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1
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Iinuma S, Kobayashi T, Nagashima T. Rectus Sheath Hematoma as a Cutaneous Manifestation of Essential Thrombocythemia. Cureus 2025; 17:e81324. [PMID: 40291272 PMCID: PMC12033973 DOI: 10.7759/cureus.81324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2025] [Indexed: 04/30/2025] Open
Abstract
Rectus sheath hematoma (RSH) is a rare cause of acute abdominal pain that is often associated with trauma, anticoagulant therapy, or coagulopathy. We present a unique case of an RSH as a cutaneous manifestation of essential thrombocythemia (ET), which is a myeloproliferative neoplasm characterized by thrombotic and hemorrhagic complications. A 66-year-old female patient presented with acute lower abdominal pain, a subcutaneous mass, and overlying skin ecchymosis. Imaging confirmed a significant RSH. Laboratory tests revealed severe anemia and marked thrombocytosis. Further evaluations, including bone marrow biopsy and genetic testing, revealed ET with a CALR mutation. RSH was managed conservatively, and cytoreductive therapy comprising hydroxyurea was administered for ET, resulting in resolution of the hematoma and improvement in hematological parameters. This case highlights the necessity of considering hematological disorders when patients present with spontaneous hematomas. Prompt diagnosis and effective management of both the hematoma and ET were achieved, demonstrating that timely recognition and appropriate treatment are important to improving patient outcomes.
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Affiliation(s)
- Shin Iinuma
- Dermatology, Japanese Red Cross Kitami Hospital, Kitami, JPN
- Dermatology, Asahikawa Medical University, Asahikawa, JPN
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2
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Suenaga A, Hashimoto Y, Kanaya A, Fukunari K, Kawahara Y, Miyazono M. A Case of Rectus Sheath Hematoma Caused by Self-Injection of Certolizumab Pegol. Cureus 2025; 17:e80154. [PMID: 40196069 PMCID: PMC11973531 DOI: 10.7759/cureus.80154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2025] [Indexed: 04/09/2025] Open
Abstract
Rectus sheath hematoma (RSH) is a condition caused by hemorrhage into the rectus sheath. A 61-year-old man with end-stage renal failure and rheumatoid arthritis presented to our hospital with abdominal pain. The patient had been receiving biweekly self-injections of certolizumab pegol to the abdominal wall. Computed tomography (CT) demonstrated a large high-density left-sided RSH. Abdominal pain gradually exacerbated; thus, transcatheter arterial embolization (TAE) for the left inferior epigastric artery (IEA) was performed. This is the first reported case of RSH caused by certolizumab pegol. Factors contributing to RSH include low abdominal wall fat, the use of auto-injector-based preparations, and anticoagulant use in dialysis.
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Affiliation(s)
- Atsuhiko Suenaga
- Department of Nephrology, National Hospital Organization Ureshino Medical Center, Ureshino, JPN
| | - Yuka Hashimoto
- Division of Nephrology, Saga University Faculty of Medicine, Saga, JPN
| | - Akiko Kanaya
- Department of Nephrology, Sasebo Kyosai Hospital, Sasebo, JPN
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3
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Matsuura H, Kojima M. Conservative Treatment for Spontaneous Rectus Sheath Hematoma: A Case Report. Cureus 2025; 17:e77065. [PMID: 39917099 PMCID: PMC11800315 DOI: 10.7759/cureus.77065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2025] [Indexed: 02/09/2025] Open
Abstract
Rectus sheath hematoma is a rare but clinically important cause of acute abdominal pain. In most cases, patients have a history of trauma or are taking antiplatelet or anticoagulant therapy. Spontaneous rectus sheath hematoma is even rarer, with atheromatous changes identified as a contributing factor in the elderly. A 100-year-old woman with a history of hypertension, chronic obstructive pulmonary disease, and congestive heart failure presented to our emergency department with sudden-onset abdominal pain and a large lower abdominal mass. She was not on anticoagulant treatment and denied any traumatic event or excessive strain on abdominal musculature such as a cough. A CT scan showed a hematoma involving the left anterior abdominal wall at the rectus sheath, extending into the lower abdomen. Subsequently, she was diagnosed with spontaneous rectus sheath hematoma. We started conservative treatment with hemostatic agents, namely, carbazochrome and tranexamic acid to control the expansion of bleeding. Her hemoglobin level and vital signs remained stable, and her symptoms improved significantly. A follow-up CT scan four days after admission revealed a reduction in the size of the hematoma. The patient's treatment course was uncomplicated, and she was eventually discharged on the sixth day of her admission. Rectus sheath hematoma is associated with a high morbidity and mortality rate in patients, especially those with additional comorbidities. Early diagnosis and sufficient supportive treatment are crucial for management. We suggest that carbazochrome and tranexamic acid are also effective therapies.
