Abstract
A 61-year-old woman developed spontaneous retroperitoneal hemorrhage during hospitalization for adrenal failure and secondary coagulopathy. She slipped into a state of shock, and therefore, we began coagulopathy correction and performed a transcatheter arterial embolization to repair the retroperitoneal hemorrhage. Concurrently, we confirmed elevated intracystic pressure (19 mmHg), but did not detect any progressive organ dysfunction. At this stage, we decided to not perform surgical decompression because disturbance of the tamponade effect could result in rebleeding. Subsequently, the bleeding stopped and the patient achieved hemodynamic stability. Two days later, however, she developed acute kidney injury and hemodynamic instability. We performed emergency surgical decompression for abdominal compartment syndrome and hemostatic retroperitoneal packing. After the surgery, we performed open abdomen management, and her general condition stabilized. On the next day, we performed abdominal closure. Therefore, in cases of spontaneous retroperitoneal hemorrhage with intraabdominal hypertension, early definitive therapy can be safely achieved with hemostatic retroperitoneal packing and open abdomen management.
