title: Not All Acute Abdomen Cases in Early Pregnancy Are Ectopic; Expect the Unexpected: Renal Angiomyolipoma Causing Massive Retroperitoneal Haemorrhage.
abstract: Retroperitoneal haemorrhage (or retroperitoneal haematoma) refers to an accumulation of blood found in the retroperitoneal space. It is a rare clinical entity with variable aetiology including anticoagulation, ruptured aortic aneurysm, acute pancreatitis, malignancy, and bleeding from renal aneurysm. Diagnosis of retroperitoneal bleed is sometimes missed or delayed as presentation is often nonspecific. Multislice CT and arteriography are important for diagnosis. There is no consensus about the best management plan for patients with retroperitoneal haematoma. Stable patients can be managed with fluid resuscitation, correction of coagulopathy if any, and blood transfusion. Endovascular options involving selective intra-arterial embolisation or stent-grafts are clearly getting more and more popularity. Open repair is usually reserved for cases when there is failure of conservative or endovascular measures to control the bleeding or expertise is unavailable and in cases where the patient is unstable. Mortality of patients with retroperitoneal haematoma remains high if appropriate and timely measures are not taken. Haemorrhage from a benign renal tumour is a rarer entity which is described in this case report which emphasizes that physicians should have a wide index of suspicion when dealing with patients presenting with significant groin, flank, abdominal, or back pain, or haemodynamic instability of unclear cause. Our patient presented with features of acute abdomen and, being pregnant, was thought of having a ruptured ectopic pregnancy.
authors.affiliation: King's Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire NG17 4JL, UK.
authors.forename: Muhammad Asim
authors.identifier: 0000-0003-3455-6974
authors.initials: MA
authors.lastname: Rana
authors.affiliation: Department of Intensive Care Medicine, King Saud Medical City, Riyadh 11373, Saudi Arabia.
authors.forename: Ahmed F
authors.initials: AF
authors.lastname: Mady
authors.affiliation: Department of Intensive Care Medicine, King Saud Medical City, Riyadh 11373, Saudi Arabia.
authors.forename: Nagesh
authors.initials: N
authors.lastname: Jakaraddi
authors.affiliation: Department of Intensive Care Medicine, King Saud Medical City, Riyadh 11373, Saudi Arabia.
authors.forename: Shahzad A
authors.identifier: 0000-0002-6300-715X
authors.initials: SA
authors.lastname: Mumtaz
authors.affiliation: King's Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire NG17 4JL, UK.
authors.forename: Habib
authors.identifier: 0000-0002-1092-1749
authors.initials: H
authors.lastname: Ahmad
authors.affiliation: King's Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire NG17 4JL, UK.
authors.forename: Kamal
authors.initials: K
authors.lastname: Naser