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Affiliation(s)
- Hirokazu Matsuura
- Department of Surgery, Hitachiomiya Saiseikai Hospital, Ibaraki, JPN
| | - Masayuki Kojima
- Department of Surgery, Hitachiomiya Saiseikai Hospital, Ibaraki, JPN
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4
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Fujieda K, Saito S, Tanaka A, Furuhashi K, Ozeki T, Yasuda Y, Sano Y, Ishida S, Maruyama S. A case of non-traumatic rectus sheath hematoma in a post-kidney transplant patient undergoing catheter embolization during anticoagulation treatment for atrial fibrillation. CEN Case Rep 2024; 13:528-533. [PMID: 38743194 PMCID: PMC11608185 DOI: 10.1007/s13730-024-00890-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
A 65-year-old man, a post living donor kidney transplant patient, was admitted to the intensive care unit (ICU) with a severe bacterial infection. He also tested positive for coronavirus disease and had a cough. On admission, heparin was administered for atrial fibrillation. On the third day of hospitalization, his general condition had recovered, and he was discharged from the ICU to the general ward. On the fourth day of hospitalization, he experienced abdominal pain, and a hard mass was palpated in the left lower abdomen. On the fifth day of hospitalization, contrast-enhanced computed tomography showed an extensive rectus sheath hematoma (RSH) extending from the left lower abdominal wall to the left side of the bladder, with extravasation from a small branch of the left inferior epigastric artery. Heparin was discontinued, and transcatheter arterial embolization was performed to control the bleeding. RSH is a rare disease, and cases of extensive hematoma in post-kidney transplant patients occur even less frequently. Patients taking anticoagulants and those with chronic kidney disease are at high risk for RSH, so physicians should be cognizant of this disease when these patients develop abdominal pain.
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Affiliation(s)
- Kumiko Fujieda
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Shoji Saito
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Akihito Tanaka
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Kazuhiro Furuhashi
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan.
| | - Takaya Ozeki
- Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yuta Sano
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shohei Ishida
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Uzu T, Hirai S, Nishigaito T. Unexpected Severe Acute Abdominal Pain in a Hemodialysis Patient. KIDNEY360 2024; 5:1948-1949. [PMID: 39724109 DOI: 10.34067/kid.0000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2024]
Affiliation(s)
- Takashi Uzu
- Division of Nephrology and Blood Purification, Nippon Life Hospital, Japan
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Nakanoh H, Takeuchi H, Morimoto S, Terajima Y, Okamoto S, Onishi Y, Tanaka K, Katsuyama T, Tsuji K, Matsumoto Y, Tanabe K, Morinaga H, Uka M, Tomita K, Uchida HA, Hiraki T, Wada J. Successful Treatment for Life Threatening Recurrent Non-traumatic Rectus Sheath Hematoma in a Case with Microscopic Polyangiitis with Rapidly Progressive Glomerulonephritis. Intern Med 2024; 63:3243-3248. [PMID: 38658341 PMCID: PMC11671202 DOI: 10.2169/internalmedicine.3239-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/06/2024] [Indexed: 04/26/2024] Open
Abstract
A 68-year-old woman was admitted to our hospital because of a rapid progression of renal dysfunction with positive myeloperoxidase antineutrophil cytoplasmic antibody and was diagnosed with rapidly progressive glomerulonephritis associated with microscopic polyangiitis (MPA). Severe right rectus sheath hematoma (RSH) bleeding from the inferior epigastric artery developed after starting hemodialysis, which required 4 transarterial embolizations due to recurrent bleeding. After additional treatment with methylprednisolone pulse therapy and rituximab, no rebleeding occurred. Although the giant hematoma reached the pelvis, it shrank spontaneously without any intervention. Nontraumatic RSH should therefore be considered when treating patients with multiple risk factors.
