From the Research
Nontender bilateral flank bruising in a patient with rectus sheath hematomas is a sign of retroperitoneal bleeding, which is a serious complication requiring immediate medical attention, as indicated by the most recent study 1. This finding suggests that blood has tracked from the retroperitoneal space to the flanks, potentially indicating that the bleeding has extended beyond the rectus sheath or that there is a separate, more extensive bleeding source.
Key Considerations
- Patients with this presentation should undergo immediate imaging studies, preferably a CT scan with contrast, to evaluate the extent of bleeding, as recommended by 2 and 3.
- Laboratory tests including complete blood count, coagulation studies, and kidney function tests should be performed to assess the severity of bleeding and guide management.
- Management typically involves hemodynamic stabilization, correction of any coagulopathy (with fresh frozen plasma, vitamin K, or reversal agents if on anticoagulants), and possible surgical intervention if bleeding is severe or ongoing, as suggested by 4 and 5.
Clinical Implications
The presence of Grey Turner's sign is concerning because retroperitoneal bleeding can lead to significant blood loss, hypovolemic shock, and organ dysfunction.
- Patients may require intensive care monitoring, blood transfusions, and interventional radiology or surgical consultation depending on the source and severity of bleeding, as indicated by 2 and 1.
- Early diagnosis and sufficient supportive treatment are crucial for management, as emphasized by 1.
- Conservative treatment with hemostatic agents, such as carbazochrome and tranexamic acid, may be effective in controlling the expansion of bleeding, as suggested by 1.