitoneal hematocele

Specialty: Gynecology and breast.

• Retroperitoneal hematoma of gynecological origin
• pelvic retroperitoneal blood collection

Why it occurs

• Rupture of the uterine artery or its branches during an instrumental vaginal delivery or after cesarean section
• Retroperitoneal vessel injury during major gynecological surgeries (radical hysterectomy, pelvic lymphadenectomy or diagnostic laparoscopy)
• Rupture of an ectopic pregnancy that erodes the posterior wall of the broad ligament into the retroperitoneal space

Initial workup

Emergency CT angiography of the abdomen and pelvis (study of choice that precisely locates the extension of the retroperitoneal hematoma and identifies the point of active arterial bleeding through contrast extravasation). Immediate and serial complete blood count. Complete coagulation profile. Abdominal FAST ultrasonography to rule out concomitant hemoperitoneum.

Standard management

• There is no direct pharmacological treatment for active bleeding from major vessels. Hemodynamic stabilization with transfusion of packed red blood cells, fresh frozen plasma, and platelets should be prioritized. If the hematoma is associated with hemodynamic instability or rapid expansion documented by CT, selective arterial embolization by interventional radiology or emergency surgical laparotomy is required to control bleeding (note: in stable patients with small, non-expanding hematomas, conservative management can be chosen under strict control of vital signs).