Clinical management and outcomes for retroperitoneal hemorrhage with active extravasation on contrast enhanced computed tomography (CT)

Objective: To assess patient characteristics, clinical management, and outcomes in patients with retroperitoneal hematoma that demonstrate active extravasation on contrast enhanced computed tomography (CT). Methods A retrospective comparative study examining 49 patients with active extravasation on CT over a 5-year period was performed. Patients were stratified into those managed conservatively (n = 32) versus those that underent angiography and embolization (n = 17). Primary endpoints included 30-day mortality, length of hospitalization, and requirement for additional intervention. Secondary endpoints included transfusion requirement, vitals, renal injury, and procedure-related complications. Results Interventional radiology was consulted in 33/49 patients with retroperitoneal hematomas demonstrated active contrast extravasation on CT. Of these patients, 17/33 were taken for angiographic intervention. Patients that required angiography had significantly larger hematomas (p < 0.001), higher heart rates (p = 0.014), lower systolic blood pressure (p = 0.001), lower hemoglobin levels (p = 0.003), and required more transfusions (p = 0.004) compared to those managed conservatively. Patients managed with angiography had significantly longer hospital stays (p = 0.002) and higher 30-day all-cause mortality (p = 0.007). There was no significant difference in hemorrhage-associated mortality or complication rates between groups. Conclusion The majority of patients in this study were successfully managed without angiographic intervention. However, patients with larger hematoma size, clinical deterioration, or increased transfusion requirement were significantly more likely to require angiography and embolization. A tailored approach that integrates imaging findings and clinical status is essential in determine which patients would most benefit from intervention.