1
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Suenaga A, Hashimoto Y, Kanaya A, Fukunari K, Kawahara Y, Miyazono M. A Case of Rectus Sheath Hematoma Caused by Self-Injection of Certolizumab Pegol. Cureus 2025; 17:e80154. [PMID: 40196069 PMCID: PMC11973531 DOI: 10.7759/cureus.80154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2025] [Indexed: 04/09/2025] Open
Abstract
Rectus sheath hematoma (RSH) is a condition caused by hemorrhage into the rectus sheath. A 61-year-old man with end-stage renal failure and rheumatoid arthritis presented to our hospital with abdominal pain. The patient had been receiving biweekly self-injections of certolizumab pegol to the abdominal wall. Computed tomography (CT) demonstrated a large high-density left-sided RSH. Abdominal pain gradually exacerbated; thus, transcatheter arterial embolization (TAE) for the left inferior epigastric artery (IEA) was performed. This is the first reported case of RSH caused by certolizumab pegol. Factors contributing to RSH include low abdominal wall fat, the use of auto-injector-based preparations, and anticoagulant use in dialysis.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology, National Hospital Organization Ureshino Medical Center, Ureshino, JPN
| | - Yuka Hashimoto
- Division of Nephrology, Saga University Faculty of Medicine, Saga, JPN
| | - Akiko Kanaya
- Department of Nephrology, Sasebo Kyosai Hospital, Sasebo, JPN
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2
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Hopf-Jensen S, Müller-Hülsbeck S. [Management of anticoagulant-related soft tissue bleeding]. RADIOLOGIE (HEIDELBERG, GERMANY) 2025; 65:28-37. [PMID: 39432063 DOI: 10.1007/s00117-024-01381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND AND OBJECTIVE Spontaneous, severe, and life-threatening soft tissue bleeding (STB) in patients taking anticoagulants is associated with high morbidity and mortality due to the substantial blood loss and nonspecific clinical symptoms. The optimal management of these predominantly older patients with multiple comorbidities has not yet been unanimously clarified. MATERIALS AND METHODS This work comprises a literature search and analysis of the pertinent retrospective studies and case series. RESULTS Structured diagnostic workup with contrast-enhanced computed tomography (CT) is essential for planning transarterial embolization (TAE). Contrast agent extravasation, the signal flare phenomenon, and the hematocrit effect are all indicative of active bleeding or an anticoagulant-related hematoma. For TAE, coils, particles, and liquid embolic agents can be used alone or in combination. A back door/front door embolization should be strived for. CONCLUSION Transarterial embolization is the method of choice for managing anticoagulant-related localized or diffuse spontaneous soft tissue bleeding in the context of hemodynamic stabilization of the patient.
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Affiliation(s)
- S Hopf-Jensen
- Institut für diagnostische und interventionelle Radiologie und Neuroradiologie, DIAKO Krankenhaus Flensburg, Knuthstraße 1, 24939, Flensburg, Deutschland.
| | - S Müller-Hülsbeck
- Institut für diagnostische und interventionelle Radiologie und Neuroradiologie, DIAKO Krankenhaus Flensburg, Knuthstraße 1, 24939, Flensburg, Deutschland
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3
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Fujieda K, Saito S, Tanaka A, Furuhashi K, Ozeki T, Yasuda Y, Sano Y, Ishida S, Maruyama S. A case of non-traumatic rectus sheath hematoma in a post-kidney transplant patient undergoing catheter embolization during anticoagulation treatment for atrial fibrillation. CEN Case Rep 2024; 13:528-533. [PMID: 38743194 PMCID: PMC11608185 DOI: 10.1007/s13730-024-00890-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
A 65-year-old man, a post living donor kidney transplant patient, was admitted to the intensive care unit (ICU) with a severe bacterial infection. He also tested positive for coronavirus disease and had a cough. On admission, heparin was administered for atrial fibrillation. On the third day of hospitalization, his general condition had recovered, and he was discharged from the ICU to the general ward. On the fourth day of hospitalization, he experienced abdominal pain, and a hard mass was palpated in the left lower abdomen. On the fifth day of hospitalization, contrast-enhanced computed tomography showed an extensive rectus sheath hematoma (RSH) extending from the left lower abdominal wall to the left side of the bladder, with extravasation from a small branch of the left inferior epigastric artery. Heparin was discontinued, and transcatheter arterial embolization was performed to control the bleeding. RSH is a rare disease, and cases of extensive hematoma in post-kidney transplant patients occur even less frequently. Patients taking anticoagulants and those with chronic kidney disease are at high risk for RSH, so physicians should be cognizant of this disease when these patients develop abdominal pain.
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Affiliation(s)
- Kumiko Fujieda
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Shoji Saito
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Akihito Tanaka
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Kazuhiro Furuhashi
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan.
| | - Takaya Ozeki
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yuta Sano
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shohei Ishida
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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4
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Devkota S, Lamichhane S, Baghi S, K.C. S, Bhola H. Spontaneous rectus sheath hematoma as a differential diagnosis for localized abdominal swelling in chronic liver disease: A rare case report. Clin Case Rep 2024; 12:e9474. [PMID: 39434765 PMCID: PMC11491412 DOI: 10.1002/ccr3.9474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/17/2024] [Accepted: 09/14/2024] [Indexed: 10/23/2024] Open
Abstract
Key Clinical Message Spontaneous rectus sheath hematoma is a rare complication in chronic liver disease patients. Early clinical suspicion with prompt radiological evaluation is crucial for accurate diagnosis and timely management. Abstract Spontaneous rectus sheath hematoma can present as an acute abdomen in the emergency department. The rupture of the upper and lower epigastric arteries and their branches is the main cause of hematoma formation. Hepatic dysfunction can affect the clotting process, increasing the risk of hematoma development. Computed tomography is the preferred diagnostic tool. Most hematomas can be managed conservatively, with only a few requiring minimal intervention or surgical management. We report an uncommon instance of spontaneous rectus sheath hematoma in a patient with chronic liver disease presenting with painful abdominal distention, mimicking a hernia and initially posing a diagnostic challenge. The rectus sheath hematoma was definitively diagnosed through clinical and radiological evaluation and subsequently evacuated with successful outcomes.
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Affiliation(s)
- Shritik Devkota
- Department of Radiodiagnosis & ImagingAnil Baghi HospitalPunjabIndia
| | - Samiksha Lamichhane
- Department of Radiodiagnosis & ImagingB. P. Koirala Institute of Health SciencesDharanNepal
| | - Saurabh Baghi
- Department of CardiologyAnil Baghi HospitalPunjabIndia
| | - Suraj K.C.
- Department of General SurgeryB. P. Koirala Institute of Health SciencesDharanNepal
| | - Harsha Bhola
- Department of General SurgeryAnil Baghi HospitalPunjabIndia
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5
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Seo YE, Lim CJ, Lim JW, Kim JS, Oh HH, Ma KY, You GR, Im CM, Lee BC, Joo YE. Successful Transcatheter Arterial Embolization of Abdominal Wall Hematoma from the Left Deep Circumflex Iliac Artery after Abdominal Paracentesis in a Patient with Liver Cirrhosis: Case Report and Literature Review. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2024; 83:167-171. [PMID: 38659254 DOI: 10.4166/kjg.2024.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
The occurrence of an abdominal wall hematoma caused by abdominal paracentesis in patients with liver cirrhosis is rare. This paper presents a case of an abdominal wall hematoma caused by abdominal paracentesis in a 67-year-old woman with liver cirrhosis with a review of the relevant literature. Two days prior, the patient underwent abdominal paracentesis for symptom relief for refractory ascites at a local clinic. Upon admission, a physical examination revealed purpuric patches with swelling and mild tenderness in the left lower quadrant of the abdominal wall. Abdominal computed tomography revealed advanced liver cirrhosis with splenomegaly, tortuous dilatation of the para-umbilical vein, a large volume of ascites, and a large acute hematoma at the left lower quadrant of the abdominal wall. An external iliac artery angiogram showed the extravasation of contrast media from the left deep circumflex iliac artery. Embolization of the target arterial branches using N-butyl-2-cyanoacrylate was then performed, and the bleeding was stopped. The final diagnosis was an abdominal wall hematoma from the left deep circumflex iliac artery after abdominal paracentesis in a patient with liver cirrhosis.
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Affiliation(s)
- Young Eun Seo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chae June Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Woong Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Je Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyung Hoon Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Keon Young Ma
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ga Ram You
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chan Mook Im
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Byung Chan Lee
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Young Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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6
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Fujii A, Matsuda Y, Yabe T, Norifumi H, Fujimoto K, Yamazaki M, Yokoyama H, Furuichi K. Nephrotic syndrome with rectus sheath hematoma: a case report. J Med Case Rep 2024; 18:148. [PMID: 38461309 PMCID: PMC10924988 DOI: 10.1186/s13256-024-04388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/16/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Rectus sheath hematoma is a rare presentation often associated with abdominal trauma and anticoagulant therapy. Here, we present a patient with severe rectus sheath hematoma accompanied by nephrotic syndrome who achieved significant clinical improvement without the need for invasive treatment. CASE PRESENTATION A 72-year-old Japanese woman was referred to our hospital for the treatment of nephrotic syndrome. She was receiving steroid and anticoagulant therapy. Then she had abdominal pain and she was diagnosed with spontaneous rectus sheath hematoma by abdominal computed tomography. She received transfusion and was managed conservatively with bed rest, which led to improvement in abdominal pain. CONCLUSION Despite the absence of trauma history, rectus sheath hematoma should be considered in patients at risk of vascular failure, including those receiving anticoagulant or steroid therapy, those who are elderly, and those with nephrotic syndrome.