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Affiliation(s)
- Hiroyuki Nakanoh
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Shiho Morimoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yuya Terajima
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Shugo Okamoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yasuhiro Onishi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Keiko Tanaka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Takayuki Katsuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Kenji Tsuji
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yoshinori Matsumoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Katsuyuki Tanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Hiroshi Morinaga
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, Japan
| | - Haruhito A Uchida
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Pardos-Gea J, Benítez O. Retroperitoneal and lower extremities muscle bleeding in acquired haemophilia A (AHA): Risk factors and implications in disability and survival. Eur J Haematol 2024; 113:685-692. [PMID: 39086272 DOI: 10.1111/ejh.14279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024]
Abstract
AIM To assess risk factors of retroperitoneal and lower extremity musculoskeletal bleed in acquired haemophilia (AHA) and perform an objective assessment of disability and influence on survival. METHODS We included 49 patients with AHA from November 2017 to May 2023. The occurrence of any retroperitoneal or/and lower extremities bleeding manifestation was investigated. On clinical follow-up, we search for compressive femoral neuropathy and quadriceps amyotrophy. The lower extremity functional scale (LEFS) was carried out one year after the last bleeding event in all AHA patients. RESULTS A 61.2% of patients in our AHA cohort presented with any retroperitoneal and/or lower extremities musculoskeletal manifestation. Those patients had higher percentage of major bleeding EACH2/ISTH criteria (90% vs. 57%, p = .01), needs of blood transfusions (86% vs. 57% of patients, p = .03), and haemostatic by-pass products (90% vs. 63%, p = .02). Hypertension (HR 2.6, 95% CI 1.1-5.9, p = .02), presence of autoimmune disease (HR 13, 95% CI 1.7-99, p = .01), and inhibitor level > 20 BU (HR 2.6 95% CI 1.0-6.8, p = .04) significantly predicted retroperitoneal/lower extremities clinical manifestations. Most frequent sequelae were quad atrophy (30.6%) and femoral nerve palsy (20.4%). Quad atrophy and LEFS scores under 50 were associated with increased mortality (HR 3, 95% CI 1.1-8.6 and HR 12, 95% CI 3.3-45, respectively). CONCLUSION AHA with retroperitoneal/lower extremities bleeding involvement is of greater severity and shows high disability and worst survival outcomes. Quadriceps atrophy and LEFS scale scoring under 50 predicted mortality in our AHA patients.
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Affiliation(s)
- José Pardos-Gea
- Autoimmune Diseases Unit, Internal Medicine, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Olga Benítez
- Departamento de Hematología Experimental, VHIO Vall d'Hebrón Instituto de Oncología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Cheruiyot I, Sehmi P, Kipkorir V, Munguti J, Ogeng’o J. Spontaneous rectus sheath hematoma complicated by deep venous thrombosis: A case report. Medicine (Baltimore) 2024; 103:e40198. [PMID: 39470497 PMCID: PMC11521082 DOI: 10.1097/md.0000000000040198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 09/27/2024] [Accepted: 10/04/2024] [Indexed: 10/30/2024] Open
Abstract
RATIONALE Rectus sheath hematoma (RSH) is an unusual cause of acute abdominal pain. It is more common in elderly patients on anticoagulation. The diagnosis is often challenging, as it mimics other more common causes of acute abdomen. No standard treatment guidelines exist, presenting therapeutic dilemmas. Herein, we describe a case of spontaneous RSH complicated by deep venous thrombosis (DVT). PATIENT CONCERNS The patient was a 58-year-old female on follow-up for end-stage renal failure, admitted for management of uremic gastritis, fluid overload state, and bronchopneumonia. On the third day of admission, she developed worsening abdominal pains, associated with dizziness, headaches, hypotension, tachycardia, and desaturation. Abdominal examination revealed tender swelling, with localized guarding. DIAGNOSES An urgent abdominal computed tomography scan demonstrated a large complex collection of approximately 12 cm × 10 cm in the left rectus sheath with intraperitoneal extension, consistent with RSH. INTERVENTIONS She underwent laparotomy with evacuation of 1.5 L of hematoma. Her postoperative recovery was complicated by the development of DVT on the sixth postoperative day. Due risk of rebleed, the inferior vena cava filter was favored over therapeutic anticoagulation. Her postoperative hospital stay was thereafter unremarkable. OUTCOMES AND LESSONS Although rare, RSH is a potential cause of acute abdomen, particularly among patients on anticoagulation, and can be life-threatening. A high index of suspicion is therefore important for early diagnosis. Clinicians should also appreciate the heightened risk of DVT in the immediate postoperative period despite mechanical anticoagulation.
