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Luo Y, Li Q, Liao Z, Luo Z. Unusual case of retroperitoneal hematoma and duodenal ulcerative bleeding after nephrectomy: Case report. Medicine (Baltimore) 2024; 103:e33765. [PMID: 38306569 PMCID: PMC10843467 DOI: 10.1097/md.0000000000033765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/24/2023] [Indexed: 02/04/2024] Open
Abstract
RATIONALE Retroperitoneal hematomas are relatively common in patients undergoing nephrectomy. Herein, we report an unusual case involving a giant retroperitoneal hematoma and subsequent duodenal ulcerative bleeding following a radical nephrectomy. PATIENT CONCERNS A 77-year-old woman was admitted to our hospital for lower back pain, and she had severe right hydronephrosis and a urinary tract infection. DIAGNOSES The patient was diagnosed and confirmed as high-grade urothelial carcinoma. INTERVENTIONS After ineffective conservative treatments, a right radical nephrectomy and ureteral stump resection were performed. The patient received proton pump inhibitors to prevent stress ulcer formation and bleeding. On the first day post-surgery, she had normal gastrointestinal (GI) endoscopy findings. On the second day post-surgery, abdominal computed tomography revealed a retroperitoneal hematoma. Notably, 14 days post-surgery, massive GI bleeding occurred, and GI endoscopy identified an almost perforated ulcer in the bulbar and descending duodenum. OUTCOMES The patient died on day 15 after surgery. LESSONS Duodenal ulceration and bleeding might occur following a retroperitoneal hematoma in patients treated with nephrectomy. Timely intervention may prevent duodenal ulcers and complications, and thus could be a promising life-saving intercession.
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Affiliation(s)
- Yong Luo
- Hengyang Medical School, University of South China; Trauma Centre & Emergency Department, The Second Affiliated Hospital of the University of South China, Hengyang, P.R. China
| | - Qing Li
- Hengyang Medical School, University of South China; Trauma Centre & Emergency Department, The Second Affiliated Hospital of the University of South China, Hengyang, P.R. China
| | - Zhanchen Liao
- Trauma Centre & Emergency Department, and Institute of Urology and Organ Transplantation, The Second Affiliated Hospital of the University of South China, Hengyang, P.R. China
| | - Zhigang Luo
- Trauma Centre & Emergency Department, and Institute of Urology and Organ Transplantation, The Second Affiliated Hospital of the University of South China, Hengyang, P.R. China
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2
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Ayyappan S, Shekhawat RS, Meshram VP, Kanchan T. Spontaneous retroperitoneal and intracranial hemorrhage following streptokinase therapy in acute myocardial infarction: An autopsy case report. J Forensic Sci 2024; 69:346-350. [PMID: 37904604 DOI: 10.1111/1556-4029.15418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/01/2023]
Abstract
Bleeding complications following thrombolytic treatment for acute myocardial infarction (AMI) are not infrequent, among which intracranial hemorrhage is commonly reported. In contrast, retroperitoneal hematoma following the administration of thrombolytics is rarely reported in the literature. We are reporting a case of a middle-aged man, who presented with left-sided chest pain and was diagnosed with acute coronary syndrome with anterior wall ST elevation AMI. The patient was administered with thrombolytic drugs, including streptokinase and heparin. Percutaneous coronary intervention in the form of Coronary angioplasty with stent insertion was done to the left anterior descending artery, given coronary artery disease. The blood investigations showed elevated activated partial thromboplastin time and prothrombin time. The patient developed vomiting, altered sensorium, and left-sided weakness, and a non-contrast computerized tomography brain was done, which showed acute hemorrhage involving the right frontal lobe with intraventricular extension, so the ventricular drain was placed. The patient developed cardiac arrest and died on the third day. On autopsy examination, the brain showed subarachnoid hemorrhage, intraparenchymal hemorrhage over the right frontal lobe, and clotted blood in all the ventricles. A retroperitoneal hematoma of around 1500 cc was seen over the left side of the peritoneal cavity. This case highlights that although intracranial hemorrhage is a known complication after administrating thrombolytic therapy, clinicians should also be aware of the possibility of retroperitoneal hemorrhage. This case emphasizes the value of an autopsy in determining the cause of death in such situations.
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Affiliation(s)
- Sathish Ayyappan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Raghvendra Singh Shekhawat
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vikas P Meshram
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Tanuj Kanchan
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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3
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Magriço M, Marto JP. Grey-Turner sign disclosing ischemic stroke reperfusion therapy complication. Acta Neurol Belg 2023; 123:2339-2340. [PMID: 37310648 DOI: 10.1007/s13760-023-02306-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Marta Magriço
- Department of Neurology, Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Rua da Junqueira 126, 1349-019, Lisbon, Portugal.
| | - João Pedro Marto
- Department of Neurology, Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Rua da Junqueira 126, 1349-019, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
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4
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Agstam S, Sharma V, Sardar S, Roy A. Bladder indentation sign: A stitch in time can save mine. J Invasive Cardiol 2023; 35. [PMID: 37992327 DOI: 10.25270/jic/23.00211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
A 70-year-old woman with diabetes presented with recurrent episodes of rest angina the previous month. She had undergone coronary angiography, which was suggestive of triple vessel disease.
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Affiliation(s)
- Sourabh Agstam
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vibhav Sharma
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Sardar
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
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5
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Pokharel P, Araim F, Adekunle F. Pelvic Hematoma With Acute Hemorrhage Secondary to Inferior Vena Cava Filters. Cureus 2023; 15:e46652. [PMID: 37937029 PMCID: PMC10627731 DOI: 10.7759/cureus.46652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/09/2023] Open
Abstract
Recurrent deep vein thrombosis (DVT) and inferior vena cava (IVC) thrombosis are well-known complications of inferior vena cava filters (IVCFs); however, pelvic hematoma is a rare finding. In this study, we present a case of a 41-year-old female who presented with severe abdominal pain. Extensive bilateral lower extremity DVT, thrombosis extending up to the level of IVCF, and a pelvic hematoma with acute hemorrhage were diagnosed. Mechanical thrombectomy of the IVC, bilateral iliac, and femoral veins with stent placement in the external iliac veins was performed under general anesthesia. This rarely reported case remains a challenge to diagnose and treat because of its complex mechanisms and multiple risk factors. Our case highlights the importance of the surgical strategy adopted and the need for a good initial assessment.
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Affiliation(s)
| | - Fawaz Araim
- Department of Surgery, St. Agnes Hospital, Baltimore, USA
| | - Faith Adekunle
- Medicine, School of Medicine, American University of the Carribbean, Cupecoy, SXM
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6
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Santiago LE, Alvi AT, Hong AM, Pasarin A, Aneja P. Ileocecal Mesentery Arteriovenous Malformation as a Rare Cause of Ectopic Variceal Bleeding in a 58-Year-Old Male With Cirrhosis. Cureus 2023; 15:e45785. [PMID: 37872923 PMCID: PMC10590625 DOI: 10.7759/cureus.45785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
Ectopic varices can be defined as dilated portosystemic venous collaterals that are located at a site other than the esophagus or stomach. These varices can be seen in patients with underlying portal hypertension, but bleeding from them is quite rare. The bleeding usually occurs in patients with a history of intra-abdominal surgery and adhesions. These varices are commonly found in the duodenum or rectum, but they can be present anywhere along the gastrointestinal tract. Currently, there are no well-established guidelines regarding the diagnosis and management of these variceal bleeds, and further investigations with randomized controlled or large-scale trials are required. Here, we report an unusual case of ectopic variceal bleeding from an ileal arteriovenous malformation (AVM), which presented as syncope associated with an acute abdomen in a patient with no prior history of intra-abdominal surgery.
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Affiliation(s)
- Luis E Santiago
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
| | - Ali Tariq Alvi
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
| | - Angelina M Hong
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
| | - Anthony Pasarin
- General Surgery, HCA Florida Westside Hospital, Plantation, USA
- General Surgery, HCA Florida Northwest Hospital, Margate, USA
| | - Pallavi Aneja
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
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7
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Fujikawa T, Nagata K, Matsuoka T, Yamana I. Massive Retroperitoneal Hematoma After Inguinal Hernia Repair Using Prolene® Hernia System: A Case Report. Cureus 2023; 15:e43300. [PMID: 37692599 PMCID: PMC10492651 DOI: 10.7759/cureus.43300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Retroperitoneal hematoma is a possibly fatal condition that is frequently observed as a complication of procedures such as femoral artery catheterizations. We currently present a case of massive retroperitoneal hematoma after inguinal hernioplasty using Prolene® Hernia System mesh in a warfarin-treated patient. Especially in the case of inguinal hernioplasty in a patient receiving warfarin therapy, surgeons must pay close attention to prevent hemorrhage from the preperitoneal space, or they may opt for a different technique, such as the Lichtenstein method or laparoscopic approach.