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Affiliation(s)
- Ai Fujii
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
- Keiju Medical Center, Nanao, Japan
| | | | - Tomohisa Yabe
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Hayashi Norifumi
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Keiji Fujimoto
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | | | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Kengo Furuichi
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
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7
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McArdle M. Trauma in the elderly: a bilateral rectus sheath haematoma. BMJ Case Rep 2023; 16:e256061. [PMID: 38061846 PMCID: PMC10711929 DOI: 10.1136/bcr-2023-256061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Life expectancy has more than doubled in the last century, and a new cohort of elderly and increasingly frail patients is presenting to emergency departments with new clinical challenges. When this patient cohort presents after injury, all aspects of clinical practice have to be recalibrated to provide safe and appropriate care. The prevalence of chronic disease, levels of organ failure, multiple comorbidities, greater use of anticoagulation and incidence of recurrent low- and high-impact trauma may delay and obscure diagnosis and, ultimately, increase mortality.Older age is a risk factor for rectus sheath haematoma (RSH), which is haemorrhage into the potential space surrounding the rectus abdominis muscle/s. It is a rare presentation following trauma but can provide diagnostic challenges and be fatal. Even more rare is bilateral RSH with only 12 reported in the literature since 1981.This case report describes bilateral RSH presenting in an elderly woman following a fall and the consequences of seemingly minor trauma in the elderly.
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Affiliation(s)
- Michael McArdle
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- South Warwickshire University NHS Foundation Trust, Warwick, UK
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8
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Fior D, Di Provvido S, Leni D, Corso R, Moramarco LP, Pileri M, Grasso RF, Santucci D, Faiella E. Spontaneous Soft Tissue Hematomas in Patients with Coagulation Impairment: Safety and Efficacy of Transarterial Embolization. Tomography 2023; 9:1083-1093. [PMID: 37368541 DOI: 10.3390/tomography9030089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this study is to report the authors' experience of percutaneous transarterial embolization (TAE) in patients with spontaneous soft tissue hematomas (SSTH) and active bleeding with anticoagulation impairment. The study retrospectively identified 78 patients who received a diagnosis of SSTH by CT scan and underwent TAE between 2010 and 2019 in a single trauma center. The patients were stratified using Popov classification into categories: 2A, 2B, 2C, and 3. The patient's 30-day survival after TAE was considered the primary outcome; immediate technical success, the need for additional TAE, and TAE-related complications were considered secondary outcomes. Immediate technical success, complication rate, and risk factors for death were analyzed. Follow-up stopped on day 30 from TAE. 27 patients (35%) fell into category 2A, 8 (10%) into category 2B, 4 (5%) into category 2C, and 39 (50%) into category 3. Immediate technical success was achieved in 77 patients (98.7%). Complications included damage at the arterial puncture site (2 patients, 2.5%) and acute kidney injury (24 patients, 31%). Only 2 patients (2.5%) had been discharged with a new diagnosis of chronic kidney disease. The 30-day overall mortality rate was 19% (15 patients). The mortality rate was higher in hemodynamically unstable patients, in Popov categories 2B, 2C, and 3, and in patients with an initial eGFR < 30 mL/min × 1.73 m2. The study demonstrated a higher mortality risk for categories 2B, 2C, and 3 compared to category 2A. Nonetheless, TAE has proven effective and safe in type 2A patients. Even though it is unclear whether type 2A patients could benefit from conservative treatment rather than TAE, in the authors' opinion, a TAE endovascular approach should be promptly considered for all patients in ACT with active bleeding demonstrated on CT scans.
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Affiliation(s)
- Davide Fior
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Stefano Di Provvido
- Department of Radiology, Desio Hospital, ASST Brianza, Via Giuseppe Mazzini 1, Desio, 20832 Monza, Italy
| | - Davide Leni
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900 Monza, Italy
| | - Rocco Corso
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900 Monza, Italy
| | - Lorenzo Paolo Moramarco
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Matteo Pileri
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Rosario Francesco Grasso
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Domiziana Santucci
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Eliodoro Faiella
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
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9
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Bao NVT, Phuoc LV, Tuan NHN, Khoa LV, Tu PD, Hoan DD, Duc NM. Endovascular management of rectus abdominis hematoma: A report of two cases. Radiol Case Rep 2023; 18:1239-1243. [PMID: 36660579 PMCID: PMC9842791 DOI: 10.1016/j.radcr.2022.12.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
Nontraumatic spontaneous hematoma of the rectus abdominis is frequently related to anticoagulation therapy. In most cases, this condition is spontaneously self-limited or can be controlled with conservative therapy. Nevertheless, in some patients, despite early and adequate medical therapy, continuous development of the condition requires rapid and complete hemostasis. Currently, endovascular management by selective transarterial embolization of the bleeding vessel is the most common treatment option. We report 2 cases of endovascular management of rectus abdominis hematoma using a mixture of n-butylcyanoacrylate and lipiodol to embolize the bleeding point of the superior epigastric artery. Clinical symptoms improved without noticeable complications.
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Affiliation(s)
| | - Le Van Phuoc
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Le-Van Khoa
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Pham Dang Tu
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Duong Dinh Hoan
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 District 10, Ho Chi Minh City, Vietnam
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10
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Transversus abdominis plane (TAP) block for pain management of rectus sheath hematoma in the emergency department (ED). Am J Emerg Med 2023; 63:183.e1-183.e3. [PMID: 36369046 DOI: 10.1016/j.ajem.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022] Open
Abstract
Peripheral nerve blocks for pain management have historically been discussed in anesthesiology literature but, until recently, have not been considered in emergency medicine contexts. Transversus abdominis plane (TAP) blocks, in particular, have recently been explored in the emergency department for pain control in acute appendicitis but are potentially helpful for managing abdominal pain of other etiologies. One such pathology is rectus sheath hematomas, where conservative management is often necessary as curative treatments often pose more significant risks than are necessary. We report the case of a 57-year-old female presenting to the emergency department with severe abdominal pain following vigorous exercise. She was found to have a large rectus sheath hematoma on computed tomography. An ultrasound-guided transversus abdominis plane block was performed in the emergency department, and the patient had complete resolution of her pain.
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11
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Dulberger A, Streiff M, Myers SD, Sanders CS. Hernia Following Rectus Sheath Hematoma. Cureus 2022; 14:e28795. [PMID: 36225418 PMCID: PMC9534222 DOI: 10.7759/cureus.28795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/05/2022] Open
Abstract
Rectus sheath hematomas (RSH) are increasing in prevalence, presumably correlating with increased use of anticoagulation medications and an aging population. Comorbidities such as blood dyscrasias, atherosclerosis, and hypertension are associated with an increased risk of developing an RSH. Iatrogenic origin of RSH, secondary to treatment of various abdominal pathologies, is not uncommon. Due to its exceptionally non-specific array of clinical signs and symptoms, RSH can be challenging to diagnose in the clinical setting without the aid of radiological images. Abdominal computed tomography (CT) is generally the modality of choice through which the RSH can be successfully identified and characterized. CT imaging can play an important role in the planning of RSH management, as effective management varies depending on the size and position of the RSH. Recurrent bleeding, hypovolemic shock, abdominal compartment syndrome, myonecrosis, and infection have been traditionally considered as the more prominent complications of RSH. However, with more cases occurring, more complications are being described in the literature. The following case presents a previously unreported complication of RSH, that of bowel herniation into a potential space created by a previously treated RSH.
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12
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Heo Y, Kang HL, Kim DH. Exercise-induced traumatic muscle injuries with active bleeding successfully treated by embolization: three case reports. JOURNAL OF TRAUMA AND INJURY 2022; 35:219-222. [PMID: 39380605 PMCID: PMC11309232 DOI: 10.20408/jti.2022.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022] Open
Abstract
Muscle injuries caused by indirect trauma during exercise are common. Most of these injuries can be managed conservatively; however, further treatment is required in extreme cases. Although transcatheter arterial embolization is a possible treatment modality, its role in traumatic muscle injuries remains unclear. In this case series, we present three cases of exercise-induced muscle hemorrhage treated by transcatheter arterial embolization with successful outcomes. The damaged muscles were the rectus abdominis, adductor longus, and iliopsoas, and the vascular injuries were accessed via the femoral artery during the procedures.