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Affiliation(s)
- Isaac Cheruiyot
- Department of Human Anatomy and Medical Physiology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Prabjot Sehmi
- Department of Human Anatomy and Medical Physiology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Vincent Kipkorir
- Department of Human Anatomy and Medical Physiology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Jeremiah Munguti
- Department of Human Anatomy and Medical Physiology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Julius Ogeng’o
- Department of Human Anatomy and Medical Physiology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
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9
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Wang W, Duan J. Rectus sheath hematoma combined with COVID-19: A case report. World J Clin Cases 2024; 12:4325-4330. [PMID: 39015905 PMCID: PMC11235532 DOI: 10.12998/wjcc.v12.i20.4325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/25/2024] [Accepted: 05/22/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Rectus sheath hematoma (RSH) is uncommon, and because people have limited knowledge about it, it is difficult to recognize the symptoms in time, often de-laying optimal treatment. CASE SUMMARY Herein, we report a case of a 77-year-old female with RSH. The patient was treated at our hospital for coronavirus disease 2019. Anticoagulant treatment was administered during this period because of thrombosis. On the 8th d of treatment, the patient complained of abdominal pain. Ultrasonography revealed a solid cystic mass in the pelvic cavity. An emergency laparotomy was performed, and a huge hematoma was found in the deep layer of the rectus abdominis muscle. We used anticoagulants with caution based on the patient's condition. CONCLUSION Optimal management of patients with RSH s depends on timely diagnosis and when to reintroduce anticoagulants.
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Affiliation(s)
- Wei Wang
- Department of Obstetrics & Gynecology, Wuhan University of Science and Technology, Wuhan 430070, Hubei Province, China
| | - Jie Duan
- Department of Obstetrics & Gynecology, Hubei Maternal and Child Health Hospital, Wuhan 430070, Hubei Province, China
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Masuda H, Yamamoto Y, Kimura S, Matsuda K, Kobayashi K, Ae R. Spontaneous Abdominal Wall Hematoma: Early Recurrence without an Anticoagulant in an Elderly Woman Receiving Chronic Corticosteroid Treatment. Intern Med 2024; 63:2097-2100. [PMID: 38008449 PMCID: PMC11309873 DOI: 10.2169/internalmedicine.2845-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/12/2023] [Indexed: 11/28/2023] Open
Abstract
Spontaneous abdominal wall hematoma is a relatively uncommon condition triggered by various factors, including anticoagulation therapy and trauma. However, reports of unprovoked cases without anticoagulants that recur shortly after treatment are limited. We herein report an elderly woman who had been prescribed corticosteroids and experienced early recurrence of hematoma following treatment, with no discernible triggers. This case highlights the possibility that patients with underlying predisposing factors may experience early hematoma recurrence at the same site, even in the absence of apparent triggers. Clinicians should monitor these patients to promptly identify and address potential recurrences.
