Causes:

– Trauma
– Vascular: Femoral Vascular access, aneurysms
– Anticoagulation
– Antiplatelets
– Gynaecological: ovarian torsion, haemorrhagic cysts, ectopic pregnancy, serosal fibroids (the majority of non-coagulopathic bleeds are gynaecological)

Classification

– Zone 1: central – related to pancreaticoduodenal injury, major vascular injury
– Zone 2: Flanks – related to genitourinary or colonic injuries
– Zone 3: Pelvis – pelvic fractures or ileo-femoral injuries

On reviewing CT, rule out adjacent organ injury including:

– Pancreaticoduodenal injury
– Abdominal or pelvic vascular injury
– Renal laceration
– Ureter disruption
– Bladder injury
– Ascending/descending colon injury
– Pelvic fracture
– Femoral pseudoaneurysm formation

TREATMENT

Medical management initially:
– Correct coagulation
– Reverse anticlotting therapies
– IV fluids
– Blood transfusion as necessary
– Admit to appropriate level for close monitoring

Interventional radiology
– Stent graft placement
– Arterial embolization
– Percutaneous drainage for infected haematoma

Role of surgery:
Inappropriate surgical evacuation often exacerbates the bleeding by removing the tamponade effect.
However, active bleeding causing haemodynamic instability needs to be controlled and in the absence of IR options, may be necessary.