{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:14:21Z","timestamp":1793124861241,"version":"4.5.0"},"reference-count":13,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T00:00:00Z","timestamp":1554681600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T00:00:00Z","timestamp":1554681600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2019,8,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH) is associated with high mortality in the literature, but studies on the subject are lacking. The objective of this study was to identify early predictors of the need for angiographic or surgical intervention (ASI) in patients with SRRSH and define risk factors for mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study at a tertiary academic hospital. All patients with computed tomography\u2010identified SRRSH between 2012 to 2017 were included. Exclusion criteria were age below 18 years, possible mechanical cause of SRRSH, aortic aneurysm rupture or dissection, and traumatic or iatrogenic sources of SRRSH. The primary outcome was the incidence of ASI and\/or mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 100 patients included (median age 70 years, 52% males), 33% were transferred from another hospital, 82% patients were on therapeutic anticoagulation, and 90% had serious comorbidities. Overall mortality was 22%, but SRRSH\u2010related mortality was only 6%. Sixteen patients underwent angiographic intervention (<jats:italic>n<\/jats:italic>\u2009=\u200910), surgical intervention (<jats:italic>n<\/jats:italic>\u2009=\u20095), or both (<jats:italic>n<\/jats:italic>\u2009=\u20091). Flank pain (OR 4.15, 95% CI 1.21\u201314.16, <jats:italic>p<\/jats:italic>\u2009=\u20090.023) and intravenous contrast extravasation (OR 3.89, 95% CI 1.23\u201312.27, <jats:italic>p<\/jats:italic>\u2009=\u20090.020) were independent predictors of ASI. Transfer from another hospital (OR 3.72, 95% CI 1.30\u201310.70, <jats:italic>p<\/jats:italic>\u2009=\u20090.015), age above 70 years (OR 4.24, 95% CI 1.25\u201314.32, <jats:italic>p<\/jats:italic>\u2009=\u20090.020), and systolic blood pressure below 110\u00a0mmHg at the time of diagnosis (OR 4.59, 95% CI 1.19\u201317.68, <jats:italic>p<\/jats:italic>\u2009=\u20090.027) were independent predictors of mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SRRSH is associated with high mortality but is typically not the direct cause. Most SRRSHs are self\u2010limited and require no intervention. Pattern identification of ASI is hard.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-04988-y","type":"journal-article","created":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T01:02:33Z","timestamp":1554771753000},"page":"1890-1897","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Spontaneous Retroperitoneal and Rectus Sheath Hemorrhage\u2014Management, Risk Factors and Outcomes"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5420-723X","authenticated-orcid":false,"given":"Josefine S.","family":"Baekgaard","sequence":"first","affiliation":[{"name":"Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital Harvard Medical School 165 Cambridge Street, Suite 810 02114 Boston MA USA"},{"name":"Department of Anesthesia, Center of Head and Orthopedics, Rigshospitalet University of Copenhagen Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trine G.","family":"Eskesen","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital Harvard Medical School 165 Cambridge Street, Suite 810 02114 Boston MA USA"},{"name":"Department of Anesthesia, Center of Head and Orthopedics, Rigshospitalet University of Copenhagen Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Moo","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital Harvard Medical School 165 Cambridge Street, Suite 810 02114 Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Dante","family":"Yeh","sequence":"additional","affiliation":[{"name":"Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery University of Miami Miller School of Medicine Miami USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haytham M. A.","family":"Kaafarani","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital Harvard Medical School 165 Cambridge Street, Suite 810 02114 Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Fagenholz","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital Harvard Medical School 165 Cambridge Street, Suite 810 02114 Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Avery","sequence":"additional","affiliation":[{"name":"Department of Radiology, Massachusetts General Hospital Harvard Medical School Boston USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noelle","family":"Saillant","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital Harvard Medical School 165 Cambridge Street, Suite 810 02114 Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"King","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital Harvard Medical School 165 Cambridge Street, Suite 810 02114 Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George C.","family":"Velmahos","sequence":"additional","affiliation":[{"name":"Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital Harvard Medical School 165 Cambridge Street, Suite 810 02114 Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742\u20101241.2007.01494.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010001\u20101133\u20101"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp080523"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2011.06.006"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735\u20106757(95)90273\u20102"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.55.639.18"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022\u20105347(17)56029\u20102"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11547\u2010014\u20100482\u20100"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2013.02.016"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2004.11.020"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11547\u2010013\u20100321\u20108"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.4081\/aiua.2014.4.266"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2007.12.003"}],"container-title":["World 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April 2019","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}