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Affiliation(s)
- Hiroya Masuda
- Department of General Medicine, Sunagawa City Medical Center, Japan
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
| | - Shinji Kimura
- Department of General Medicine, Sunagawa City Medical Center, Japan
| | - Koji Matsuda
- Department of General Medicine, Sunagawa City Medical Center, Japan
| | - Kanami Kobayashi
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Japan
| | - Ryusuke Ae
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Japan
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Orsini F, Mazzotta G, Carbone L, Dell'Atti C, Del Ciello A, Angeli ML, Larosa L, Petrucci M, Iezzi R, Franceschi F, Covino M. Clinical and radiological risk factors for poor outcomes in patients with spontaneous muscle hematomas. Eur J Radiol 2024; 175:111480. [PMID: 38677040 DOI: 10.1016/j.ejrad.2024.111480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/25/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Spontaneous muscle hematomas (SMH) are frequently seen in the Emergency Department (ED), particularly as a complication of anticoagulation treatments. To date, there are no standard guidelines for the management of this condition in the ED. This work aims to identify clinical-radiological parameters of SMH at risk of poor outcomes. METHOD This is a retrospective, observational cohort study conducted in an urban teaching hospital from 2016 to 2019. A multivariate logistic regression analysis was performed to identify parameters independently associated with an adverse outcome defined as the need for treatment (blood products, TAE, surgery) or hospitalization. The parameters analyzed were hematoma size, anticoagulation therapy, age, and the Charlson Comorbidity Index (CCI). ROC analysis was performed to identify the best cut-off hematoma size value to predict poor outcomes. RESULTS Our study enrolled 231 patients aged between 18 and 96 years, with a mean age of 67 years. In our population, 125 patients (54.1 % %) were on anticoagulant therapy. Multivariate analysis showed that an SMH diameter > 5.5 cm was independently associated with poor outcome ((odds Ratio [95 % CI] 4,009 [1,786-9,001], p 0.001). Among clinical parameters, only advanced age was proved to be an independent predictor of adverse outcomes (odds Ratio [95 % CI] 1,035 [1,003-1,069], p = 0.033) CONCLUSIONS: Our data suggest that an SMH diameter greater than 5.5 cm on a CT scan and advanced age are predictors of poor outcomes. Surprisingly, anticoagulant therapy seems to play a minor role in the outcome of SMHs.
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Affiliation(s)
- Federico Orsini
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giorgio Mazzotta
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Luigi Carbone
- Department of Emergency Medicine - Ospedale Fatebenefratelli Isola Tiberina, Gemelli - Isola, Roma, Italy
| | - Claudia Dell'Atti
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Annemilia Del Ciello
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Maria Luigia Angeli
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luigi Larosa
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Martina Petrucci
- Emergency Department - Fondazione, Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Roberto Iezzi
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Franceschi
- Emergency Department - Fondazione, Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Marcello Covino
- Emergency Department - Fondazione, Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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12
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Gupta J, Tahir S, Oshikoya A, Ganti L. Rectus Sheath Hematoma. Cureus 2024; 16:e61488. [PMID: 38952600 PMCID: PMC11216019 DOI: 10.7759/cureus.61488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/30/2024] [Indexed: 07/03/2024] Open
Abstract
The authors report on the case of a 69-year-old female who presented to the emergency department due to exquisite abdominal pain she described as occurring after she coughed. Imaging revealed a rectus sheath hematoma (RSH). A RSH is an uncommon but significant cause of acute abdominal pain that occurs when blood accumulates in the sheath of the rectus abdominis muscle. It can be caused by a muscular tear or a ruptured epigastric artery and can happen spontaneously or after trauma. The etiology, presentation, diagnosis, and management are discussed.
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Affiliation(s)
- Jai Gupta
- Biology, Seminole Science, Lake Mary, USA
| | - Sana Tahir
- Medicine, Orlando College of Osteopathic Medicine, Winter Garden, USA
| | - Amelie Oshikoya
- Medicine, Orlando College of Osteopathic Medicine, Winter Garden, USA
| | - Latha Ganti
- Research, Orlando College of Osteopathic Medicine, Winter Garden, USA
- Medical Sciences, The Warren Alpert Medical School of Brown University, Providence, USA
- Emergency Medicine and Neurology, University of Central Florida College of Medicine, Orlando, USA
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13
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Vaduva P, Duntze C, Guenego A, Cocquerel N, Guilhem I. Hemorrhagic Shock Associated with a Subcutaneous Insulin Pump Catheter: First Time Reported Side Effect. Diabetes Technol Ther 2024; 26:276-278. [PMID: 38156960 DOI: 10.1089/dia.2023.0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Patricia Vaduva
- Endocrinology, Diabetes and Nutrition Department, Rennes University Hospital, Rennes, France
| | - Camille Duntze
- Geriatrics Department, Saint Laurent Polyclinic, Rennes, France
| | - Agathe Guenego
- Endocrinology, Diabetes and Nutrition Department, Rennes University Hospital, Rennes, France
| | | | - Isabelle Guilhem
- Endocrinology, Diabetes and Nutrition Department, Rennes University Hospital, Rennes, France
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14
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Sun XX, Liu H, Qin XZ, Li MR, Yan QH, Zhang GJ. The Diagnostic Value of Carnett's Test with Chronic Abdominal Pain: A Narrative Review. Curr Pain Headache Rep 2024; 28:251-257. [PMID: 38340209 DOI: 10.1007/s11916-024-01223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW Chronic abdominal wall pain is a poorly recognized cause of chronic abdominal pain, and patients frequently go misdiagnosed despite a battery of medical tests. The Carnett's test is a diagnostic tool used to distinguish between abdominal wall pain and visceral pain. This review synthesizes the current literature on the Carnett's test, merges the viewpoints of diverse writers, and evaluates and reports on the Carnett's test's applicability. RECENT FINDINGS Several clinical investigations have established the usefulness of the Carnett's test in the diagnosis of chronic abdominal wall pain. Furthermore, the Carnett's test is quite useful in determining the depth of the mass and detecting psychogenic abdominal pain. However, its diagnostic use for acute abdominal pain is limited. The Carnett's test is a simple and safe point-of-care diagnostic technique, with several studies supporting its usefulness. Early detection of abdominal wall pain is critical for chronic abdominal wall pain therapy. Carnett's test is very useful in patients with chronic, unexplained local abdominal discomfort who are compliant and do not have a clear rationale for surgery.
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Affiliation(s)
- Xiao-Xiao Sun
- Department of Pain, Yanbian University Hospital, Yanji, Jilin Province, China
| | - Heng Liu
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Xiang-Zheng Qin
- Department of Anatomy, Basic Medical Sciences of Yanbian University, Yanji, Jilin Province, China
| | - Mei-Rui Li
- Department of Pain, Yanbian University Hospital, Yanji, Jilin Province, China
| | - Qing-Hua Yan
- Department of Pain, Yanbian University Hospital, Yanji, Jilin Province, China
| | - Guang-Jian Zhang
- Department of Pain, Yanbian University Hospital, Yanji, Jilin Province, China.
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15
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Mathew GG, Asokan A, Varadharajan J, Sailapathy S. Rectus sheath haematoma in a haemodialysis patient. BMJ Case Rep 2024; 17:e255955. [PMID: 38367995 PMCID: PMC10875516 DOI: 10.1136/bcr-2023-255955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 02/19/2024] Open
Affiliation(s)
- Gerry George Mathew
- Nephrology, SRM Medical College Hospital and Research Centre, Kanchipuram, Tamil Nadu, India
| | - Arunkumar Asokan
- Nephrology, SRM Medical College Hospital and Research Centre, Kanchipuram, Tamil Nadu, India
| | | | - Sreedhar Sailapathy
- Nephrology, SRM Medical College Hospital and Research Centre, Kanchipuram, Tamil Nadu, India
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16
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Eltahir BA, Abdelhameed ME, Abdulla Ghaleb WE. Lateral Abdominal Wall Hematoma Mimicking Aortic Dissection Presentation: A Case Report. Cureus 2024; 16:e54717. [PMID: 38524083 PMCID: PMC10960730 DOI: 10.7759/cureus.54717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Lateral abdominal wall hematoma is a rare clinical entity but a great mimicker of other diseases' clinical presentations. In this case report, we present a 42-year-old male patient with a constellation of signs and symptoms that were mistaken for aortic dissection before the lateral abdominal wall hematoma diagnosis was confirmed with computed tomography (CT) imaging. Uncontrolled hypertension and persistent cough were most likely predisposing factors; the patient was managed conservatively and discharged in a stable condition.