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Affiliation(s)
| | - Keiji Nagata
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
| | | | - Ippei Yamana
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
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8
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DeLeon AM, Gande M, Garcia Tomas V. Spontaneous Retroperitoneal Hematoma After Total Hip Arthroplasty. Cureus 2023; 15:e38971. [PMID: 37193095 PMCID: PMC10182854 DOI: 10.7759/cureus.38971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 05/18/2023] Open
Abstract
Spontaneous retroperitoneal hematomas are a rare yet potentially devastating occurrence associated with antiplatelet and anticoagulant therapies. We present a case of a spontaneous retroperitoneal hematoma post-operatively after a total hip arthroplasty surgery performed under a midline approach spinal anesthetic. A 79-year-old male with a BMI of 25.72 kg/m2 presented for anterior total hip arthroplasty. A midline approach with an uncomplicated spinal anesthetic was performed. On the night of postoperative day 0, the patient received a prophylactic dose of dalteparin. The patient reported back pain, contralateral leg numbness, and weakness that began overnight on postoperative day 0. A computed tomography (CT) scan confirmed a 10 cm, contralateral retroperitoneal hematoma. The patient underwent interventional radiology embolization followed by surgical evacuation and demonstrated improvement in the neurologic function of his affected leg. Despite the rarity of a spontaneous retroperitoneal hematoma formation in the perioperative period, it could be simultaneously evaluated when performing an MRI to rule out spinal hematoma if a patient suffers a post-op neurologic deficit after a neuraxial technique. Understanding the evaluation and timely treatment of patients at risk for a perioperative retroperitoneal hematoma could help clinicians prevent a permanent neurologic deficit.
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Affiliation(s)
- Alexander M DeLeon
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Mukund Gande
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Vicente Garcia Tomas
- Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, USA
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9
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Yamazaki M, Nagao T, Kono K, Kanda T, Tomonaga A, Ito K. Abdominal compartment syndrome secondary to a large retroperitoneal hematoma caused by ruptured gastroduodenal artery pseudoaneurysms in a patient with severe acute pancreatitis. Acute Med Surg 2023; 10:e866. [PMID: 37387799 PMCID: PMC10301691 DOI: 10.1002/ams2.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 07/01/2023] Open
Abstract
Background Abdominal compartment syndrome (ACS) is a known complication of severe acute pancreatitis. It is typically secondary to visceral edema and aggressive fluid resuscitation, but rarely caused by a retroperitoneal hematoma due to ruptured visceral pseudoaneurysms. Case Presentation A 49-year-old man presented in shock with a history of heavy alcohol use and was transferred to the intensive care unit with a diagnosis of severe acute pancreatitis. Computed tomography scan on hospital day 2 revealed a large retroperitoneal hematoma due to ruptured gastroduodenal artery pseudoaneurysms. Despite adequate resuscitation, the patient developed ACS, which required decompressive laparotomy on hospital day 10. Open abdominal management was continued until multiorgan failure resolved. He was eventually discharged to a rehabilitation hospital 3 months after presenting. Conclusion We report a patient with severe acute pancreatitis who underwent decompressive laparotomy for ACS secondary to a large retroperitoneal hematoma due to ruptured gastroduodenal artery pseudoaneurysms.
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Affiliation(s)
- Maiko Yamazaki
- Department of Emergency MedicineTeikyo University School of MedicineTokyoJapan
| | - Tsuyoshi Nagao
- Department of Emergency MedicineTeikyo University School of MedicineTokyoJapan
- Department of Surgery, Division of Acute Care SurgeryTeikyo University School of MedicineTokyoJapan
| | - Kaori Kono
- Department of Emergency MedicineTeikyo University School of MedicineTokyoJapan
| | - Tomoki Kanda
- Department of Emergency MedicineTeikyo University School of MedicineTokyoJapan
| | - Ayumi Tomonaga
- Department of Emergency MedicineTeikyo University School of MedicineTokyoJapan
| | - Kaori Ito
- Department of Surgery, Division of Acute Care SurgeryTeikyo University School of MedicineTokyoJapan
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10
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Muacevic A, Adler JR, Viveiros C, S. Santos M, Esteves J. Monoclonal Gammopathy of Renal Significance and Thrombotic Microangiopathy: A Case Report. Cureus 2022; 14:e32753. [PMID: 36686103 PMCID: PMC9851652 DOI: 10.7759/cureus.32753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Monoclonal gammopathy of renal significance (MGRS) is a group of pathologies that includes all kidney disorders related to a monoclonal protein in patients without diagnostic criteria for B-cell malignancies. There are multiple MGRS-associated kidney disorders, and more are still being discovered, which makes this diagnosis challenging. The relationship between monoclonal gammopathies and thrombotic microangiopathy (TMA) is of growing interest in literature. This article describes the case of a patient with newly diagnosed MGRS, presenting with rapidly progressing kidney failure and with histologic characteristics of TMA. The patient progressed to end-stage renal disease (ESRD) despite treatment with plasmapheresis and clone-directed therapy, as is currently advised in the literature. Although rare, the association between these two entities should not be unnoticed because of patients' renal and vital prognosis.
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11
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Fu Y, Li R, Mao X, Zhao X, Cheng C, Xu D. Spontaneous rupture of an ovarian artery during pregnancy: A case report and literature review. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022; 47:1615-1621. [PMID: 36481641 PMCID: PMC10930614 DOI: 10.11817/j.issn.1672-7347.2022.220350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Indexed: 12/13/2022]
Abstract
Spontaneous rupture of the ovarian artery is very rare and can cause retroperitoneal hemorrhage, which is seriously life-threatening. Herein, we reported a case of massive retroperitoneal hematoma caused by spontaneous rupture of the right ovarian artery during pregnancy and intrauterine fetal death. A 32-year-old woman, gravida 6 para 5, had non-specific right lower abdomen and low back pain in the third trimester. Emergency cesarean section was performed due to the increased pain and decreased fetal heart rate. A huge retroperitoneal hematoma and intrauterine fetal death were found. Then, the abdomen was closed due to unknown source of bleeding and unstable vital signs. Computed tomography scan was conducted to clarify the extent of the retroperitoneal hematoma. Digital subtraction angiography confirmed the rupture of the right ovarian artery. A transcatheter artery embolization was successfully performed to control the bleeding. The patient ultimately recovered well after surgery.
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Affiliation(s)
- Yingqin Fu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Ruizhen Li
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xuetao Mao
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Xingping Zhao
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Chunxia Cheng
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
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12
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Fujiwara T, Ikeda H, Kuriyama A, Ono T, Takada K, Handa A, Uezato M, Kinosada M, Kurosaki Y, Chin M. Inferior Epigastric Artery Injury due to Femoral Venipuncture for Neuroendovascular Intervention: Two Cases Requiring Transcatheter Arterial Embolization. J Neuroendovasc Ther 2022; 16:467-473. [PMID: 37502792 PMCID: PMC10370989 DOI: 10.5797/jnet.cr.2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/01/2022] [Indexed: 07/29/2023]
Abstract
Objective Injury to the inferior epigastric artery (IEA) caused by femoral puncture may lead to retroperitoneal hematoma. We report on two cases of IEA injury due to femoral venipuncture for neuroendovascular intervention that resulted in hemorrhagic shock and required transcatheter arterial embolization. Case Presentations A 67-year-old woman and a 71-year-old man receiving dual antiplatelet therapy sustained injury to a branch of the IEA in the process of right femoral venipuncture for neuroendovascular intervention. In both cases, stent placement in the intracranial artery was accomplished as intended with systemic heparinization throughout the procedure; however, the patients became hypotensive during the procedure, and contrast-enhanced CT scans taken after the stenting revealed extravasation of contrast from the IEA and retroperitoneal hematoma. Transcatheter arterial embolization of the bleeding branch of the IEA was performed with the left femoral approach, and subsequent angiography confirmed the disappearance of the extravasation of contrast. Conclusion Femoral venipuncture for neuroendovascular intervention in patients receiving antithrombotic agents may cause IEA injury requiring transcatheter arterial embolization. The risk of IEA injury may be reduced by using the femoral head as a reference, performing ultrasound-guided puncture, and confirming the course of the IEA by femoral angiography before venipuncture.
