Raha Maroyi1,2,3, Nyakio Ngeleza4,5, Kiminyi Kalunga4,5, Cikwanine Buhendwa4,5, Usama Shahid6, Roland Boij7, Denis Mukwege4,5,8. 1. Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo. ken.raha01@gmail.com. 2. Université Evangélique en Afrique (U.E.A), Bukavu, Democratic Republic of Congo. ken.raha01@gmail.com. 3. The International Center for Advanced Research and Training (ICART), Bukavu, Democratic Republic of Congo. ken.raha01@gmail.com. 4. Panzi General Referral Hospital, Bukavu, Democratic Republic of Congo. 5. Université Evangélique en Afrique (U.E.A), Bukavu, Democratic Republic of Congo. 6. Royal Australian College of Obstetricians and Gynaecologists trainee, James Cook University, Townsville, Australia. 7. The University of Gothenburg, Gothenburg, Sweden. 8. The International Center for Advanced Research and Training (ICART), Bukavu, Democratic Republic of Congo.
Abstract
BACKGROUND: Retroperitoneal hematoma after vaginal delivery is rare but can lead to maternal morbidity and mortality. Diagnosis of this condition is challenging due to its complexity and its nonspecific signs and symptoms. To date, studies and case reports regarding retroperitoneal hematoma are few, particularly in low-income countries where risk factors for this condition may be more prevalent and the prognosis poorer. CASE PRESENTATION: We report the case of a 37-year-old multiparous african (Congolese) woman who presented to the emergency department of a large referral hospital in Bukavu, Democratic Republic of the Congo (DRC), 2 weeks after a spontaneous nontraumatic vaginal delivery. She had abdominal pain that began immediately after delivery and progressed throughout the postpartum period. The patient had anemia, hypotension, tachycardia, and a left costo-lumbar arch distorting the body shape on a soft and depressed abdomen. She had visited a private clinic on days 3 and 7 postpartum; however, signs and symptoms of retroperitoneal hematoma went unrecognized. Using abdominal ultrasound, we diagnosed an extensive hematoma in the retroperitoneal space from the left iliac fossa to the left flank. Laparotomy was performed to evacuate the hematoma, and the patient recovered. CONCLUSION: Retroperitoneal hematoma following a nontraumatic vaginal delivery is an unusual situation in general obstetrical practice. The knowledge of this potentially life-threatening condition in resource-limited settings enables effective diagnosis and management by ultrasound and laparotomy.
BACKGROUND:Retroperitoneal hematoma after vaginal delivery is rare but can lead to maternal morbidity and mortality. Diagnosis of this condition is challenging due to its complexity and its nonspecific signs and symptoms. To date, studies and case reports regarding retroperitoneal hematoma are few, particularly in low-income countries where risk factors for this condition may be more prevalent and the prognosis poorer. CASE PRESENTATION: We report the case of a 37-year-old multiparous african (Congolese) woman who presented to the emergency department of a large referral hospital in Bukavu, Democratic Republic of the Congo (DRC), 2 weeks after a spontaneous nontraumatic vaginal delivery. She had abdominal pain that began immediately after delivery and progressed throughout the postpartum period. The patient had anemia, hypotension, tachycardia, and a left costo-lumbar arch distorting the body shape on a soft and depressed abdomen. She had visited a private clinic on days 3 and 7 postpartum; however, signs and symptoms of retroperitoneal hematoma went unrecognized. Using abdominal ultrasound, we diagnosed an extensive hematoma in the retroperitoneal space from the left iliac fossa to the left flank. Laparotomy was performed to evacuate the hematoma, and the patient recovered. CONCLUSION:Retroperitoneal hematoma following a nontraumatic vaginal delivery is an unusual situation in general obstetrical practice. The knowledge of this potentially life-threatening condition in resource-limited settings enables effective diagnosis and management by ultrasound and laparotomy.