Revisiting the 'dented bladder'--a bona fide sign of retroperitoneal bleed.

摘要

Retroperitoneal (RP) bleed is the most catastrophic complication of vascular access. Early recognition and prompt therapy with aggressive intravascular resuscitation including saline infusion and blood products, reversal of anticoagulation and site control are the keys to ensure survival. The diagnosis of RP bleed must be made primarily on clinical grounds and one must have a high index of suspicion and a very low threshold to promptly institute therapy without further delay in trying to reach the diagnosis. The retroperitoneum is a large space that can accommodate several liters of blood in a short period of time. Hence, the first manifestation of RP bleed usually is hypotension. The definitive diagnosis is made on CT scan or autopsy.Extreme care must be undertaken to prevent vascular access site complications. Both fluoroscopic and anatomic landmarks must be used in obtaining arterial access, the mid portion of the femoral head as being the ideal site for optimal puncture of the common femoral artery. Thus, other techniques including micro-puncture and ultrasound guided access may also be considered for ideal vascular access [1].