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Affiliation(s)
- Toshio Fujiwara
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Hiroyuki Ikeda
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takafumi Ono
- Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Kensuke Takada
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akira Handa
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Minami Uezato
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masanori Kinosada
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yoshitaka Kurosaki
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masaki Chin
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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Elikowski W, Fertała N, Zawodna-Marszałek M, Karoń J, Skrzywanek P, Mozer-Lisewska I, Szczęśniewski P, Łazowski S, Żytkiewicz M. Retroperitoneal hematoma in COVID-19 patients - case series. Pol Merkur Lekarski 2022; 50:118-123. [PMID: 35436275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED COVID-19 patients, particularly those with severe pulmonary involvement, are at an increased thromboembolic risk related, among various causes, to the cytokine storm and excessive activation of the coagulation cascade and platelets. Different intensity of anticoagulation for them is proposed, mainly with low molecular weight heparins (LMWHs); in a confirmed pulmonary embolism (PE) the therapeutic dose of LMWH is routinely used. Some authors suggest that hemorrhagic complications in COVID-19 patients are rare. At the same time, one can find reports on internal bleeding, including retroperitoneal hematoma (RPH) and other abdominal hematomas. CASE REPORTS The authors describe 5 cases (3 of those aged more than 80 years) with giant RPHs and with moderate/severe COVID-19 pneumonia, treated before RPH diagnosis with different enoxaparin doses. The therapeutic dose was given to the male with verified PE limited to the segmental/subsegmental pulmonary arteries and initially to the female in whom echocardiography was strongly suggestive of PE, yet this diagnosis was excluded on CT angiography. In one patient, the enoxaparin dose was escalated from 40 mg bd to 60 mg bd after the D-dimer increase. Two patients had bleeding complications despite the enoxaparin dose restricted to 40 mg/daily or bd. Two males had a coexistent psoas hematoma while in only one female there was a coexistent femoral hematoma. RPHs occurred between day 4 and 14 of hospitalization and all were treated conservatively. Three patients who died were particularly charged, so their deaths were not merely directly associated with RPH, which was closely analyzed in one autopsy performed. The authors underline that the choice of anticoagulation intensity in patients with COVID-19 pneumonia without venous thromboembolism seems sometimes difficult but recent publications indicate the low prophylactic enoxaparin dose as an optimal option. Anticoagulation dose escalation based only on the D-dimer level may not be appropriate for certain patients; moreover, the D-dimer increase is commonly observed during internal bleeding.
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Affiliation(s)
- Waldemar Elikowski
- Department of Internal Medicine, Józef Struś Hospital, temporarily: COVID-19 dedicated Hospital, Poznań, Poland
| | - Natalia Fertała
- Department of Internal Medicine, Józef Struś Hospital, temporarily: COVID-19 dedicated Hospital, Poznań, Poland
| | - Magdalena Zawodna-Marszałek
- Department of Internal Medicine, Józef Struś Hospital, temporarily: COVID-19 dedicated Hospital, Poznań, Poland
| | - Jacek Karoń
- Department of General and Colorectal Surgery, Józef Struś Hospital, temporarily: COVID-19 dedicated Hospital, Poznań, Poland
| | - Paweł Skrzywanek
- Radiology Unit, Józef Struś Hospital, temporarily: COVID-19 dedicated Hospital, Poznań, Poland
| | - Iwona Mozer-Lisewska
- Department of Infectious Diseases, Józef Struś Hospital, temporarily: COVID-19 dedicated Hospital, Poznań, Poland
| | - Patryk Szczęśniewski
- Intensive Care Unit, Józef Struś Hospital, temporarily: COVID-19 dedicated Hospital, Poznań, Poland
| | - Stanisław Łazowski
- Pathomorphology Unit, Józef Struś Hospital, temporarily: COVID-19 dedicated Hospital, Poznań, Poland
| | - Marcin Żytkiewicz
- Department of Internal Medicine, Józef Struś Hospital, temporarily: COVID-19 dedicated Hospital, Poznań, Poland
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14
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Decker JA, Brill LM, Orlowski U, Varga-Szemes A, Emrich T, Schoepf UJ, Schwarz F, Kröncke TJ, Scheurig-Münkler C. Spontaneous Iliopsoas Muscle Hemorrhage-Predictors of Associated Mortality. Acad Radiol 2022; 29:536-542. [PMID: 34176729 DOI: 10.1016/j.acra.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Spontaneous iliopsoas muscle hemorrhage (SIPH) is a rare clinical condition associated with high mortality. In this work we aimed to retrospectively investigate the predictors of mortality in a single-institution cohort of consecutive SIPH patients. MATERIALS AND METHODS Consecutive patients (n = 61, 30 men, 76 years [range 51-93]) with computed tomography (CT) confirmed diagnosis of SIPH were retrospectively included between January 2010 and April 2020. CT studies were assessed for signs of active bleeding, extramuscular retroperitoneal hematoma, visible sedimentation, and hematoma volume. Medication history, laboratory parameters, comorbidities, and disease management were also recorded. All parameters were subsequently examined with regard to their impact on outcome and survival. Univariate and multivariate Cox regressions were performed to identify variables associated with time to death. RESULTS The overall mortality was 22.9%. A total of 77% of patients received anticoagulant therapy prior to the onset of SIPH. Active bleeding in contrast enhanced CT (CECT) was the only independent variable associated with shorter survival (p = 0.01, hazard ratio 7.05 [1.45-34.20]). Hematoma volume or extramuscular retroperitoneal hematoma had no significant influence on short-term mortality. CONCLUSION Only active bleeding but not hematoma volume or extra-muscular bleeding is an independent risk factor for short-term mortality in patients with SIPH.
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15
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Kim TH, Lee DJ, Kim W, Do HK. Compressive femoral neuropathy caused by anticoagulant therapy induced retroperitoneal hematoma: A case report. Medicine (Baltimore) 2022; 101:e28876. [PMID: 35363199 PMCID: PMC9282122 DOI: 10.1097/md.0000000000028876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Spontaneous retroperitoneal hematomas due to anticoagulant therapy rarely occur. Retroperitoneal hematomas can cause severe pain in the groin, quadriceps femoris muscle weakness, hemodynamic instability, and abdominal distension. They rarely cause compressive neuropathy of the femoral nerve transversing the iliacus muscle. Differential diagnosis is not easy because they have similar clinical features to retroperitoneal hematomas. PATIENT CONCERNS A 72-year-old female patient whose right arm was stuck in a bookshelf for 5 days developed right cephalic vein thrombosis. After 5 days of intravenous heparin therapy for venous thrombosis, she presented with sudden right groin pain, right leg paresis, hemodynamic instability, and abdominal distension. DIAGNOSIS Emergency abdominal and pelvic CT showed a large number of hematomas in the bilateral retroperitoneal space with active bleeding of the right lumbar artery. An electrodiagnostic study was performed 2 weeks later to check for neuromuscular damage in the right lower extremity, and right compressive femoral neuropathy was confirmed. INTERVENTIONS Heparin therapy was discontinued; emergency embolization of the lumbar artery was performed. After 2 weeks, the patient started receiving physical, occupational, and transcutaneous electrical stimulation therapies. OUTCOMES She became hemodynamically stable after arterial embolization; a significant decrease in hematoma and patency of the femoral nerve was confirmed on follow-up pelvic MRI. After 2 months of comprehensive rehabilitation, the muscle strength of the right leg significantly improved, and the pain disappeared. LESSONS Although rare, spontaneous retroperitoneal hematomas may occur in patients receiving anticoagulant medications. They may even occur in patients receiving emergency anticoagulant therapy. Compressive femoral neuropathy due to retroperitoneal hematomas should be considered if muscle weakness and groin pain are observed. Early diagnosis and appropriate treatment plan of compressive femoral neuropathy due to retroperitoneal hematoma are helpful for a good prognosis.
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Affiliation(s)
- Tae-Hoon Kim
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Da-Jung Lee
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Wanil Kim
- Department of Biochemistry, Department of Convergence Medical Science, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Hwan-Kwon Do
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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16
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Tanal M, Celayir MF, Kale ZS. Unexpected tendency to bleeding in COVID-19 patients: A case of spontaneous retroperitoneal hematoma. SAGE Open Med Case Rep 2022; 9:2050313X211067907. [PMID: 34987821 PMCID: PMC8721400 DOI: 10.1177/2050313x211067907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022] Open
Abstract
While COVID-19 pandemic has become an enormous and devastating pandemic for today’s world, studies on the morbidity of the disease mainly show the disease’s progress with pneumonia and thromboembolic pathologies. In this disease with a predisposition to thromboembolism, findings of nontraumatic focused hemorrhages are unexpected. As spontaneous retroperitoneal hematoma is a serious condition with the absence of symptoms, creating a challenge for diagnosis, it should also be considered in COVID-19 which is thought to be predisposed to thromboembolism. Here, a 47-year-old woman with COVID-19 pneumonia diagnosis (diagnosed by computed tomography (CT) scan and approved by nasopharyngeal swab test) is presented with spontaneous retroperitoneal hematoma, and its management is reported. This case highlights the importance of considering both thromboembolic events and bleeding in cases with COVID-19 positivity. The balance between two sides of clotting mechanisms needs to be understood with novel research.
