title: Management of massive retroperitoneal hemorrhage from an adrenal tumor.
abstract: Spontaneous massive retroperitoneal hemorrhage from an adrenal gland is a rare event. A thoughtful and meticulous approach to such a patient, with appropriate diagnostic studies, ICU and surgical care are essential for patient survival. In patients with active bleeding, angiographic embolization is a valuable adjunct to achieve hemostasis, to allow for further work-up of the adrenal tumor, and an improved subsequent oncologic resection. Hemodynamically unstable patients, however, may require supportive transfusions in the intensive care unit, potential embolization if deemed feasible, or urgent surgical exploration. If possible, however, the acute surgical removal of an adrenal tumor within a large retroperitoneal hematoma should be avoided, as under such conditions a proper oncologic resection may not be possible. The possibility of a pheochromocytoma must always be entertained. Early recognition and treatment of patients with presumed adrenal insufficiency may decrease patient morbidity and mortality.
authors.affiliation: Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Hendrickson
authors.forename: P J
authors.initials: PJ
authors.lastname: Katzman
authors.forename: R
authors.initials: R
authors.lastname: Queiroz
authors.forename: J V
authors.initials: JV
authors.lastname: Sitzmann
authors.forename: L G
authors.initials: LG
authors.lastname: Koniaris
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000328:Adult; D004621:Embolization, Therapeutic; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging