Published: 2022-07-26

Spontaneous retroperitoneal hematoma in COVID-19 patients

Teodor D. Atanasov, Katya T. Todorova, Alexandar I. Tsvetanov


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that has led to a global pandemic and unfortunately has caused a health crisis. Severe coronavirus disease 2019 (COVID-19) can manifest with bilateral pneumonia and hypoxemic respiratory failure but also can affect different organ systems. Spontaneous rectus sheath haematomas and retroperitoneal haematomas are recognized, rare, complications of anti-coagulation therapy, including LMWH. A prompt diagnosis is important to antagonize anticoagulation and prevent further bleeding. Massive bleeding into the retroperitoneum represents a problem not only because of the loss of intravascular volume, but also because the increase in abdominal pressure may compromise perfusion to different organs, such as the liver, gut, and kidneys. We present 3 cases of severe spontaneous soft tissue hematomas (SSTH) in patient with SARS-CoV-2 infection, who were taking low molecular weight heparin for prophylaxis of DIC and venous thromboembolism. First one is 56-yeard-old female patient with retroperitoneal and extraperitoneal haematoma presenting with dysuria and haematuria, the second one is 67-year-old male patient with iliopsoas haematoma and the third one is 51-year-old female patient with rectus sheath haematoma. All patients were treated conservatively. Clinicians should be attentive about bleeding complications as retroperitoneal haematomas in COVID-19 patients on anticoagulant therapy. There is no consensus on management of retroperitoneal haematomas. Each decision as conservative treatment, embolization or surgery should be made according to the clinical stability of the patient and by risk and benefit assessment.


Retroperitoneal hematoma, Low molecular weight heparin, COVID-19, Non-operative treatment

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