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Affiliation(s)
- Mert Tanal
- Department of General Surgery, Tekirdag Ismail Fehmi Cumalioglu State Hospital, Tekirdag, Turkey
| | - Mustafa Fevzi Celayir
- Department of General Surgery, Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zulfiye Sumeyye Kale
- Department of General Surgery, Hamidiye Etfal Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
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17
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Abstract
Retroperitoneal hematoma is a life-threatening condition where early diagnosis and correct treatment are of utmost importance. Bleeding in the retroperitoneal space has a high mortality rate. The aim of this study was to present current published scientific evidence regarding the incidence, mechanism of injury, diagnostic methods and treatment based on a review of international literature covering the last 40 years. The systematic review of the literature was performed using the SCOPUS and PUBMED databases. Publications in English were included. We have not included publications dealing with this issue in children. Systematic reviews showed an increasing trend toward nonsurgical management of retroperitoneal injuries.
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18
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Nakai S, Uchida T, Kuroda Y, Yamashita A, Ohba E, Mizumoto M, Hayashi J, Kobayashi K, Ochiai T. Spontaneous Lumbar Artery Injury Resulting in Retroperitoneal Hematoma Mimicking Abdominal Aortic Aneurysm Rupture. Ann Vasc Dis 2021; 14:384-387. [PMID: 35082946 PMCID: PMC8752927 DOI: 10.3400/avd.cr.21-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/26/2021] [Indexed: 11/23/2022] Open
Abstract
A 73-year-old woman, who had previously undergone endovascular aortic repair (EVAR), developed severe back pain while shoveling snow. Preoperative computed tomography (CT) revealed marked retroperitoneal hematoma around the abdominal aortic aneurysm (AAA) with extravasation of contrast media. Intraoperative angiography demonstrated spontaneous lumbar artery injury (SLI). The bleeding lumbar artery was embolized using lipiodol, and deteriorated hemodynamics were stabilized. SLI is rare and can mimic the clinical symptoms and CT findings of AAA rupture. Vascular surgeons should focus on the status of the aneurysmal sac and the possibility of another retroperitoneal disease to determine appropriate treatment options, despite successful EVAR for AAA.
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Affiliation(s)
- Shingo Nakai
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Tetsuro Uchida
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Yoshinori Kuroda
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Atsushi Yamashita
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Eiichi Ohba
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Masahiro Mizumoto
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Jun Hayashi
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Kimihiro Kobayashi
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Tomonori Ochiai
- Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
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19
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Mohanpuria A, Salvi V, Shah M, Surti A. Spontaneous retroperitoneal hematoma: A case report of a rare post-cesarean complication managed conservatively. Int J Gynaecol Obstet 2021; 157:476-477. [PMID: 34839553 DOI: 10.1002/ijgo.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/05/2021] [Accepted: 11/26/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Amita Mohanpuria
- Department of Obstetrics & Gynecology, Surya Hospital, Mumbai, Maharashtra, India
| | - Vinita Salvi
- Department of Obstetrics & Gynecology, Surya Hospital, Mumbai, Maharashtra, India
| | - Mohit Shah
- Department of Radiology, Surya Hospital, Mumbai, Maharashtra, India
| | - Ami Surti
- Department of Obstetrics & Gynecology, Surya Hospital, Mumbai, Maharashtra, India
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20
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Fuchs A, Parthasarathy KN, Coots A, Chauhan NR, Jiang X. Large Retroperitoneal Hematoma: A Rare Intraoperative Complication of Total Vaginal Hysterectomy. Cureus 2021; 13:e16760. [PMID: 34476135 PMCID: PMC8403485 DOI: 10.7759/cureus.16760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/05/2022] Open
Abstract
Retroperitoneal (RP) hematoma is a rare complication of total vaginal hysterectomy. A 45-year-old female G4P3013 with a history of abnormal uterine bleeding refractory to treatment by endometrial ablation and stress urinary incontinence underwent total vaginal hysterectomy, bilateral salpingectomy, bilateral uterosacral ligament suspension, anterior colporrhaphy, and cystoscopy. After the hysterectomy the left uterine artery pedicle was hemostatic; however, the patient became hemodynamically unstable and anemic. Laparoscopy revealed a stable zone III RP hematoma. Intraoperative observation revealed no further expansion of the hematoma. Left iliac angiography and aortography revealed there was no extravasation from the uterine arteries and gonadal vessels. Four days post-operative abdominal CT showed a stable hematoma. Hemodynamic instability resolved over the post-operative course. RP hematoma must be included in the differential for the evaluation of acute intraoperative hemodynamic instability with an unclear source.
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Affiliation(s)
- Anna Fuchs
- Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, USA
| | | | - Abigail Coots
- Trauma, Acute Care Surgery, and Surgical Critical Care, Reading Hospital Tower Health, Reading, USA
| | - Nikunj R Chauhan
- Interventional Radiology, Reading Hospital Tower Health, Reading, USA
| | - Xuezhi Jiang
- Obstetrics and Gynecology, Reading Hospital Tower Health, Reading, USA
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21
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Yu D, Jeon I, Kim SW. An unusual penetrating injury of the back: retroperitoneal hematoma from a glass stabbing injury: a case report. Ann Palliat Med 2021; 11:2157-2161. [PMID: 34379985 DOI: 10.21037/apm-21-1097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
In stab injury of the back visceral or vascular injuries are more uncommon than anterior abdominal stab injuries. The authors report the case of a 52-year-old man who presented to the emergency center with glass fragments lodged in his back after falling on a glass door on his back. On a retroperitoneal computed tomography (CT) scan, two foreign bodies were detected in left paraspinal and psoas muscles. Furthermore, hematoma with active bleeding was seen in the retroperitoneal cavity. He was referred to a general surgeon for retroperitoneal active bleeding, but emergency laparotomy was not deemed necessary considering the patient's stable condition in terms of vital signs, the level of hemoglobin, and the amount of bleeding. Therefore, we performed conservative treatment, such as packed cell transfusion and back compression, after removing the glass fragment through the posterior approach. The paravertebral muscle was dissected through the open wound, the tip of the piece of glass was accessible. The piece of glass was carefully removed, and there was no active bleeding. The postoperative CT scan showed continued active bleeding and increased retroperitoneal hematoma, but the patient's vital signs were stable. Conservative treatment was administered continuously, a follow-up CT scan taken a month later showed hematoma resolution and no more dye leakage. If the patient's vital signs are stable and the patient is neurologically intact, conservative treatment may be prioritized without laparotomy.
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Affiliation(s)
- Dongwoo Yu
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
| | - Ikchan Jeon
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
| | - Sang Woo Kim
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
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22
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Pirouzram A, Hamam L, Wallin G, Larzon T, Nilsson KF. Novel Experimental Technique to Create Size-Controlled Retroperitoneal Bleeding in the Infrarenal Aorta of Anesthetized Pigs. Innovations (Phila) 2021; 16:379-385. [PMID: 34077271 DOI: 10.1177/15569845211013803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Rupture of abdominal aortic aneurysm (rAAA) with a contained retroperitoneal hematoma is potentially fatal. Physiological studies are difficult to perform in patients suffering from life-threatening conditions such as rAAA. A translational model of the condition is therefore needed. The aim was to develop and validate an endovascular animal model for retroperitoneal bleeding of the abdominal aorta with contained hematoma. METHODS In anesthetized pigs, a puncture hole was made in the posterolateral portion of the infrarenal aorta by an Outback re-entry catheter device. The hole was gradually enlarged using angioplasty balloons to a specific diameter of either 4 mm (n = 6), 6 mm (n = 7), or 8 mm (n = 6). Onset of bleeding was verified by angiography and macroscopically examined on completion of the experiments. Survival up to 180 min was the primary outcome. Hemodynamic and metabolic markers in arterial blood were secondary outcomes. RESULTS Aortic injury with a contained retroperitoneal hematoma was achieved in all animals. Survival rate at 180 min after onset of bleeding was higher in the 4 mm group compared to the 6 mm (P = 0.021) and 8 mm groups (P = 0.002), but not when comparing the 6 mm and 8 mm groups. Systemic hypotension, arterial acidosis, and lactatemia were provoked in the 6 mm and 8 mm groups but not in the 4 mm group. CONCLUSIONS A porcine model for a controlled contained left posterolateral retroperitoneal bleeding was created using endovascular methods and validated. This model makes it possible to study the pathophysiology of a retroperitoneal hematoma.
