Giant retroperitoneal hematoma mimicking pancreatic solid neoplasm: Case presentation and a brief literature review

Abstract text (incl. references and figure legends)

BACKGROUND: Spontaneous retroperitoneal hematoma is a relatively rare clinical entity with a high degree of morbidity and mortality. Much of the literature on the subject is limited to case series and retrospective cohort studies. The clinical presentation can be varied and insidious for the emergency surgeon. CASE REPORT Patient of 62 years old was admitted in satisfactory condition with complaints of pain in mesogaster, radiating to the back and lower abdomen, Not history of trauma and surgical inerventions. Bio-chemical analysis, cancer biomarkers were normal with the exception of PCR (3,24 mg/Dl). CT revealed pathological solid bilobed foam of 17x8x14 cm. Abdominal aorta free from aneurysmal dilatations. RMN confirmed the voluminous solid mass with a bilobed aspect with well defined margins. During the period of observation (30 days) there was an increase in predominantly direct bilirubin levels with mild pancreatic secretion. Ecoendoscopy performed in suspicion of a pancreatic neoplasm revealed a solid lesion with inhomogeneous echostructure, mainly hypoechoic with multiple anechoic gaps inside. Following an oncological evaluation, cyst was punctured and was performed FNAB that resulted as inconclusive findings, with numerous red blood cells and granulocytes. A control CT scan was performed 25 days away which revealed in the arterial phase, an aneurysm of 18mm pertaining to a small arterial branch of the pancreatic-duodenal arch is found; probably secondary to an ostial stenosis of the celiac trunk, and a voluminous buffered hematoma in the organization phase. Only at this point did we proceed to angioembolization at the level of a lower pancreatic-duodenal arch of the aneurysmal-pseudoaneurysmatic formation. CONCLUSIONS: Despite the fact that organized retroperitoneal hematomas are quite rare, their diagnosis can be extremely complex, requires detailed examination and ambiguous interpretation of the obtained results needs histological verification.

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