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Affiliation(s)
- Yoonjung Heo
- Department of Medicine, Dankook University Graduate School, Cheonan, Korea
- Department of Trauma Surgery, Trauma Center, Dankook University Hospital, Cheonan, Korea
| | - Hye Lim Kang
- Department of Surgery, Dankook University Hospital, Cheonan, Korea
| | - Dong Hun Kim
- Department of Trauma Surgery, Trauma Center, Dankook University Hospital, Cheonan, Korea
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13
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Angeramo CA, Méndez P, Eyheremendy EP, Schlottmann F. Rectus sheath hematoma: conservative, endovascular or surgical treatment? A single-center artificial neural network analysis. Eur J Trauma Emerg Surg 2022; 48:2157-2164. [PMID: 35031823 DOI: 10.1007/s00068-021-01854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/02/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Rectum sheath hematoma (RSH) is a rare and often misdiagnosed disease. We aimed to determine outcomes of patients affected by RSH and identify variables associated with the need of prompt intervention. METHODS Patients diagnosed with RSH during the period 2012-2020 were retrospectively identified. Demographics, diagnostic, and therapeutic variables were evaluated. RSH was classified with computed tomography (CT) according to the Berna system. An artificial neural network (ANN) model including 12 variables was used to identify patients that might require a prompt endovascular or surgical treatment. RESULTS A total of 20 patients were included for analysis; mean age was 69 (35-98) years and 14 (70%) were females. Iatrogenic injury and forceful contraction of the abdominal wall were the leading causes of RSH. Eleven (55%) patients were anticoagulated or antiaggregated. There were 3 (15%) grade 1, 5 (25%) grade 2, and 12 (60%) grade 3 RSH; 6 (30%) were treated conservatively, 10 (50%) with artery embolization, and 4 (20%) with surgery. Overall morbidity was 45% and there was no mortality in the series. According to the ANN, patients at high risk of requiring an invasive treatment were those with active extravasation on CT angiography, Berna grade III, age ≥ 65 years, hemodynamic instability, chronic use of corticosteroids, hematoma volume ≥ 1000 mL, and/or transfusion of ≥ 4 units of red blood cells. CONCLUSION Conservative treatment might be effective in selected patients with RSH. Our artificial neural network analysis might help selecting patients who require endovascular or surgical treatment.
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Affiliation(s)
- Cristian A Angeramo
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina.
- Department of Radiology, Interventional Radiology Service, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
| | - Patricio Méndez
- Department of Radiology, Interventional Radiology Service, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Eduardo P Eyheremendy
- Department of Radiology, Interventional Radiology Service, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina
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14
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Di Pietro S, Tiralongo F, Desiderio CM, Vacirca F, Palmucci S, Giurazza F, Venturini M, Basile A. Efficacy of Percutaneous Transarterial Embolization in Patients with Spontaneous Abdominal Wall Hematoma and Comparison between Blind and Targeted Embolization Approaches. J Clin Med 2022; 11:jcm11051270. [PMID: 35268360 PMCID: PMC8911449 DOI: 10.3390/jcm11051270] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Endovascular treatment of abdominal wall hematomas (AWHs) has been increasingly used when conservative treatments were not sufficiently effective, and it is often preferred to surgical interventions. The aim of our study was to evaluate the safety and technical and clinical success of percutaneous transarterial treatment of AWH and to evaluate the efficacy of blind embolization compared to targeted embolization. Materials and Methods: We retrospectively enrolled 43 patients (23 men and 20 females) with spontaneous AWH who underwent digital subtraction angiography (DSA) and embolization, focusing on the presence of signs of bleeding at pre-procedural CT-Angiography (CTA) and at DSA. Furthermore, we divided patients into two groups depending on blind or targeted embolization approaches. Results: The mean age of the study population was 71 ± 12 years. CTA revealed signs of active bleeding in 31 patients (72%). DSA showed signs of active bleeding in 34 patients (79%). In nine patients (21%), blind embolization was performed. The overall technical success rate was 100%. Clinical success was achieved in 33 patients (77%), while 10 patients (23%) rebled within 96 h, and all of them were re-treated. No major peri-procedural complication was reported. The comparison between blind and targeted embolization showed no statistically significant differences for characteristics of groups and for clinical success rates (78% and 77%, respectively, −p = 0.71). The technical success was 100% in both groups. Conclusions: Our study confirms that transarterial embolization is a safe and effective option for the treatment of spontaneous AWHs, and it suggests that the efficacy and safety of blind embolization is comparable to non-blind.
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Affiliation(s)
- Stefano Di Pietro
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
- Correspondence: ; Tel.: +39-393-2067-572
| | - Carla Maria Desiderio
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Francesco Vacirca
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Stefano Palmucci
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
| | - Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, 80131 Naples, Italy;
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, 21100 Varese, Italy;
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, 95123 Catania, Italy; (S.D.P.); (C.M.D.); (F.V.); (S.P.); (A.B.)
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15
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Semeraro V, Vidali S, Borghese O, Ganimede MP, Gandini R, Di Stasi C, Burdi N. Glue Embolization in the Management of Rectus Sheath Hematomas. Vasc Endovascular Surg 2022; 56:269-276. [PMID: 35068270 DOI: 10.1177/15385744211068742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aims to describe the results achieved in the management of rectus sheath hematoma (RSH) using glue embolization. METHOD Data about all consecutive patients presenting with RSH, between January 2005 and December 2020 were retrospectively reviewed. RSHs were classified according to the Berna CT scan Classification. Clinical and technical outcomes were evaluated during in-hospital period and 1-month follow-up. RESULTS Among 74 patients presenting with RSH, CTA revealed an active bleeding in 61 (n = 42, 69% women; median age = 68.8 y range: 47-91). 19 cases of type 1 RSH (25.7%), under anticoagulation therapy and hemodynamically stable, were successfully managed conservatively. Conversely, endovascular embolization with cyanoacrylate glue diluted with ethiodized oil (Lipiodol Ultrafluid, Guerbet, France) was needed in n = 42 (56.8%) patients, in 16 cases after failure of conservative management; a single session of percutaneous glue embolization was adequate to achieve technical and clinical success in all patients with stabilization or progressive improvement of hemoglobin values after procedure (7.1 + 1.8 g/dL pre-procedure vs 11.1 + 1.6 g/dL post-procedure). No major complications occurred. Two minor complications were reported: 1 case (2.4%) of puncture site-related complication (local self-limiting hematoma) and 1 case (2.4%) of post-embolization syndrome (abdominal pain) spontaneously regressive. The median hospital stay was 7 d. At 30-day follow-up, 2 patients (2.7%) died of multiorgan failure. CONCLUSIONS In the management of RSH, glue embolization was shown to be safe and efficacious. Glue allowed the immediate occlusion of both the "front and back doors" of bleeding without the need to reach the bleeding point, preventing potentially life-threatening recurrence.
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Affiliation(s)
- Vittorio Semeraro
- Department of Interventional Radiology, 170131Santissima Annunziata Hospital,Taranto, Italy
| | - Sofia Vidali
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, 18654University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Ottavia Borghese
- Angio-cardio-thoracic Pathophysiology and Imaging, Sapienza University, Rome, Italy
| | - Maria Porzia Ganimede
- Department of Interventional Radiology, 170131Santissima Annunziata Hospital,Taranto, Italy
| | - Roberto Gandini
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, 18654University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Carmine Di Stasi
- Department of Interventional Radiology, 170131Santissima Annunziata Hospital,Taranto, Italy
| | - Nicola Burdi
- Department of Neuroradiology, Santissima Annunziata Hospital, Taranto, Italy
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16
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Tyagunov AE, Polyaev AY, Stradymov EA, Nechay TV, Trudkov DY, Mosin SV, Tyurin IN, Sazhin AV. [Computed tomography and endovascular occlusion in diagnosis and treatment of spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space in patients with COVID-19]. Khirurgiia (Mosk) 2022:11-19. [PMID: 36469464 DOI: 10.17116/hirurgia202212111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To investigate the results of therapeutic and prophylactic endovascular hemostasis of spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space in patients with COVID-19. MATERIAL AND METHODS We retrospectively studied 35 patients with COVID-19 complicated by spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space. According to CT data, the volume of hematoma was 1193.4±706.1 ml. In all patients, CT signs of ongoing bleeding were detected. Moreover, contrast agent extravasation in all phases of examination was established in 15 patients. In other ones, extravasation was detected in late phases or study phase was not identified. All patients underwent angiography. Ongoing bleeding was detected in 12 (34.3%) patients (group 1). They underwent embolization of the target vessel. In 23 patients, bleeding was not established during angiography. Of these, 13 ones underwent prophylactic embolization (group 2). No embolization was carried out in 10 patients (group 3). All groups differed in hematoma localization and COVID-19 severity. RESULTS Fourteen (40%) patients died in postoperative period. Mortality was similar in all groups. The most common cause of death was progressive respiratory failure following pneumonia. The last one was established by autopsy in 10 (71.4%) patients. CONCLUSION Angiography confirmed MR signs of contrast agent extravasation in 34.3% of patients. In case of extravasation in all CT phases, ongoing bleeding was confirmed in 66.7% of patients. Endovascular embolization is effective for arterial bleeding into soft tissues. However, large-scale studies are needed to assess the effect of this technique on survival.
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Affiliation(s)
- A E Tyagunov
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - A Yu Polyaev
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia
| | - E A Stradymov
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - T V Nechay
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - D Yu Trudkov
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia
| | - S V Mosin
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia
| | - I N Tyurin
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia
| | - A V Sazhin
- Pirogov Russian National Research Medical University, Moscow, Russia
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17
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Nematihonar B, Qaderi S, Shah J, Bagherpour JZ. Spontaneous giant rectus sheath hematoma in patients with COVID-19: two case reports and literature review. Int J Emerg Med 2021; 14:40. [PMID: 34301186 PMCID: PMC8300980 DOI: 10.1186/s12245-021-00366-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019, COVID-19, as a global public health emergency, has come with a broad spectrum of clinical manifestations and complications. In this study, we present a unique complication of this disease. PRESENTATION OF CASES: (A) A 65-year-old woman with a known case of COVID-19; on the second day of admission, the patient presented sudden tachycardia and hypogastric pain; on abdomen physical examination, a huge lower abdominal tender mass was noticed. (B) A 50-year-old woman with COVID-19, 4 days after admission, started complaining of tachycardia, pain, and mass in the lower abdomen. On abdomen physical examination, a huge lower abdominal tender mass was noticed. Both of the patients underwent an abdomen CT scan which confirmed a huge rectus sheath hematoma (RSH). Both of the patients underwent angioembolization of the inferior epigastric artery. The patient recovered completely and no evidence of further expansion was seen after 2 weeks of follow-up. DISCUSSION Hemorrhagic issues in COVID-19 patients remain poorly understood. Physicians should discuss risks of RSH in patients where continuous anticoagulation therapy will be reinstated. With increased clinician awareness of the need for RSH screening in COVID-19 patients with acute abdominal pain, the interprofessional team of healthcare providers can maximize patient safety and reduce hospitalization time, especially in high-risk patients at risk for unnecessary surgery. CONCLUSIONS These two reports and literature review demonstrate the need of active surveillance for possible hemorrhagic complications in patients with COVID-19 infection.