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Affiliation(s)
- Artai Pirouzram
- 56750 Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Sweden
| | - Leonardo Hamam
- Department of Surgery, Höglandssjukhuset Eksjö, Region Jönköping County Council, Sweden
| | - Göran Wallin
- 6233 Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Thomas Larzon
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Kristofer F Nilsson
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Sweden
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23
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Chang CY. A Fatal Case of Dengue-Associated Hemophagocytic Lymphohistiocytosis and Retroperitoneal Hematoma in a Patient With Autoimmune Hemolytic Anemia. Cureus 2021; 13:e15001. [PMID: 34131542 PMCID: PMC8196493 DOI: 10.7759/cureus.15001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening complication of dengue infection which necessitates early diagnosis and treatment to improve patient outcomes. Severe dengue infection complicated by HLH may require interventions such as systemic corticosteroids, intravenous immunoglobulin, or chemotherapy. Here, we report a case of concurrent dengue-induced HLH and flare of underlying autoimmune hemolytic anemia (AIHA). The disease was refractory to treatment including corticosteroids and intravenous immunoglobulin. The course of illness was later complicated by dengue shock syndrome, severe liver dysfunction, and a large retroperitoneal hematoma. Unfortunately, the patient succumbed on day 10 of illness.
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Affiliation(s)
- Chee Yik Chang
- General Medicine, Hospital Sultanah Aminah, Johor Bahru, MYS
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24
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Yu H, Huang H, Jin Y. Pelvic gauze packing combined with an external fixator for the treatment of unstable pelvic fractures with a huge retroperitoneal hematoma: a case report. Ann Palliat Med 2020; 9:4371-4376. [PMID: 33222448 DOI: 10.21037/apm-20-1994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/03/2020] [Indexed: 11/06/2022]
Abstract
Pelvic fractures with retroperitoneal hematoma are frequent injuries, and there are multiple treatment options for patients. In this case, a 35-year-old female patient suffered an unstable pelvic fracture due to a car crash, accompanied by the formation of a huge retroperitoneal hematoma. The vital signs of patient were not stable. The patient immediately underwent active anti-shock therapies such as multi-channel infusion, blood transfusion, blood volume supplementation, and blood pressure elevation. However, the vital signs of patient remained unstable, the abdominal circumference increased, hemoglobin decreased rapidly, and the plasma protamine paracoagulation (3P) test was positive. So, tracheal intubation and mechanical ventilation were performed. Experts from various departments were invited to form an emergency multidisciplinary team (MDT), and exploratory laparotomy was selected. Intraoperative exploration revealed the formation of a huge retroperitoneal hematoma, and there was no bleeding or abdominal organ rupture. So, five large gauzes were developed and packed into the extra peritoneal space to stanch bleeding. Following successful hemostasis, the pelvic external fixator was positioned. Re-surgery was performed 78 hours after surgery to remove all gauzes. At 2.5 months postoperatively, the pelvic external fixator was also removed. Ultimately, the patient achieved good surgical results. Pelvic gauze packing combined with an external fixator is a rapid and effective treatment strategy for critical and huge retroperitoneal hematomas caused by unstable pelvic fractures. To our knowledge, this has not been previously reported.
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Affiliation(s)
- Haibo Yu
- Department of General Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shaoxing University Shengzhou Branch, Shengzhou, China.
| | - Haifeng Huang
- Department of General Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shaoxing University Shengzhou Branch, Shengzhou, China
| | - Yibing Jin
- Department of General Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shaoxing University Shengzhou Branch, Shengzhou, China
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25
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Venkateswaran S, Declet-Bauzo R, Shodeinde M, Gilford P. Postoperative Retroperitoneal Hematoma: A Case of Saw Palmetto and the Importance of Primary Care Intervention. HCA Healthc J Med 2020; 1:279-282. [PMID: 37426613 PMCID: PMC10324748 DOI: 10.36518/2689-0216.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Introduction A middle-aged male with a history of bilateral inguinal hernia repair was admitted for acute abdominal pain. The patient reported that he took prescribed hydrocodone and a saw palmetto supplement prior to surgery. He denied any recent trauma after the procedure, and he was unable to schedule a follow-up appointment with the surgeon or the primary care physician. Clinical Findings Diagnosis: The CT angiography of the abdomen/pelvis was indicative of new interval development of a large left retroperitoneal hematoma. Intervention: No emergent intervention was required following the evaluation by the surgery and interventional radiology (IR) departments. Outcome: There was no evidence of overt bleeding over the 3-day hospital course, and his hemoglobin was within normal limits. The patient was stable for discharge as the hematoma would slowly absorb over the next 2 months. Conclusions A retroperitoneal hematoma (RPH) has a multi-factorial etiology, such as endovascular procedures and surgeries. Detection and presentation of an RPH serves as a guide in management. There are various modes of detection. However, a multi-detector computer tomography-angiography (MDCTA) provides greater information in regards to the anatomical etiology and extent of RPH. Despite the common risk factors associated with a RPH, there are understudied and underreported influences of medications and herbal supplements, such as saw palmetto, in the development of this outcome. A large portion of the population consume herbal and/or dietary supplements, which belong to the category of complementary and alternative medicine (CAM). The challenge for health care providers, especially in the primary-care setting, is the unregulated use of herbal supplements and the associated effects. It is imperative for primary-care physicians to recognize these unknown risks and attempt to inquire about supplement use. Future education should be aimed at integrating CAM into the medical curriculum to improve physician-patient interaction in addressing this topic.
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26
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Galgano JA, Bernshteyn M, Kaul P. Spontaneous Retroperitoneal Hematoma in the Setting of Myasthenic Crisis. Cureus 2020; 12:e11116. [PMID: 33240712 PMCID: PMC7682541 DOI: 10.7759/cureus.11116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Our case highlights a patient with spontaneous retroperitoneal hematoma without clear cause in the setting of myasthenic crisis. While myasthenia gravis (MG) has been reported in the literature to be associated with vascular pathology such as polyarteritis nodosa, its association with coagulopathy and spontaneous major bleed is currently unclear. The patient in this case developed a sudden unprovoked iliopsoas hematoma while in the ICU for the management of newly diagnosed MG. Acute anemia was the only clinical sign which was later confirmed by imaging findings.
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Affiliation(s)
- Joseph A Galgano
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Michelle Bernshteyn
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Pratibha Kaul
- Critical Care Medicine, State University of New York Upstate Medical University, Syracuse, USA
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27
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Sui YG, Teng SY, Qian J, Wu Y, Dou KF, Tang YD, Qiao SB, Wu YJ. Cross-sectional study of retroperitoneal hematoma after invasive intervention in a Chinese population: Prevalence, characteristics, management and outcomes. Exp Ther Med 2020; 20:2975-2984. [PMID: 32855663 PMCID: PMC7444352 DOI: 10.3892/etm.2020.9040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/11/2019] [Indexed: 11/25/2022] Open
Abstract
The present study aimed to explore the clinical characteristics and management of retroperitoneal hematoma (RPH) after invasive intervention during a 12-year period in China. A retrospective review of patients with RPH after various invasive interventions was conducted at the China National Center for Cardiovascular Diseases. A total of 42 patients with a mean age of 63.1±2.5 years were continuously recruited in the study between January 2007 and September 2018. The incidence, manifestations and management of RPH were analyzed. A total of 20 patients had punctures in the femoral arterial access under the inguinal ligament and 5 patients had punctures above the inguinal ligament. The majority of RPH occurred within 24 h after intervention, while some occurred after postoperative 24 h. Pain was the most common symptom in patients with RPH. All patients who underwent intervention presented a reduction in hemoglobin (HB) concentration. The overall incidence of nosocomial infection was 38.1% and mortality was 7.1%. The findings demonstrated that RPH is a rare complication after invasive intervention of cardiovascular diseases with non-specific clinical manifestations. The reduction of HB concentration was a vital manifestation for RPH. Most RPH cases could be treated by conservative treatment and blood transfusion. A puncture in the femoral arterial access under the inguinal ligament may result in RPH.
