Chen Xi, Li Zheng, Zou Liangping, Lan Yupin, Wu Xiaoling, Wang Hui
Department of Gastroenterology, Zhangzhou Traditional Chinese Medicine Hospital, Zhangzhou, China.
Department of Gastroenterology, Mulei County People's Hospital, Mulei, China.
Medicine (Baltimore). 2025 Jan 10;104(2):e41077. doi: 10.1097/MD.0000000000041077.
Spontaneous retroperitoneal hematoma (SRH) is a rare but potentially fatal condition, often associated with anticoagulation therapy. With the global prevalence of COVID-19 and the widespread use of anticoagulants in its management, there is an increasing need to recognize rare but serious complications like SRH. This case report aims to emphasize the importance of early recognition and intervention of SRH in patients with COVID-19 undergoing anticoagulation therapy, to improve patient outcomes and reduce mortality.
An 86-year-old male with a history of COVID-19 presented with recurrent cough, hemoptysis, and fever. Initial treatment included antiviral and anticoagulant therapy. The patient later developed abdominal distension, pain, and eventually hypovolemic shock, leading to the diagnosis of SRH confirmed by imaging and a significant drop in hemoglobin levels.
The patient received comprehensive supportive care, including noninvasive ventilation, antiviral therapy, and anticoagulants. Upon the onset of SRH, emergency interventions included fluid resuscitation, vasopressors, and interventional embolization of the bleeding vessels.
The patient initially responded well to COVID-19 treatment but developed SRH, which was managed successfully with interventional embolization. Post-procedure, the patient's vital signs stabilized, hemoglobin levels gradually increased without the need for further transfusions, and he regained full consciousness. Over the following weeks, the patient showed continuous improvement, with resolution of abdominal pain and a return to baseline mobility. He was discharged in stable condition with scheduled follow-ups.
This case underscores the critical need for vigilance in monitoring patients on anticoagulation therapy, particularly those with COVID-19, for signs of SRH. Early recognition and prompt intervention are essential to improve outcomes. Clinicians should maintain a high index of suspicion for SRH in patients presenting with unexplained abdominal pain and hypovolemic shock, even in the absence of typical risk factors.
自发性腹膜后血肿（SRH）是一种罕见但可能致命的疾病，常与抗凝治疗相关。随着新冠病毒病（COVID-19）在全球的流行以及抗凝剂在其治疗中的广泛应用，识别诸如SRH等罕见但严重的并发症的需求日益增加。本病例报告旨在强调在接受抗凝治疗的COVID-19患者中早期识别和干预SRH的重要性，以改善患者预后并降低死亡率。
一名86岁有COVID-19病史的男性出现反复咳嗽、咯血和发热。初始治疗包括抗病毒和抗凝治疗。患者后来出现腹胀、疼痛，最终发展为低血容量性休克，经影像学检查及血红蛋白水平显著下降确诊为SRH。
患者接受了全面的支持治疗，包括无创通气、抗病毒治疗和抗凝治疗。SRH发生后，紧急干预措施包括液体复苏、血管活性药物以及对出血血管进行介入栓塞。
患者最初对COVID-19治疗反应良好，但出现了SRH，通过介入栓塞成功治疗。术后，患者生命体征稳定，血红蛋白水平逐渐升高，无需进一步输血，意识完全恢复。在接下来的几周里，患者持续好转，腹痛消失，恢复到基线活动能力。他出院时病情稳定，并安排了随访。
本病例强调了在监测接受抗凝治疗的患者，尤其是COVID-19患者时，警惕SRH迹象的迫切需要。早期识别和及时干预对于改善预后至关重要。临床医生应对出现不明原因腹痛和低血容量性休克的患者保持高度的SRH怀疑指数，即使没有典型的危险因素。