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Affiliation(s)
- Behzad Nematihonar
- Department of General Surgery, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani Street, Tehran, 161776341 Iran
| | - Shohra Qaderi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Jaffer Shah
- Drexel University College of Medicine, Philadelphia, PA USA
| | - Javad zebarjadi Bagherpour
- Department of General Surgery, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani Street, Tehran, 161776341 Iran
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18
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Phan DHL, Leslie AS. Bladder perforation: an unusual complication caused by rectus sheath haematoma. J Surg Case Rep 2021; 2021:rjab180. [PMID: 34055286 PMCID: PMC8158849 DOI: 10.1093/jscr/rjab180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
Rectus sheath haematoma (RSH) is an uncommon cause of abdominal pain. Despite being previously viewed as a benign, self-limiting condition, there is increasing evidence suggesting significant local and systemic complications with RSH. We present a case of an 82-year-old female who developed a large RSH following prescription of therapeutic anticoagulation for her new onset atrial fibrillation. She subsequently developed significant haemodynamic collapse, which necessitated emergency radiological intervention. We describe a novel approach to prevent recurrence of bleeding by inserting a covered endovascular stent across the origin of inferior epigastric artery. We also describe a rare finding of bladder perforation, presumed secondary to pressure necrosis from the haematoma. Our report contributes to the growing evidence which suggests RSH, particularly secondary to anticoagulation in the elderly, can result in catastrophic complications. In addition, bladder perforation is a rare but possible complication that needs to be considered.
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19
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Teta M, Drabkin MJ. Fatal retroperitoneal hematoma associated with Covid-19 prophylactic anticoagulation protocol. Radiol Case Rep 2021; 16:1618-1621. [PMID: 33880136 PMCID: PMC8049380 DOI: 10.1016/j.radcr.2021.04.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 01/30/2023] Open
Abstract
Due to the association between Covid-19 and thromboembolic events, there has been a surge in anticoagulation use during the pandemic based on evolving guidelines for management of hospitalized Covid-19 patients. Spontaneous soft tissue hematoma can be a severe complication of anticoagulation. Herein we present a fatal case of severe spontaneous soft tissue hematoma secondary to anticoagulant therapy in a 67kg 81-year-old female with chronic kidney disease who was admitted to the hospital with Covid-19 pneumonia. There is currently no evidence of mortality benefit among Covid-19 patients on high-dose anticoagulation. In the future we hope that practitioners will consider the bleeding risks of anticoagulation and consider patients’ age, weight and renal function when determining prophylactic anticoagulation regimens in Covid-19 patients.
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Affiliation(s)
- Michael Teta
- Critical Care, Catholic Health, Long Island, New York
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20
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Abstract
Tetanus is a nervous system disorder characterized by muscular spasms and autonomic hyperactivity, such as unstable blood pressure. We herein report a case of tetanus in a patient in shock complicated with a rectus sheath hematoma caused by rupture of a pseudo-aneurysm of the inferior epigastric artery. A rectus sheath hematoma might be misdiagnosed as unstable blood pressure associated with autonomic hyperactivity, which is usually observed in patients with tetanus. The possibility of the occurrence of bleeding complications should be considered if a patient with tetanus has severe and persistent blood pressure reduction.
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Affiliation(s)
- Fumiya Inoue
- Department of Emergency Medicine, Hiroshima Citizens Hospital, Japan
| | - Toshihisa Ichiba
- Department of Emergency Medicine, Hiroshima Citizens Hospital, Japan
| | - Hiroshi Naitou
- Department of Emergency Medicine, Hiroshima Citizens Hospital, Japan
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21
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Diamantopoulos A, Mulholland D, Katsanos K, Ahmed I, McGrath A, Karunanithy N, Sabharwal T. Transcatheter Embolization of the Inferior Epigastric Artery: Technique and Clinical Outcomes. Vasc Endovascular Surg 2020; 55:221-227. [PMID: 33308092 DOI: 10.1177/1538574420980576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Symptomatic rectus muscle sheath hematoma may be the result of bleeding originating from the inferior epigastric artery. We report the technique and the results from a series of consecutive patients treated by transcatheter embolization, evaluating both ipsilateral and contralateral retrograde approaches. METHODS This was a retrospective study including patients with verified rectus muscle sheath hematoma as a result of active extravasation from the inferior epigastric artery referred for transcatheter embolization. Technical success, clinical success and major complications were calculated. In addition, minor complications, blood transfusions required after a technically successful embolization, length of stay, peri-procedural and 30-day mortality and overall survival at 6 months were obtained. All statistical analysis was performed using SPSS. RESULTS Twenty-one patients (mean age = 59.67 ± 19.51 years old) were included. The cause of the bleeding in the vast majority was iatrogenic trauma (n = 12/21, 57.14%). Both contralateral (n = 12/21, 57.14%%) and ipsilateral (n = 9/21, 42.86%) retrograde approaches were used. Embolic materials included micro-coils (n = 13/20, 65%), microspheres (PVA) (n = 1/20, 5%), a combination of PVA and micro-coils (n = 5/20, 25%) and gel-foam (n = 1/20, 5%). Overall technical success was 95.2% (n = 20/21) while clinical success was achieved in all but one of the technically successful cases 95% (n = 19/20). One patient died peri-procedurally due to profound hemodynamic shock. There were no other major complications. Additional transfusion was necessary in 7 patients (n = 7/21, 33.33%). There was a significant increase in the hemoglobin levels after the embolization (7.03 ± 1.78 g/dL pre-procedure Vs 10.91 ± 1.7 g/dL post-procedure, p = 0.048). The median hospital stay was 8 days. The peri-procedure and 30-day mortality was 4.8% (n = 1/21) and 28.6% (n = 6/21) respectively. The 6-month survival was 61.9% (13/21). CONCLUSION Percutaneous embolization of the inferior epigastric artery is a minimally invasive method with satisfactory results. Both ipsilateral and contralateral retrograde approaches are feasible.
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Affiliation(s)
- Athanasios Diamantopoulos
- Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK.,School of Biomedical Engineering & Imaging Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Douglas Mulholland
- Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Patras, Rion, Greece
| | - Irfan Ahmed
- Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK
| | - Andrew McGrath
- Department of Radiology, 57978Beaumont Hospital, Dublin, Ireland
| | - Narayan Karunanithy
- Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK
| | - Tarun Sabharwal
- Department of Radiology, 8945Guy's and St. Thomas' NHS Trust, St Thomas' Hospital, London, UK
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22
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Nakayama M, Kato K, Yoshioka K, Sato H. Coagulopathy-related soft tissue hematoma: a comparison between computed tomography findings and clinical severity. Acta Radiol Open 2020; 9:2058460120923266. [PMID: 32528727 PMCID: PMC7263130 DOI: 10.1177/2058460120923266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/08/2020] [Indexed: 11/15/2022] Open
Abstract
Background Despite increases in the incidence of coagulopathy-related soft-tissue hematoma (CRSH), the relationship between computed tomography (CT) features and clinical severity remains unclear. Purpose To retrospectively evaluate the correlation between CT findings and clinical outcomes in CRSH. Material and Methods We retrospectively reviewed data of patients diagnosed with CRSH between March 2011 and March 2018. CRSH was morphologically classified according to the presence or absence of the fluid level pattern and was also divided into groups with or without extravasation as per CT findings. These CT findings were compared with the patients' vital signs and laboratory investigation results. Results A total of 47 patients with CRSH were examined. Fluid level and non-fluid level patterns were observed in 28 (60%) and 19 (40%) patients, respectively. Anticoagulant therapy and extravasation were significantly correlated with the fluid level pattern. However, other clinicolaboratory outcomes, including shock index, hemoglobin, hematocrit, platelet count, and coagulation factors, showed no significant difference between the two patterns. In the comparison of hematomas with and without extravasation, none of the clinicolaboratory outcomes except for anticoagulant therapy showed significant differences. Conclusion CRSH with a fluid level pattern is significantly associated with extravasation. However, extravasation, which is generally suggestive of active bleeding, does not seem to be related to clinical severity in CRSH.