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Affiliation(s)
- Yong-Gang Sui
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Si-Yong Teng
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Jie Qian
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Yuan Wu
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Ke-Fei Dou
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Yi-Da Tang
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Shu-Bin Qiao
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Yong-Jian Wu
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
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28
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Guo SH, Zhu SM, Yao YX. Giant Retroperitoneal Hematoma During Extracorporeal Membrane Oxygenation in a Patient With Coronavirus Disease-2019 Pneumonia. J Cardiothorac Vasc Anesth 2020; 34:2839-2840. [PMID: 32600997 PMCID: PMC7267793 DOI: 10.1053/j.jvca.2020.05.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/24/2020] [Accepted: 05/24/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Shao-Hui Guo
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Sheng-Mei Zhu
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yong-Xing Yao
- Department of Anesthesia, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
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29
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Nasr MA, Khallafalla H, Kumar VR, Pathan SA. Warfarin-induced spontaneous retroperitoneal hemorrhage from the renal vein: A rare case with an uncommon etiology. Qatar Med J 2019; 2019:6. [PMID: 31392172 PMCID: PMC6671935 DOI: 10.5339/qmj.2019.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/30/2019] [Indexed: 11/03/2022] Open
Abstract
The overall rate of major bleeding in patients with atrial fibrillation receiving warfarin therapy is approximately 4%. Among these 4% patients, spontaneous retroperitoneal hemorrhage (SRH) is a rare but potentially lethal complication with a nonspecific presentation that can lead to missed or delayed diagnosis. The current literature provides little direction for diagnosis and management of such cases. Anticoagulation-related SRH is associated with a high mortality rate (approximately 20%). Despite the vague presentation, prompt diagnosis is crucial to reverse the anticoagulation and prevent further bleeding. Contrast-enhanced computed tomography (CT) of the abdomen is the imaging modality of choice in suspected cases. Patients with SRH require aggressive treatment with blood transfusions, interventional radiological procedures, percutaneous drainage or surgical evacuation of the hematoma. We report a case of warfarin-induced SRH from the renal vein in a patient who presented to our emergency department with acute, nonspecific abdominal pain and shock. We diagnosed the patient with warfarin-induced SRH on the basis of clinical suspicion and characteristic CT findings. We initially treated the patient conservatively, followed by embolization of the right renal artery during the late course of hospital stay, and he was discharged with good recovery. SRH should be considered in the differential diagnosis of abdominal pain, hypotension, and/or decreased hemoglobin levels in patients receiving anticoagulation therapy, especially in those with preexisting end-stage renal disease.
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Affiliation(s)
- Mohamed A Nasr
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hosam Khallafalla
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Vajjala R Kumar
- Emergency Radiology Section, Radiology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sameer A Pathan
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Ullah A, Marwat A, Suresh K, Khalil A, Waseem S. Spontaneous Retroperitoneal Hematoma: A Rare Presentation of Polyarteritis Nodosa. J Investig Med High Impact Case Rep 2019; 7:2324709619858120. [PMID: 31234656 PMCID: PMC6593925 DOI: 10.1177/2324709619858120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spontaneous retroperitoneal hematoma is a rare clinical entity that is most commonly caused by renal tumors and vascular disease. In this article, we present a case of spontaneous retroperitoneal hemorrhage caused by polyarteritis nodosa in a patient who presented with severe left flank pain. He underwent computed tomography angiography of his abdomen that showed left retroperitoneal hematoma, which was followed by arteriogram that showed multiple bilateral renal artery aneurysms with active extravasation, findings consistent with polyarteritis nodosa. The patient underwent successful coiling of the bleeding vessel that secured the bleeding and was started on high-dose prednisone, which resulted in resolution of his symptoms.
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Affiliation(s)
- Asad Ullah
- 1 Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Asghar Marwat
- 1 Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | | | - Ahmed Khalil
- 1 Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Saba Waseem
- 1 Conemaugh Memorial Medical Center, Johnstown, PA, USA
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Ohtsuka R, Amano H, Niida K, Yoshino T, Owari M, Takano R, Akama Y, Watanabe Y, Iwao T. Massive retroperitoneal hematoma following colonoscopy: A case report. Medicine (Baltimore) 2018; 97:e11723. [PMID: 30075581 PMCID: PMC6081176 DOI: 10.1097/md.0000000000011723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/04/2018] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Colonoscopy has been used for screening and treatment of diseases worldwide. Endoscopic mucosal resection (EMR) has many major complications such as colon perforation and bleeding. However, cases of minor complications have also been reported. Here, we present a case of massive retroperitoneal hematoma, as a minor complication, after colonoscopy. PATIENT CONCERNS A 57-year-old man was admitted to our hospital because of abdominal pain. He had no past medical history relating to his present condition, and he received EMR at another hospital 11 days before his admission. Dynamic computed tomography (CT) was performed, which showed a massive retroperitoneal hematoma near the third portion of the duodenum. DIAGNOSIS The patient had a superior mesenteric vein injury after the colonoscopy. OUTCOMES The patient did not complain of nausea or vomiting and was discharged after 43 days. LESSONS Although massive retroperitoneal hematoma is a minor complication after colonoscopy, it can be life threatening; thus, we need to know more about this complication. Dynamic CT may be useful in detecting whether the bleeding occurs from the artery or not.
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Abstract
RATIONALE Hydronephrosis caused by retroperitoneal hematoma after a seatbelt injury is a unique clinical entity. PATIENT CONCERNS A 21-year-old man, who had been wearing a seatbelt, was brought to our hospital after a motor vehicle collision, complaining of abdominal pain. Computed tomography (CT) revealed retroperitoneal hematoma in the upper pelvic region. Since he was hemodynamically stable throughout admission, he was managed conservatively. Seventeen days after initial discharge, the patient revisited our emergency department due to right back pain. DIAGNOSES CT scans indicated retroperitoneal hematoma growth resulting in hydronephrosis of the right kidney. INTERVENTIONS Laparoscopic drainage of the retroperitoneal hematoma was successfully performed. OUTCOMES His symptoms resolved after the surgery. Follow-up CT scans three months later demonstrated complete resolution of the hydronephrosis and retroperitoneal hematoma. LESSONS Our case highlights a patient with delayed hydronephrosis because of retroperitoneal hematoma expansion after a seatbelt injury.
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Affiliation(s)
- Tetsuya Yumoto
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
| | - Yoshitaka Kondo
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kento Kumon
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Yoshihisa Masaoka
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Taihei Yamada
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
| | - Hiromichi Naito
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
| | - Atsunori Nakao
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital
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Abstract
RATIONALE Menkes disease (MD), also known as Menkes kinky hair disease, is a fatal neurodegenerative disease caused by a defect in copper metabolism. The symptoms involve multiple organ systems, such as the brain, lung, gastrointestinal tract, urinary tract, connective tissue, and skin. There is currently no cure for this disease entity, and patients with the classic form of MD usually die from complications between 6 months and 3 years of age. Intracranial hemorrhage secondary to tortuous intracranial arteries is a well-known complication of MD, but spontaneous retroperitoneal hemorrhage, to the best of our knowledge, has never been reported in a patient with MD. Herein, we describe the first case of retroperitoneal hematoma as a complication of MD in a 4-year-old boy. PATIENT CONCERNS A 4-year-old Taiwanese male patient with MD was referred to the hospital and presented with a palpable epigastric mass. DIAGNOSES On the basis of the findings of ultrasonography and enhanced computed tomography, the diagnosis was retroperitoneal hematoma. INTERVENTIONS Interventions included laparotomy with evacuation of the hematoma, manual compression, and suture of the bleeding vessels. OUTCOMES There were no postoperative complications. LESSONS This case emphasizes that bleeding in patients with MD is possible at any site in the body owing to the unstable structure of the connective tissues. Timely diagnosis with proper imaging studies can lead to prompt and appropriate management and save patients from this life-threatening condition.
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Affiliation(s)
- Chia-Huei Peng
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
| | | | - Nien-Lu Wang
- Department of Pediatric General Surgery and Urology
| | - Hung-Chang Lee
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Shuan-Pei Lin
- Department of Genetics and Metabolism, MacKay Children's Hospital, Taipei
- Department of Medicine, MacKay Medical College, New Taipei City
- Division of Biochemical Genetics, Department of Medical Research, MacKay Memorial Hospital
- Department of Early Childhood Care, National Taipei University of Nursing and Health Sciences
| | - Wai-Tao Chan
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Chun-Yan Yeung
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Chuen-Bin Jiang
- Department of Pediatric Gastroenterology, Hepatology and Nutrition
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
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Inoue M, Sudo T, Yamaguchi M, Seo S, Miyamoto T, Misumi T, Shimizu W, Irei T, Suzuki T, Onoe T, Shimizu Y, Hinoi T, Tashiro H. Aneurysm of the inferior vena cava with thrombosis. Clin Case Rep 2018; 6:402-406. [PMID: 29445486 PMCID: PMC5799648 DOI: 10.1002/ccr3.1321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/06/2017] [Accepted: 11/19/2017] [Indexed: 11/08/2022] Open
Abstract
Inferior vena cava (IVC) aneurysms are extremely rare. Patients can be asymptomatic, have thrombosis, rupture, or pulmonary embolism. Thrombosis of the IVC aneurysm may mimic a retroperitoneal tumor. Surgical treatment of abdominal venous aneurysms with thrombosis is warranted and is necessary for the management of intraoperative bleeding and thrombosis.
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Affiliation(s)
- Masashi Inoue
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Takeshi Sudo
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Megumi Yamaguchi
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Shingo Seo
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Tatsuya Miyamoto
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Toshihiro Misumi
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Wataru Shimizu
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Toshimitsu Irei
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Takahisa Suzuki
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Takashi Onoe
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Yosuke Shimizu
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Takao Hinoi
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
| | - Hirotaka Tashiro
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center Kure Japan
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Gündeş E, Aday U, Bulut M, Çiyiltepe H, Ali Çetin D, Gülmez S, Senger AS, Cumhur Değer K, Polat E, Duman M. Factors affecting treatment, management and mortality in cases of retroperitoneal hematoma after cardiac catheterization: a single-center experience. Postepy Kardiol Interwencyjnej 2017; 13:218-24. [PMID: 29056994 DOI: 10.5114/aic.2017.70189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/19/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There is little information available on the clinical aspects, results, treatment and management of cardiac catheterization-related retroperitoneal hematoma. Data on the subject are rather limited, and current publications are based on a limited number of retrospective cohort studies and case reports. AIM To perform a retrospective analysis of the demographic, clinical, and in-hospital results of patients who developed retroperitoneal hematoma (RPH) after cardiac catheterization (CC). MATERIAL AND METHODS The cases of 124,064 patients who had CCs between January 2010 and October 2016 were retrospectively analyzed. Patients diagnosed with RPH were classified into three groups depending on the method of treatment: conservative (group 1), endovascular stenting (group 2), and surgery (group 3). The independent risk factors, based on RPH-related mortality, were determined by logistic regression analysis. RESULTS Of the 68 (0.054%) patients with RPH, 75% received conservative treatment, 13.2% underwent angiographic stent placement, and 11.7% had surgical treatment. Red blood cell packets (RBCPs) (p = 0.043), duration of hospitalization (p = 0.007), and mortality rates (p = 0.006) were statistically significantly higher in group 3 in comparison to the other groups. Multivariate subgroup analysis was conducted to determine mortality rates, with post-procedural highest creatinine ≥ 2 mg/dl and RBCPs ≥ 10 established as independent risk factors. CONCLUSIONS Hemodynamically stable patients with no active hemorrhaging are shown to have good results with conservative treatment. We believe that endovascular methods should be used initially for hemodynamically unstable patients, while surgical treatment should be employed in cases where endovascular methods fail or abdominal compartment syndrome develops.
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Abstract
We report on a 81-year-old female admitted to the emergency department for the occurrence of abdominal pain after a minor trauma. She was on treatment with warfarin for atrial fibrillation. The abdominal computed tomography (CT) angiography revealed a retroperitoneal hematoma (RH) of the left iliopsoas muscle with no evidence of active bleeding. The international normalized ratio exceeded the upper recommended anticoagulation limit. Prothrombin complex concentrates (PCCs) were used for anticoagulation reversal. Two days later, the patient presented acute dyspnea and a pulmonary CT angiography showed an embolus in the right pulmonary artery. Enoxaparin was started. Thoracic symptoms improved and a second abdominal CT angiography revealed a reduction in RH. Apixaban was started from day 11. No further bleedings occurred and clinical conditions improved. Anticoagulation reversal with PCCs rapidly restores hemostasis, but, on the other side, the thrombotic risk due to their procoagulant effect should be considered.
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Affiliation(s)
- Serenella Conti
- Division of Cardiology-UTIC-Cardiovascular Rehabilitation, Spoleto Hospital, USL Umbria 2, Spoleto, Italy
| | - Marco Ciuffetti
- Department of Radiology, Spoleto Hospital, USL Umbria 2, Spoleto, Italy
| | - Maria Cristina Vedovati
- Department of Medicine, Internal and Cardiovascular Medicine and Stroke Unit, University of Perugia, Perugia, Italy
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Epstein NE. Non-neurological major complications of extreme lateral and related lumbar interbody fusion techniques. Surg Neurol Int 2016; 7:S656-S659. [PMID: 27843680 PMCID: PMC5054631 DOI: 10.4103/2152-7806.191071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 06/14/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Complications exclusive of new neurological deficits/injuries that follow extreme lateral interbody fusion (XLIF) and related lateral lumbar interbody techniques should be better recognized to determine the safety of these procedures. Unfortunately, a review of the XLIF literature did not accurately reflect the frequency of these "other complications" as few US surgeons publish such adverse events that may lead to medicolegal suits. METHODS Major complications occurring with XLIF included sympathectomy, major vascular injuries, bowel perforations, sterile seromas, and instrumentation failures. RESULTS The frequency of sympathectomy was 4% for XLIF vs. 15% for anterior lumbar interbody fusion (ALIF). There were three major vascular injuries for XLIF; one fatal intraoperative event, one life-threatening retroperitoneal hematoma, and one iatrogenic lumbar artery pseudoaneurysm that was successfully embolized. Two bowel perforations were reported, whereas a third was a "direct communication." One patient developed a sterile recurrent seroma due to vancomycin powder utilized for an XLIF. One study cited malpositioning of an XLIF cage resulting in a lateral L3-L4 extrusion, whereas the second series looked at the 45% risk of cage-overhang when XLIF devices were placed in the anterior one-third of the vertebral body. CONCLUSION Excluding new neurological deficits, XLIF techniques resulted in multiple other major complications. However, these small numbers likely reflect just the tip of the iceberg (e.g., 10%) and the remaining 90% may never be known as many US-based spine surgeons fail to publish such adverse events as they are discoverable in a court of law and may lead to medicolegal suits.
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Affiliation(s)
- Nancy E Epstein
- Department of Neuroscience, Winthrop Neuroscience, Winthrop University Hospital, Mineola, New York, USA
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Lakhdar K, Malki SM, Er-Raji I, Derkaoui A, Shimi A, Khatouf M. [ Retroperitoneal hematoma revealing a tumor of the inferior vena cava: about a case]. Pan Afr Med J 2016; 24:93. [PMID: 27642432 PMCID: PMC5012762 DOI: 10.11604/pamj.2016.24.93.6241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 04/07/2016] [Indexed: 11/25/2022] Open
Abstract
Les tumeurs de la veine cave inférieure sont rares, représentées essentiellement par le léiomyosarcome. Elles ont une présentation clinique peu spécifique, cependant, la littérature ne rapporte pas de manifestations hémorragiques. Le diagnostic préopératoire repose sur la tomodensitométrie et l'imagerie par résonance magnétique et la confirmation est histologique. Nous rapportons un cas d'hématome rétro-péritonéal révélant une tumeur de la veine cave inférieure. Le diagnostic a été posé sur des arguments cliniques et radiologiques.
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Affiliation(s)
- Karim Lakhdar
- Service de Réanimation Polyvalente A1, CHU Hassan II, Fès, Maroc
| | | | | | - Ali Derkaoui
- Service de Réanimation Polyvalente A1, CHU Hassan II, Fès, Maroc
| | - Abdelkrim Shimi
- Service de Réanimation Polyvalente A1, CHU Hassan II, Fès, Maroc
| | - Mohamed Khatouf
- Service de Réanimation Polyvalente A1, CHU Hassan II, Fès, Maroc
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Adeolu AO, Oluseye AA, Adedayo KO, David RA, Wuraola FO. Severity, Challenges, and Outcome of Retroperitoneal Hematoma in a Nigeria Tertiary Hospital. Niger J Surg 2016; 22:96-101. [PMID: 27843273 PMCID: PMC5013750 DOI: 10.4103/1117-6806.188986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Retroperitoneal hematoma (RH) can present as an acute life-threatening condition, report on RH in low-income countries are lacking. OBJECTIVE We present the severity, pattern, challenges, and outcome of RH in a low-resource country such as Nigeria. METHODS This was a retrospective observational study of all patients with blunt or penetrating abdominal injury needing surgery, patients with RH among them were analyzed. RESULTS In the last one decade spanning 2005-2015, our operation database record showed that 247 patients had exploratory laparotomy for blunt and penetrating abdominal trauma. Out of the 115 patients with complete record available, only 43 had RH. The median age of the patients was 30 years, and the most affected age group was 20-29 years. Female to male ratio was 1:13. Only eight patients (18.6%) reached the hospital from the accident site within the first Golden Hour of accident, which is the first 1 h postrauma during which treatment intervention believed to have the best outcome. Only two patients (4.7%) got to operating theater within 1 h of reaching hospital. None of our patients had preoperative diagnosis of RH; overall, mortality was two patients (4.7%). CONCLUSION Logistical infrastructural inadequacies such as lack of sterile theater bundle and drapes/nonavailability or busy theater space caused delay for patients between presentation in the Accident and Emergency Center and operating theater. None of our patients had a preoperative diagnosis of RH because of lack of access to computerized tomography scan dedicated to trauma in Accident and Emergency Center. The overall mortality of 4.7% in this study, which is on the low side, tends to suggest that mostly mild and stable cases which can make it to the operating table were eventually operated upon.
