Spontaneous Retro Peritoneal Bleeding with COVID 19: Management Modalities and Mortality Predictors

Background: COVID-19 infection was associated with high risk of thromboembolism in high-risk patients, so
variable anticoagulation agents were used in different doses, as a rare complication of anticoagulants; spontaneous
retroperitoneal bleeding (SRB) might occur.
Aim of work: To study SRB associated with COVID-19 infection due to anticoagulation at wider spectrum as
regard comorbidities, factors associated with SRB and to discuss available modalities of treatment, factors affecting
decision, outcome, and associated mortality with each other.
Methods: 17 patients with COVID-19 presented with SRB, 11 patients were managed surgically, 6 patients were
managed conservatively, assessment of comorbidities, timing of intervention and outcome were established.
Results: 6 patients were managed conservatively, 4 of them died due to refractory shock. 11 patients were managed
surgically, 8 of them died, 3 out of the 8 deaths were because of Myocardial Infarction, respiratory complications
and massive stroke, Timing of surgical consultation was significantly related to management, hemoglobin drop and
outcome. Increased blood components need was significantly related to mortality.
Conclusion: Management should be conservative, but with no delay of intervention if needed, this brings better
results rather than conservation in progressive hematoma. Vital instability, increased hemoglobin drop and
transfusion needs are independent factors that mandate intervention.