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Affiliation(s)
- Manabu Nakayama
- Department of Radiology, Iwate Medical University, Morioka, Japan
- Manabu Nakayama, Department of Radiology, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate 020-8505, Japan.
| | - Kenichi Kato
- Department of Radiology, Iwate Medical University, Morioka, Japan
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23
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Contrella BN, Park AW, Wilkins LR, Sheeran D, Hassinger TE, Angle JF. Spontaneous Rectus Sheath Hematoma: Factors Predictive of Conservative Management Failure. J Vasc Interv Radiol 2020; 31:323-330. [PMID: 31734076 DOI: 10.1016/j.jvir.2019.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate radiographic, laboratory, and clinical factors associated with conservative management (CM) failure in spontaneous rectus sheath hematoma (RSH). MATERIALS AND METHODS Retrospective review of 72 patients with spontaneous RSH between 2006 and 2017 was performed. Patients were initially managed conservatively and then divided into 2 groups based on decision to embolize. No differences were found between embolization (n = 32) and CM (n = 40) groups in age (67.5 vs 69.5 y; P = .79), sex (31% vs 38% male; P = .58), body mass index (27.7 vs 25.7 kg/m2; P = .20), or medical comorbidities. Univariate analyses compared initial hemoglobin level, change in hemoglobin level, coagulation parameters, transfusion requirements, hematoma volume, and active extravasation on computed tomographic (CT) angiography between groups. Multivariable logistic regression identified factors predictive of CM failure. A scoring system was then created to predict CM failure. RESULTS CM failed in 32 of 72 patients. Multivariable regression identified active extravasation on CT angiography (P = .02), hematoma volume (P = .01), and packed red blood cell (pRBC) transfusion of ≥ 4 U (P = .03) as predictors of embolization. A scoring system using these factors along with maximum rate of hemoglobin decrease yielded a sensitivity of 100% and specificity of 98% in determining need for embolization. CONCLUSIONS CM for RSH was more likely to fail in patients with active extravasation on CT angiography, larger hematoma volume, pRBC transfusion of ≥ 4 U, and higher rate of hemoglobin decrease. Using these parameters, a scoring system was created that achieved high sensitivity and specificity in identifying patients who would require embolization.
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Affiliation(s)
- Benjamin N Contrella
- Department of Radiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908.
| | - Auh Whan Park
- Department of Radiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908
| | - Luke R Wilkins
- Department of Radiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908
| | - Daniel Sheeran
- Department of Radiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908
| | - Taryn E Hassinger
- Department of Medical Imaging and Surgery, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908
| | - J Fritz Angle
- Department of Radiology, University of Virginia, 1215 Lee Street, Charlottesville, VA 22908
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24
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Han DY, Hwang JH, Kang HJ, Yoon J, Kwon SH, Seo TS, Oh JH. Basic Arterial Anatomy and Interpretation of CT Angiography for Intra-Abdominal or Gastrointestinal Bleeding: Correlation with Conventional Angiographic Findings for Beginners. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:119-134. [PMID: 36238116 PMCID: PMC9432091 DOI: 10.3348/jksr.2020.81.1.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 11/15/2022]
Abstract
복강 내 혹은 소화기계의 활동성 출혈이 있는 경우, 원인이 되는 동맥 혈관을 파악하는 것이 중요하다. 조영증강 컴퓨터단층촬영술을 이용한 혈관조영술과 고식적인 카테터 혈관조영술에서 원인이 되는 동맥을 파악하기 위해서는 기본적인 혈관 해부학을 숙지하고 있어야 한다. 기본 해부학을 숙지하고 있다면 혈관의 기원과 주행에 다양한 변이가 있다고 하더라도 이에 대한 접근이 한결 쉬워질 것이다. 영상의학에 갓 입문한 초심자들을 대상으로 하여, 복강 내 혹은 소화기계 활동성 출혈의 원인이 될 수 있는 혈관들을 파악하는 데 도움이 될만한 기본 해부학을 설명하고자 한다.
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Affiliation(s)
- Dong Yoon Han
- Department of Radiology, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji Hye Hwang
- Department of Radiology, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hye Jin Kang
- Department of Radiology, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jehong Yoon
- Department of Radiology, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Se Hwan Kwon
- Department of Radiology, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Tae-Seok Seo
- Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Joo Hyeong Oh
- Department of Radiology, Kyung Hee University Medical Center, College of Medicine, Kyung Hee University, Seoul, Korea
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25
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Kalantari J, Nashed MH, Smith JC. Post paracentesis deep circumflex iliac artery injury identified at angiography, an underreported complication. CVIR Endovasc 2019; 2:24. [PMID: 32026994 PMCID: PMC6966403 DOI: 10.1186/s42155-019-0068-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though injury to the inferior epigastric artery (IEA) is reported to be the most common source of hemorrhagic complications from paracentesis, we wish to present our experience involving deep circumflex iliac artery (DCIA) injuries that in our experience is the artery most frequently injured during paracentesis. METHODS Sixteen patients with clinically significant hemorrhage following paracentesis were referred to our Interventional Radiology service for trans-catheter embolization. Patterns of hemorrhage from diagnostic cross-sectional imaging and subsequent angiographic findings and management were investigated. RESULTS 8/16 patients (50%) had angiographic evidence of injury to the DCIA and 4/16 patients (25%) had evidence of injury to the IEA, with two of these patients demonstrating hemorrhage from both the DCIA and IEA; 3/16 patients had injuries to subcostal and/or intercostal arteries; while 3/16 patients had negative angiograms. All patients underwent embolization of the identified injured arteries, and empiric embolization was performed of the DCIA and/or IEA in the three patients with negative angiograms. Fourteen of sixteen patients stabilized post embolization, while two patients required a second embolization procedure to achieve hemostasis; all patients were subsequently discharged home in stable condition. CONCLUSION Both the IEA and the lesser known DCIA need to be considered when performing paracentesis and at subsequent angiography for post paracentesis iatrogenic hemorrhage. Knowledge of both of these at-risk abdominal wall arteries may help minimize hemorrhagic complications from paracentesis.
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Affiliation(s)
- Jalil Kalantari
- 0000 0000 9340 4063grid.411390.eDepartment of Interventional Radiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354 USA
| | - Mark H. Nashed
- 0000 0000 9340 4063grid.411390.eDepartment of Interventional Radiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354 USA
| | - Jason C. Smith
- 0000 0000 9340 4063grid.411390.eDepartment of Interventional Radiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354 USA
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Abstract
Background Rectus sheath hematoma (RSH) is an uncommon entity associated with predisposing factors such as anticoagulation. It may mimic more frequent abdominal conditions and its accurate diagnosis is important to focus on the correct treatments and improve morbidity and mortality. Case presentation An elderly patient with shock, abdominal pain, palpable abdominal mass, and anemia was suspected of having a large RSH by point-of-care ultrasound (POCUS), which was then confirmed by computed tomography. Surgery was performed, markedly improving his clinical status. Conclusions POCUS has a good sensitivity for the diagnosis of RSH and it is also an excellent tool for patient follow-up. Electronic supplementary material The online version of this article (10.1186/s13089-019-0129-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gabriela Bello
- Intensive Care Unit, Hospital Central de las Fuerzas Armadas (DNSFFAA), 3060, 8 de Octubre Ave., 11600, Montevideo, Uruguay
| | - Pablo Blanco
- Intensive Care Unit, Clínica Cruz Azul, 2651, 60 St., Necochea, 7630, Argentina.
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Spiliopoulos S, Festas G, Theodosis A, Palialexis K, Reppas L, Konstantos C, Brountzos E. Incidence and endovascular treatment of severe spontaneous non-cerebral bleeding: a single-institution experience. Eur Radiol 2019; 29:3296-3307. [PMID: 30519935 DOI: 10.1007/s00330-018-5869-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/16/2018] [Accepted: 10/29/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the incidence and endovascular treatment of severe spontaneous non-cerebral hemorrhage (SSNCH) in a high-volume, tertiary university hospital. METHODS All patients diagnosed with SSNCH between January 2016 and June 2017 were retrospectively analyzed. Endovascular treatment (group EVT) was offered only in patients demonstrating active bleeding at CT angiography (CTA). In cases without active bleeding at CTA, conservative management was decided (group CM). Outcome measures included the incidence of SSNCH, 6-month rebleeding, and survival rates in the two groups as well as EVT technical success and related complications. RESULTS Within the 18-month period, 44 SSNCH cases were identified, resulting in an annual incidence of 29.3 cases. In 37/44 cases (84.1%), bleeding was attributed to the antithrombotic therapy. In total, 19/44 patients underwent EVT (43.2%), and 25/44 patients (56.8%) were managed conservatively. Two patients who were initially treated conservatively finally underwent EVT due to rebleeding (7.4%). The technical success of EVT was 100%, while rebleeding occurred in 1 case (5.2%) following lumbar artery embolization and was successfully re-embolized. According to the Kaplan-Meier analysis, the 1-, 3-, and 6-month survival rates were 68.4%, 63.2%, and 42.1% for group EVT and 87.5%, 75.0%, and 58.3% for group CM, respectively. There were no EVT-related complications. CONCLUSIONS The annual incidence of SSNCH in our institution is substantial. EVT resulted in uncomplicated, high bleeding control rates. The mortality rate was similarly high following either EVT or conservative treatment and was mainly attributed to severe comorbidities. KEY POINTS • This study demonstrates that the incidence of severe spontaneous non-cerebral hemorrhage (SSNCH) in our institution is substantial. • Endovascular treatment was offered only in patients with clinical signs of ongoing hemorrhage and active bleeding at CT angiography and resulted in effective and uncomplicated, minimal invasive hemostasis, in a population with severe comorbidities. • This is the first study to evaluate the outcomes of both endovascular hemostasis and conservative management. Rebleeding following either conservative or endovascular treatment was minimal.
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Affiliation(s)
- Stavros Spiliopoulos
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
| | - Georgios Festas
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Theodosis
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chysostomos Konstantos
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Division of Interventional Radiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Barral M, Pellerin O, Tran VT, Gallix B, Boucher LM, Valenti D, Sapoval M, Soyer P, Dohan A. Predictors of Mortality from Spontaneous Soft-Tissue Hematomas in a Large Multicenter Cohort Who Underwent Percutaneous Transarterial Embolization. Radiology 2019; 291:250-258. [DOI: 10.1148/radiol.2018181187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Costa R, Ferreira I, Pedroso A, Martins M, Gouveia C, de Sousa IE, Vicente P. A Reflection on the Use of Enoxaparin Based on Three Case Reports. Eur J Case Rep Intern Med 2019; 5:001000. [PMID: 30756002 PMCID: PMC6346970 DOI: 10.12890/2018_001000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 11/30/2022] Open
Abstract
Enoxaparin is indicated for the treatment or prevention of many clinical disorders including deep vein thromboembolism, atrial fibrillation and mechanical valve thrombosis. It is one of the most commonly prescribed drugs in hospitals. However, haemorrhagic complications can occur, particularly in the elderly, patients with renal function impairment and patients with a very high or very low body weight. The authors describe the cases of three patients who had one or more risk factors for haemorrhagic complications, such as abdominal haematomas. The clinical presentation was similar in all three cases, with sudden-onset abdominal pain, an altered state of consciousness and hypotension. In all cases, investigation showed acute anaemia and large abdominal haematomas on imaging studies. A conservative approach was taken in the three patients, with suspension and reversal of anticoagulation, fluid resuscitation and red blood cell transfusion. Haemodynamic stability was achieved in two of the patients, but the third patient died. The authors consider it is important to present these case reports because of the widespread use of enoxaparin, and the need for rigorous dose adjustment for renal function variations and body weight. We hope this article raises awareness of haemorrhagic complications in high-risk groups and propose protocols are introduced for dose adjustment and monitoring the efficacy of enoxaparin.
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Affiliation(s)
- Rui Costa
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal
| | - Inês Ferreira
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal
| | - Ana Pedroso
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal
| | - Mariana Martins
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal
| | - Carolina Gouveia
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal
| | | | - Patrícia Vicente
- Internal Medicine Department, Hospital São Francisco Xavier, Lisbon, Portugal
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Transcatheter Arterial Embolization of Spontaneous Soft Tissue Hematomas: A Systematic Review. Cardiovasc Intervent Radiol 2018; 42:335-343. [PMID: 30327927 DOI: 10.1007/s00270-018-2086-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/28/2018] [Indexed: 12/12/2022]
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Comparison of the Different Treatment Strategies for Patients with Rectus Sheath Haematoma. ACTA ACUST UNITED AC 2018; 54:medicina54030038. [PMID: 30344269 PMCID: PMC6122111 DOI: 10.3390/medicina54030038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 12/31/2022]
Abstract
Background and objective: Rectus sheath haematoma (RSH) is an uncommon condition that may vary from contained haematoma to life-threatening bleeding. Timely diagnosis and treatment is crucial in this patient population. The aim of the current study was to investigate the results of the different RSH treatment strategies among patients admitted to a surgery department. Materials and methods: A retrospective analysis of 29 patients treated for RSH in surgery departments of two medical centres from 1 January 2007 to 30 September 2017 was conducted. The patient's age, sex, ASA (American Society of Anesthesiologists; physical status classification system), use of anticoagulants, cause of haematoma, radiological data, vital signs, blood investigations, and type of treatment were extracted. The results were analysed according to the type of treatment. Results: The patients' mean age was 67.6 ± 14.3 years, and the mean duration of in-hospital stay was 10.7 ± 6.7 days. All patients were on anticoagulant treatment, and 82.8% of them had spontaneous haematoma. Nine patients (31%) needed transfusion of packed red blood cells with an average of 2.6 units (range: 1⁻4). Five patients (17.2%) presented with symptoms and signs of hypovolemic shock, and four of them underwent embolisation. Embolisation was successful in all cases. Open surgery was performed in 6 patients, 8 patients underwent percutaneous drainage, and 10 patients were treated conservatively. Two patients (6.7%) died in our series. Both of these patients had type III RSH. Patients in the conservatively treated group had the shortest hospital stay. There were no readmissions due to repeated haematoma or infection. Conclusions: Embolisation of epigastric arteries is a useful tool to stop bleeding into RSH in patients with unstable haemodynamics. Conservative treatment is comparable to ultrasound (US) drainage of RSH but results in a shorter hospital stay. Type III RSH is associated with a higher death rate.
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Spontaneous rectus sheath hematoma: The utility of CT angiography. Radiol Case Rep 2018; 13:328-332. [PMID: 29904466 PMCID: PMC6000050 DOI: 10.1016/j.radcr.2018.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 01/04/2018] [Indexed: 02/01/2023] Open
Abstract
We described the utility of computed tomography (CT) angiography in detection of bleeding vessels for a rapid percutaneous arterial embolization of the spontaneous rectus sheath hematoma. A 70-year-old woman comes to our attention with acute abdominal pain and a low hemoglobin level. An unenhanced CT was performed demonstrating a large rectus sheath hematoma. A conservative management was initially established. Despite this therapy, the abdominal pain increased together with a further decrease of hemoglobin values. A CT angiography was then performed, demonstrating an active bleeding within the hematoma and addressing the patient to a rapid percutaneous arterial embolization.
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Jawhari R, Chevallier O, Falvo N, d'Athis P, Gehin S, Charles PE, Midulla M, Loffroy R. Outcomes of Transcatheter Arterial Embolization with a Modified N-Butyl Cyanoacrylate Glue for Spontaneous Iliopsoas and Rectus Sheath Hematomas in Anticoagulated Patients. J Vasc Interv Radiol 2017; 29:210-217. [PMID: 29056401 DOI: 10.1016/j.jvir.2017.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/02/2017] [Accepted: 08/08/2017] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of n-butyl cyanoacrylate methacryloxy sulfolane (NBCA-MS) transcatheter arterial embolization for anticoagulation-related soft-tissue bleeding and to evaluate predictive factors of clinical success and 30-day mortality. MATERIALS AND METHODS A retrospective review of 50 anticoagulated patients (25 male; mean age, 71.7 y ± 14.2; range, 19-87 y) who underwent emergent Glubran 2 NBCA-MS embolization for iliopsoas hematomas (IPHs; n = 38), rectus sheath hematomas (n = 11), or both (n = 1) between 2011 and 2016 was performed. Inclusion criteria were active bleeding on computed tomography (CT) and anticoagulation. The mean number of red blood cell (RBC) units transfused was 4.8 ± 3.2 (range, 0-14), median hemoglobin level before embolization was 9.7 g/dL (range, 6.2-18 g/dL), and median "mean blood pressure" (MBP) was 62.5 mm Hg (range, 58.3-75 mm Hg). Mean International Normalized Ratio before intervention was 2.5 ± 1.5 (range, 1.0-6.9). Angiograms revealed extravasation in 44 of 50 patients (88%). Mean hematoma volume was 1,119.2 cm3 ± 863.5 (range, 134.0-3,589.0 cm3). RESULTS Technical success was achieved in 100% of patients, and 30-day clinical success was achieved in 66% of patients. Recurrent bleeding and mortality rates within 30 days of embolization were 34% and 44%, respectively. No complications related to the embolization procedure occurred. Lower MBP (P = .003), greater number of RBC units transfused (P = .003), greater volume of hematoma (P = .04), and IPH location (P = .02) were associated with decreased clinical success. Clinical failure (P = .00002), lower MBP (P = .004), greater number of RBC units transfused (P = .002), and IPH location (P = .01) were significantly associated with higher 30-day mortality rates. CONCLUSIONS Transcatheter arterial embolization with NBCA-MS is safe and effective in treating refractory soft-tissue bleeding in anticoagulated patients despite the high mortality rates associated with this patient population.
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Affiliation(s)
- Rany Jawhari
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon, France
| | - Philippe d'Athis
- Department of Epidemiology and Biostatistics, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon, France
| | - Sophie Gehin
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon, France
| | - Pierre-Emmanuel Charles
- Department of Medical Intensive Care, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, 14 Rue Gaffarel, BP 77908, 21079 Dijon, France.
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Landecy M, Paquette B, Revel L, Behr J, Badet N, Delabrousse E. Does IV contrast extravasation on CT in anticoagulant-related rectus sheath and iliopsoas hematoma predict hematoma expansion and patient outcomes? Abdom Radiol (NY) 2016; 41:2241-2247. [PMID: 27405643 DOI: 10.1007/s00261-016-0818-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of the study was to evaluate if IV contrast extravasation on CT in anticoagulant-related rectus sheath and iliopsoas hematoma predict hematoma expansion and patient outcomes. MATERIALS AND METHODS All patients presented with anticoagulation-related spontaneous IP hematoma or RS hematoma and who underwent contrast-enhanced CT exploration, with injection of a contrast material, from January 2012 to January 2015 in our institution were included in this study. Considering the retrospective nature of our study, our institutional review board judged our study to be exempted from ethical approval and no patient consent was required. Computed tomography (CT) images were retrospectively analyzed blindly of the evolution and treatment of hematomas. The type of muscle involved; the presence of contrast extravasation after contrast injection; the volume of the hematoma, as well as, clinical and biological results (hemoglobin value g/dL); and for each patient, the type of anticoagulation used, patient's treatment and outcomes were noted. The analyses were conducted using R 3.1.0. All statistical tests were 2-sided, and probability values <0.05 were regarded as significant. RESULTS Sixty-eight patients were reviewed. Among 68 patients, 44 (65%) patients presented spontaneous IP hematoma and 24/68 (35%) a RS hematoma. There were 37 men (54%) and 31 (46%) women, ranging from 39 to 93 years with a median age of 75 years. Hemodynamic instability was statistically associated with IP hematomas and large volume of hematoma (p < 0.001). Only 15 patients had follow-up CT, 10 without and with IV contrast, 2 with IV contrast only, and 3 without contrast. Follow-up CT was performed from J0 to J8. Detection of contrast extravasation did not appear related to hemodynamically instability (p = 0.35), to a neurological deficit (p = 1), or to the increase in the volume of the hematoma on follow-up CT (p = 0.81). The different types of anticoagulant were not related to muscular type more than the other (p = 0.9). Among anticoagulant therapy, only vitamin K antagonist therapy was statistically associated with surgery (p = 0.04). CONCLUSION CT extravasation of contrast material in IP and RS hematoma does not appear to be related with clinical criteria of severity, and therefore should not be solely considered as a radiological decision criteria.
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Affiliation(s)
- Marie Landecy
- Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - Brice Paquette
- Department of Visceral Surgery, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - Lucie Revel
- Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - Julien Behr
- Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - Nicolas Badet
- Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France.
- EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, Besançon, France.
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A rare cause of acute abdomen – Spontaneous rectus sheath hematoma. Asian Pac J Trop Biomed 2016. [DOI: 10.1016/j.apjtb.2016.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Transcatheter Arterial Embolization with N-Butyl-2-Cyanoacrylate in the Management of Spontaneous Hematomas. Cardiovasc Intervent Radiol 2016; 40:41-49. [PMID: 27646523 DOI: 10.1007/s00270-016-1463-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/09/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Spontaneous hematoma refractory to conservative management is a potentially serious condition that requires prompt diagnosis and intervention. The purpose of this study was to evaluate the performance of computed tomography (CT) in the treatment planning and to report the effectiveness of transcatheter embolization with N-butyl-2-cyanoacrylate (NBCA). MATERIALS AND METHODS Forty-one interventions in 38 patients within a 12-year period were evaluated. CT and angiograms were reviewed for the location of the hematoma, the presence of extravasation, and the correlation of CT and angiography findings. RESULTS Arterial extravasation was present on 34/39 CT scans. Angiograms confirmed the CT scans in 29 cases. Angiograms revealed extravasation in four cases which CT showed venous bleeding (n = 2) or no bleeding (n = 2). Five patients with arterial and 1 patient with venous extravasation on CT images had no extravasation on angiograms. Embolization was performed to all arteries with extravasation on angiograms. Empiric embolization of the corresponding artery on the CT was performed when there was no extravasation on angiograms. Embolization procedures were performed with 15 % NBCA diluted with iodized oil. Technical success was achieved in 40/41 (97.6 %) interventions. Clinical success was achieved in 35 patients with a single, in 1 patient with 2, and in 1 patient with 3 interventions. No complications related to embolization procedure occurred. None of the patients died due to a progression of the hematoma. CONCLUSION NBCA is an effective and safe embolic agent to treat hematoma refractory to conservative management. Contrast-enhanced CT may provide faster and more effective intervention. LEVEL OF EVIDENCE III Retrospective.
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Mendoza Moreno F, Díez Alonso M, Villeta Plaza R, Minaya Bravo AM, Ovejero Merino E, Córdova García DM, Granell Vicent J. Spontaneous haematoma of the anterior rectus abdominis muscle. Cir Esp 2016; 94:294-9. [PMID: 27021620 DOI: 10.1016/j.ciresp.2016.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Spontaneous haematoma of the rectus abdominis muscle is an uncommon cause of abdominal pain. It occurs mostly in anticoagulated patients. The objective of this paper is to analyse the onset, diagnosis and treatment in patients under anticoagulant therapy. METHODS A retrospective analysis of a prospectively maintained database of all patients with a diagnosis of spontaneous hematoma of the abdominal rectus muscle between March 2003 and December 2014. RESULTS The study included 34 patients, of whom 28 were women, with an average age of 80 years old. All the patients showed a unilateral infraumbilical haematoma. Twenty- 8 patients had received long-term anticoagulant treatment (26 with acenocumarol and 2 low molecular weight heparin); and 6 patients were under anticoagulant prophylaxis with low molecular weight heparin. The diagnosis was performed with ultrasound in 7 cases, computed tomography angiography in 27 patients, and with both methods in 6 cases. The treatment consisted of stopping the anticoagulant drug, correcting haemostasis parameters and blood transfusion when required. Ten patients displayed active bleeding in the computed tomography angiography, and 8 underwent selective arterial embolization. The evolution was successful in 34 patients, however, 2 patients required surgery and, finally, died due to persistent haemorrhage. CONCLUSION Spontaneous haematoma of the rectus abdominis muscle is more frequent in elderly women under oral anticoagulant treatment. Non-operative treatment is successful in most cases. Computed tomography angiography is useful to determine which patients could benefit from selective arterial embolization.
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Affiliation(s)
- Fernando Mendoza Moreno
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España.
| | - Manuel Díez Alonso
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España
| | - Rafael Villeta Plaza
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España
| | - Ana María Minaya Bravo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España
| | - Enrique Ovejero Merino
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España
| | - Diego Martín Córdova García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España
| | - Javier Granell Vicent
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares (Madrid), España
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Sreenivas J, Karthikeyan VS, SampathKumar N, Umesha L. Spontaneous rectus sheath haematoma in a deceased donor renal transplant recipient: a rare complication. BMJ Case Rep 2016; 2016:bcr-2015-214144. [PMID: 26847807 DOI: 10.1136/bcr-2015-214144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Rectus sheath haematoma (RSH) is rarely thought of as a cause of abdominal pain in renal transplant recipients. A 36-year-old woman, a post-deceased donor renal allograft transplant recipient for chronic interstitial nephritis, on triple drug immunosuppression (tacrolimus, mycophenolate mofetil and prednisolone) with basiliximab induction, developed acute vascular rejection and acute tubular injury with suspected antibody-mediated rejection. While on plasmapheresis and haemodialysis for delayed graft function, she developed acute left lower abdominal pain on the 16th postoperative day with tender swelling in the left paraumbilical region. CT of the abdomen showed a large haematoma in the left rectus sheath with no extension. The patient underwent haematoma evacuation through a left paramedian incision and had an uneventful recovery. Serum creatinine stabilised at 0.8 mg/dL and she is on regular follow-up with excellent graft function at 6 months. Diagnosis requires a high index of suspicion, and prompt treatment prevents morbidity and can expedite patient recovery.
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Affiliation(s)
- Jayaram Sreenivas
- Department of Urology, Institute of Nephro Urology, Bangalore, Karnataka, India
| | | | - Nathee SampathKumar
- Department of Urology, Institute of Nephro Urology, Bangalore, Karnataka, India
| | - Lingaraju Umesha
- Department of Nephrology, Institute of Nephro Urology, Bangalore, Karnataka, India
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Isik A, Peker K, Soyturk M, Firat D, Yoruker U, Yilmaz I. Diagnostic evaluation and treatment of patients with rectus abdominis hematoma. Cir Esp 2015; 93:580-588. [PMID: 26048431 DOI: 10.1016/j.ciresp.2015.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/12/2015] [Accepted: 02/27/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE To identify clinical characteristics, treatment modalities, and course of spontaneous rectus sheath hematoma (SRSH). In the literature, there is no prospective clinical trial that is intended for treatment in clinical research. METHODS Seventeen SRSH patients diagnosed and treated between March 2012 and March 2014 at the general Surgery Department of Erzincan University Training and Research Hospital were included. Age, sex, weight, height, predisposing factors, comorbid diseases, Charlson index, current medical treatment, physical examination signs, imaging methods, lowest hemoglobin value, blood type, SRSH type, INR/Factor V Leiden mutation/Factor VII/Factor VIII/Factor X/Protein S/Protein C values, treatment method, transfusions hospitalization duration, and outcome were studied. RESULTS Thirteen patients were female. The mean age was 63.3 ± 18.7 years (range, 22-87 years), and the mean BMI was 27.8 ± 3.5 (range, 20.9-33.7). Six patients had Grade I SRSH, 5 had Grade II SRSH, and 6 had Grade III SRSH. Thirteen were hospitalized for a mean duration of 9.3 ± 8.1 days (range, 1-30 days). The death rate attributable to SRSH was 5.8%. CONCLUSION Early diagnosis of SRSH by ultrasonography and/or computerized tomography is important for a low mortality rate. Even though medical treatments are important, arterial embolization by interventional radiology, or more radical interventions such as surgery, may be required.
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Affiliation(s)
- Arda Isik
- Departamento de Cirugía General, Universidad de Erzincan, Erzincan, Turquía.
| | - Kemal Peker
- Departamento de Cirugía General, Universidad de Erzincan, Erzincan, Turquía
| | - Mehmet Soyturk
- Departamento de Radiología, Universidad de Erzincan, Erzincan, Turquía
| | - Deniz Firat
- Departamento de Cirugía General, Universidad de Erzincan, Erzincan, Turquía
| | - Uygar Yoruker
- Departamento de Cirugía Cardiovascular, Universidad de Erzincan, Erzincan, Turquía
| | - Ismayil Yilmaz
- Departamento de Cirugía General, Universidad de Erzincan, Erzincan, Turquía
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Bodmer NA, Thakrar KH. Evaluating the Patient with Left Lower Quadrant Abdominal Pain. Radiol Clin North Am 2015; 53:1171-88. [PMID: 26526432 DOI: 10.1016/j.rcl.2015.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Left lower quadrant pain is a frequent indication for imaging in the emergency department. Most causes of pain originate from the colon, including diverticulitis, colitis, fecal impaction, and epiploic appendagitis. Left-sided urolithiasis and spontaneous hemorrhage in the retroperitoneum or rectus sheath are additional causes of pain. Computed tomography is the preferred imaging modality in the emergent setting for all of these pathologic conditions. Gynecologic, testicular, and neoplastic pathology may also cause left lower quadrant pain but are not discussed in this article.
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Affiliation(s)
- Nicholas A Bodmer
- Department of Radiology, Advocate Good Samaritan Hospital, 3815 Highland Avenue, Downers Grove, IL 60515, USA.
| | - Kiran H Thakrar
- Department of Radiology, Evanston NorthShore University, 2650 Ridge Avenue, Evanston, IL 60201, USA
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Tas Tuna A, Palabiyik O, Beyaz SG. Retracted: Spontaneous rectus sheath haematoma associated with rivaroxaban treatment. J Clin Pharm Ther 2015; 40:486-8. [PMID: 25381906 DOI: 10.1111/jcpt.12228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/07/2014] [Indexed: 11/28/2022]
Abstract
http://onlinelibrary.wiley.com/doi/10.1111/jcpt.12228/pdf The above article, published online on 10 November 2014 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor in Chief, A. Li Wan Po, and John Wiley & Sons Ltd. The retraction has been agreed because, unknown to the authors, another group published a similar study based on the same material in the Indian Journal of Pharmacology: Kocayigit I, Can Y, Sahinkus S, et al. Spontaneous rectus sheath haematoma during rivaroxaban therapy. Indian Journal of Pharmacology. 2014;46(3):339-340. doi:10.4103/0253-7613.132193.
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Affiliation(s)
- A Tas Tuna
- Department of Anaesthesiology and Reanimation, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - O Palabiyik
- Department of Anaesthesiology and Reanimation, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - S G Beyaz
- Department of Anaesthesiology and Reanimation, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Spontaneous soft-tissue hemorrhage in anticoagulated patients: safety and efficacy of embolization. AJR Am J Roentgenol 2015; 204:1303-10. [PMID: 26001242 DOI: 10.2214/ajr.14.12578] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this study was to report the effectiveness and safety of selective arterial embolization for the management of anticoagulation-related soft-tissue bleeding. MATERIALS AND METHODS All consecutive patients from June 1, 2003, to June 1, 2010, with intractable anticoagulation-related soft-tissue bleeding treated by embolization were included. The clinical files, MDCT angiographic examinations, and procedure details were reviewed. The primary goal of this study was to report the safety and efficacy of embolization for the management of anticoagulation-related soft-tissue bleeding. The secondary goal was to evaluate the correlation between the MDCT angiography (MDCTA) findings and conventional catheter angiography. RESULTS Thirty-six consecutive patients were included. All patients were under anticoagulant therapy. Overdosage of the anticoagulant was found in 12 (33%) patients. MDCT was performed with multiphasic contrast media injection in 30 patients (83%) and showed extravasation in 22 (73.3%) of those 30 patients. Catheter angiography revealed extravasation in 27 of 36 (75%) patients, and no active bleeding was observed in nine patients who were empirically embolized. The sensitivity of MDCTA for depicting ongoing active bleeding was 87%. The transfusion requirement for RBC units decreased from 4.0 (range, 0-12.0) before to 0 (range, 0-4.0) after embolization. Nine patients underwent a second embolization but only one in the same vascular territory. Eleven patients died within 30 days despite the embolization. No complications related to embolization were reported. CONCLUSION Anticoagulation-related soft-tissue bleeding can be efficiently and safely treated by selective arterial embolization. However, this serious pathologic condition may be fatal in many cases, and rebleeding is not rare. MDCTA could help to guide treatment.
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Dohan A, Darnige L, Sapoval M, Pellerin O. Spontaneous soft tissue hematomas. Diagn Interv Imaging 2015; 96:789-96. [PMID: 26066549 DOI: 10.1016/j.diii.2015.03.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
Spontaneous muscle hematomas are a common and serious complication of anticoagulant treatment. The incidence of this event has increased along with the rise in the number of patients receiving anticoagulants. Radiological management is both diagnostic and interventional. Computed tomography angiography (CTA) is the main tool for the detection of hemorrhage to obtain a positive, topographic diagnosis and determine the severity. Detection of an active leak of contrast material during the arterial or venous phase is an indication for the use of arterial embolization. In addition, the interventional radiological procedure can be planned with CTA. Arterial embolization of the pedicles that are the source of the bleeding is an effective technique. The rate of technical and clinical success is 90% and 86%, respectively.
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Affiliation(s)
- A Dohan
- Université Paris-Diderot, 10, rue de Verdun, 75010 Paris, France; Inserm U965, French National Institute for Health and Medical Research Unit 965, France; Assistance publique-Hôpitaux de Paris, Hôpital Lariboisière, Visceral and Vascular Radiology Department, 2, rue Ambroise-Paré, 75475 Paris, France
| | - L Darnige
- Faculté de médecine, Université Paris Descartes Sorbonne Paris Cité Assistance Public Hôpitaux de Paris, Hôpital Européen Georges Pompidou Hematology Department, 20, rue Leblanc, 75015 Paris, France
| | - M Sapoval
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15, rue de l'École de Médecine, 75006 Paris, France; INSERM U970, Faculté de médecine, Université Paris Descartes Sorbonne Paris Cité Assistance Public Hôpitaux de Paris, Hôpital Européen Georges Pompidou Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France; Assistance publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France
| | - O Pellerin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 15, rue de l'École de Médecine, 75006 Paris, France; INSERM U970, Faculté de médecine, Université Paris Descartes Sorbonne Paris Cité Assistance Public Hôpitaux de Paris, Hôpital Européen Georges Pompidou Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France; Assistance publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Vascular and Oncological Interventional Radiology Department, 20, rue Leblanc, 75015 Paris, France.
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Lee SB, Park SJ, Yeo KH, Kim HH, Park CY, Kim JH, Kim CW, Choi SU, Kim SH, Hwang JJ, Cho HM. Successful Angiographic Embolization of Superficial Circumflex Iliac Artery Rupture Caused by Blunt Abdominal Trauma: A Case Report. JOURNAL OF TRAUMA AND INJURY 2015. [DOI: 10.20408/jti.2015.28.1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sang Bong Lee
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Sung Jin Park
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Kwang Hee Yeo
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Ho Hyun Kim
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Chan-Yong Park
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Jae Hun Kim
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Chang Wan Kim
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Seon Uoo Choi
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Seon Hee Kim
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Jung Joo Hwang
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
| | - Hyun Min Cho
- Department of Trauma Surgery, Pusan National University Hospital, Busan, Korea
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Waseem T, Latif H, Shabbir B. An unusual cause of acute abdominal pain in dengue fever. Am J Emerg Med 2014; 32:819.e3-4. [DOI: 10.1016/j.ajem.2014.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 01/11/2014] [Indexed: 10/25/2022] Open
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Spontaneous rectus sheath hematoma in the elderly: an unusual case and update on proper management. Case Rep Emerg Med 2014; 2014:675678. [PMID: 24839570 PMCID: PMC4006569 DOI: 10.1155/2014/675678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 02/16/2014] [Indexed: 11/18/2022] Open
Abstract
Spontaneous rectus sheath hematoma (SRSH) is an uncommon medical emergency in the elderly. We present a case of SRSH with an atypical clinical presentation and discuss literature regarding diagnosis and proper management. A 75-year-old female patient was transferred to the emergency department due to acute dyspnoea and confusion. Her medical history revealed a viral infection of the upper respiratory tract, and no coughing or use of anticoagulants. The clinical examination showed tenderness of the left lower abdomen, although palpation was misleading due to patient's obesity. Laboratory investigations showed light anaemia. Ultrasonography and computed tomography revealed a large rectus sheath hematoma of the left abdominal wall. Despite further deterioration of the patient, conservative management including bed rest, fluid replacement, blood products transfusion, and proper analgesia was successful. No surgical intervention was needed. Prompt diagnosis and management of SRSH plays significant role in the prognosis, especially in elder patients. Independently of size and severity, conservative management remains the first therapeutic choice. Only by failure of supportive management, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated.
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Feizzadeh Kerigh B, Maddah G. Bilateral rectus sheath hematoma in kidney transplant patient: case study and literature review. Nephrourol Mon 2013; 5:921-3. [PMID: 24350093 PMCID: PMC3842565 DOI: 10.5812/numonthly.9577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/08/2013] [Indexed: 11/16/2022] Open
Abstract
Rectus sheath hematoma usually occurs unilateral but rare cases of bilateral hematoma have been reported. Herein we report the first case of spontaneous bilateral Rectus Sheath Hematoma in the kidney transplanted patient.
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Affiliation(s)
- Behzad Feizzadeh Kerigh
- Urology Department, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Behzad Feizzadeh Kerigh, Surgery Department, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118012857, Fax: +98-5118417404, E-mail:
| | - Ghodratolah Maddah
- Urology Department, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Endovascular treatment of spontaneous extraperitoneal haemorrhage: immediate and long-term clinical efficiency. LA RADIOLOGIA MEDICA 2013; 119:121-7. [DOI: 10.1007/s11547-013-0321-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 07/06/2012] [Indexed: 10/26/2022]
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