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Affiliation(s)
| | | | - Kolawole Oladapo Adedayo
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Rotimi Adedeji David
- Department of Surgery, Obafemi Awolwowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Funmilola Olanike Wuraola
- Department of Surgery, Obafemi Awolwowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
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Abstract
Vascular complications after percutaneous renal biopsy are uncommon and may require interventional management. In most of these cases, the pathology is a renal arterial pseudoaneurysm (PsA) or an arterio-venous fistula. Injury to other vessels like aorta, lumbar arteries or mesenteric arteries is rare with only one case of left colic artery PsA reported in literature. We report a case of a 60-year-old female, who developed left colic artery PsA after renal biopsy, which was successfully embolized through endovascular route using microcoils.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A K Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Ghadimi K, Vernick WJ, Horak J, Gutsche JT, Hanif H, Tagarakis GI, Whitlock RP, Augoustides JG. CASE 12--2014. Inferior vena cava compression by retroperitoneal hematoma during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2014; 28:1403-9. [PMID: 24461363 DOI: 10.1053/j.jvca.2013.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Kamrouz Ghadimi
- Cardiovascular and Thoracic Section, Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - William J Vernick
- Cardiovascular and Thoracic Section, Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jiri Horak
- Cardiovascular and Thoracic Section, Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hasib Hanif
- Division of Cardiac Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Georgios I Tagarakis
- Division of Cardiothoracic Surgery, Department of Surgery, Aristotle University, Thessaloniki, Greece
| | - Richard P Whitlock
- Division of Cardiac Surgery, Department of Surgery Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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CALIN IS, MAGDA LS, CINTEZA M. Benefit vs. Risk of a Permanent Inferior Vena Cava Filter in Pulmonary Embolism with Anticoagulation Contraindication. Maedica (Bucur) 2013; 8:355-359. [PMID: 24790668 PMCID: PMC3968472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/06/2013] [Indexed: 06/03/2023]
Abstract
Cases of pulmonary embolism (PE) with contraindication of anticoagulation have low incidence. Under these circumstances the placement of an inferior vena cava (IVC) filter may be life-saving. Paradoxically, the presence of the filter imposes anticoagulation itself, due to the risk of filter thrombosis, promoting stasis and increasing the risk of filter related deep venous thrombosis (DVT) and PE recurrence by means of a substantial collateral venous return that bypasses the IVC filter (1,2). We present the case of a woman with DVT, complicated with high risk PE. After thrombolysis with alteplase the patient develops retroperitoneal hematoma originating from undiagnosed renal angiomyolipoma. Therefore long term anticoagulation is considered contraindicated and an IVC filter is installed. Shortly after hospital release the patient presents occlusion of the IVC filter with DVT recurrence. The initiation of low molecular weight heparin and afterwards of acenocumarol has a favorable outcome, and after six months of follow up the patient is completely recovered.
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Affiliation(s)
| | | | - Mircea CINTEZA
- Department of Cardiology, Emergency University Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
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Yaman İ, Sağlam İ, Kurt K. Acute abdomen and hemorrhagic shock caused by spontaneous rupture of renal cyst in autosomal dominant polycystic kidney disease. Ulus Cerrahi Derg 2013; 29:45-7. [PMID: 25931844 DOI: 10.5152/ucd.2013.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 11/18/2011] [Indexed: 11/22/2022]
Abstract
Autosomal dominant polycystic kidney disease is an important cause of end stage renal failure. Rarely, these patients may present with hemorrhagic shock caused by rupture of the renal cyst. The aim of this study was to report a rare case of a patient who arrived at the emergency department with autosomal dominant polycystic kidney disease presenting with acute abdominal pain and hemorrhagic shock. A 58-year-old male with chronic renal failure was admitted to the emergency department with acute abdominal pain and hemorrhagic shock. The patient was admitted to the Department of Surgery with diagnosis of acute abdomen and perirenal hematoma. Although the patient was on conservative treatment, his symptoms did not improve and the patient was operated emergently. During exploration, there was bleeding from the right polycystic kidney, which was 30×20 cm in dimension. The patient underwent nephrectomy and drainage of the hematoma, and was discharged on the fifth postoperative day without any problems. Bleeding due to rupture of a cyst in autosomal dominant polycystic kidney disease occurs rarely but it may be life threatening. Although conservative methods are often preferable in treatment, surgery can be life saving for patients in whom the clinical situation does not improve.
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Affiliation(s)
- İsmail Yaman
- Department of General Surgery, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - İsmet Sağlam
- Clinic of General Surgery, Manisa Merkez Efendi State Hospital, Manisa, Turkey
| | - Kamile Kurt
- Clinic of Pathology, Manisa Merkez Efendi State Hospital, Manisa, Turkey
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Singh VA, Zeltsman D. TRALI Syndrome Complicated by Retroperitoneal Bleeding. Int J Angiol 2012; 20:173-6. [PMID: 22942633 DOI: 10.1055/s-0031-1283219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) is an underdiagnosed and underreported syndrome which by itself is the third leading cause of transfusion-related mortality. The incidence of TRALI is reported to be 1 in 2000 to 5000 transfusions. When combined with uncontrollable bleeding, survival is unachievable. We report the case of a 25-year-old man, who underwent open heart surgery as an infant to correct his congenital heart disease in association with right pulmonary artery atresia. He presented with hemoptysis secondary to aspergilloma and required a pneumonectomy of the nonfunctional right lung. During pneumolysis, significant bleeding occurred from the superior vena cava. The patient required a blood transfusion and was placed on cardiopulmonary bypass to control the bleeding. Simultaneous occurrence of severe pulmonary edema and retroperitoneal bleeding were noted. Approximately 8 L of frothy edema fluid were drained from the only functional left lung starting ~15 minutes after the transfusion and lasting for several hours until the end of the case. It most likely represented TRALI syndrome. Increasing abdominal girth and poor volume return to the pump were consistent with and pathognomonic for retroperitoneal bleeding. Though primary surgical bleeding in the chest was controlled successfully and a pneumonectomy performed without further difficulty, we were unable to separate the patient from cardiopulmonary bypass due to the inability to oxygenate. As a result, we could not reverse the anti-coagulation which potentially exacerbated the retroperitoneal bleeding. After multiple unsuccessful attempts the patient succumbed. This ill-fated case demonstrates the quandary of obtaining vascular access for emergency cardiopulmonary bypass while in the right thoracotomy position. It may be beneficial to have both the femoral artery and vein cannulated before positioning a patient in a lateral decubitus position. In addition, early direct access to the right atrium may obviate a need for femoral venous cannulation. Also, adult extracorporeal membrane oxygenation may be indicated if faced with such a severe pulmonary edema without ongoing hemorrhage.
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Affiliation(s)
- Vijay A Singh
- Division of Cardiothoracic Surgery, Department of Surgery, North Shore-Long Island Jewish Hospital Systems, New York
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45
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Abstract
Idiopathic retroperitoneal hematoma is a rare, but potentially life threatening cause of an acute surgical abdomen. Initially diagnosis may be overlooked, leading to unnecessary exploration, which may have implications for prognosis of the patient. An enhanced Computer Tomography (CT) scan of the abdomen is the principle method of diagnosis. However, as in our case, laparoscopic management of the acute abdomen can play a vital role in this group of patients. Importantly, early diagnosis and vigilant conservative management can improve the outcome in idiopathic retroperitoneal hematoma.
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Affiliation(s)
- Sherif Monib
- - General Surgery Department, Mouwasat Hospital, Qatif, UK
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Khan SNH, Adeoye O, Abruzzo TA, Shutter LA, Ringer AJ. Intracranial dural sinus thrombosis: novel use of a mechanical thrombectomy catheter and review of management strategies. Clin Med Res 2009; 7:157-65. [PMID: 20048139 PMCID: PMC2801689 DOI: 10.3121/cmr.2009.847] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Management of intracranial dural sinus thrombosis with involvement of multiple sinuses is complex, often involving not only the primary problem (thrombosis) but acute adverse events consequent to the disease. We highlight the novel use of an endovascular device (typically for suction thrombectomy in the peripheral vascular system) used in our patient with a life-threatening multi-sinus thrombosis. As there is no standard treatment yet for cranial sinus thrombosis, our review of the literature highlights some effective management strategies. A 35-year-old woman developed associated complications of cranial sinus thrombosis that included intracranial hypertension caused by an expanding intracranial hematoma, pulmonary embolism treated by placement of filters in superior and inferior vena cava to eliminate intra- and extracranial sources of emboli, and procedure-related retroperitoneal hematoma that necessitated peripheral vascular intervention. After failure of several common devices during mechanical thrombolysis, a thrombectomy catheter (typically for peripheral vascular intervention to aide in the clot removal) was used. Our case highlights the fine balance of anticoagulation and thrombolysis and the proactive, aggressive approach used by our multispecialty team to manage concurrent factors.
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Affiliation(s)
- Shah-Naz Hayat Khan
- The Neuroscience Institute,University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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