Spontaneous retroperitoneal hematoma in patients with severe SARS-CoV-2 pneumonia. A systematic review

Abstract

Recently, cases of spontaneous retroperitoneal haematomas (SRH) in the context of SARS-CoV-2 infection have been published. This study presents a systematic review with the aim of further investigating this rare association. Thirty-two cases were identified, with a 28,1 % of critical patients. Atotal of 68,7 % received anticoagulation with LMWH, and a 15,6 % with UFH. The median number of days to diagnosis was 10,5 (0-38). Conservative management was chosen in 31,2 %, while another 31,2 % required angio-embolisation. Ten exitus (31,2 %) were reported, 6 related to SRH. There are hypotheses on the link between SARS-CoV-2 infection and haemorrhagic phenomena. Two mechanisms have been described that would explain coagulopathy: the binding of SARS-CoV-2 to the ACE2 receptor and its direct action on the vascular endothelium. Furthermore, the platelet dysfunction, immune thrombocytopenia and SIRS, added to the endothelial disruption in retroperitoneal vessels, as well as microtrauma secondary to cough stress, invasive mechanical ventilation and/or postural changes, suggest a multicausal origin of SRH. The literature concerning this association is scarce. Given the excess morbidity and mortality involved, it is considered necessary to investigate it further. © 2023 SEACV.