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Affiliation(s)
- Babiker A Eltahir
- Department of Emergency, NMC Royal Hospital, Khalifa City, Abu Dhabi, ARE
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17
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Soheilipour M, Tabesh E, Afsharzadeh M, Tabibian A. Rectus abdominis muscle abscess after performing colonoscopy-A case report. Clin Case Rep 2024; 12:e8552. [PMID: 38415191 PMCID: PMC10896747 DOI: 10.1002/ccr3.8552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/05/2023] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
Endoscopic removal of premalignant polyps can prevent colorectal cancers. It is considered a safe procedure, yet there are some complications reported. Rectus abdominis muscle abscess (RAMA) is a type of pyomyositis seen as a complication of rectus sheath hematoma. Predisposing factors to RAMA include trauma, diabetes mellitus, alcohol abuse, Intravenous drug abuse and hematologic diseases.In this article, we report a case of a 74-year-old patient with abscess formation in the Rectus Abdominis muscle after colonoscopy and polypectomy with the application of abdominal pressure techniques without any early complications. Diagnosis of RAMA was made after a Computed Tomography scan and ultrasound-guided drainage, in addition to antibiotic therapy, were used as treatment.Although colonoscopy is considered a generally safe procedure, endoscopists should be aware of Rectus Abdominis sheath hemorrhage and RAMA in the following as a complication with the presentation of abdominal pain. Applying abdominal pressure should be done carefully To reduce minor trauma likelihood, owing to it being a predisposing factor of RAMA.
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Affiliation(s)
- Maryam Soheilipour
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC)Isfahan University of Medical SciencesIsfahanIran
| | - Elham Tabesh
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC)Isfahan University of Medical SciencesIsfahanIran
| | | | - Amirhossein Tabibian
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC)Isfahan University of Medical SciencesIsfahanIran
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18
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McArdle M. Trauma in the elderly: a bilateral rectus sheath haematoma. BMJ Case Rep 2023; 16:e256061. [PMID: 38061846 PMCID: PMC10711929 DOI: 10.1136/bcr-2023-256061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Life expectancy has more than doubled in the last century, and a new cohort of elderly and increasingly frail patients is presenting to emergency departments with new clinical challenges. When this patient cohort presents after injury, all aspects of clinical practice have to be recalibrated to provide safe and appropriate care. The prevalence of chronic disease, levels of organ failure, multiple comorbidities, greater use of anticoagulation and incidence of recurrent low- and high-impact trauma may delay and obscure diagnosis and, ultimately, increase mortality.Older age is a risk factor for rectus sheath haematoma (RSH), which is haemorrhage into the potential space surrounding the rectus abdominis muscle/s. It is a rare presentation following trauma but can provide diagnostic challenges and be fatal. Even more rare is bilateral RSH with only 12 reported in the literature since 1981.This case report describes bilateral RSH presenting in an elderly woman following a fall and the consequences of seemingly minor trauma in the elderly.
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Affiliation(s)
- Michael McArdle
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- South Warwickshire University NHS Foundation Trust, Warwick, UK
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19
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Mizutani Y, Nagao T, Sato K, Ito K. An infected chronic expanding haematoma treated with hip disarticulation. BMJ Case Rep 2023; 16:e255977. [PMID: 38050387 PMCID: PMC10693880 DOI: 10.1136/bcr-2023-255977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
This is a report of an anticoagulated patient with septic shock caused by an infected chronic expanding haematoma (CEH) that required hip disarticulation as a means of definitive surgical source control. As far as we know, we did not find any report of an infected giant CEH in the lower extremity as large as in the present patient.
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Affiliation(s)
- Yasushi Mizutani
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Nagao
- Department of Surgery, Division of Acute Care Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kenji Sato
- Department of Orthopedic Surgery, Teikyo University School fo Medicine, Tokyo, Japan
| | - Kaori Ito
- Department of Surgery, Division of Acute Care Surgery, Teikyo University School of Medicine, Tokyo, Japan
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20
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Harris E, Fleshman T, Franks A. A case of rectus sheath hematoma in the setting of paroxysmal coughing and platelet dysfunction. J Family Med Prim Care 2023; 12:3422-3424. [PMID: 38361870 PMCID: PMC10866229 DOI: 10.4103/jfmpc.jfmpc_851_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/21/2023] [Accepted: 09/06/2023] [Indexed: 02/17/2024] Open
Abstract
Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that may mimic other intra-abdominal pathologies. It is caused by the rupture of the superior or inferior epigastric artery or vein in the rectus abdominis muscle. Clinical features include sudden-onset abdominal pain and a palpable mass, and common risk factors include anti-coagulants, platelet dysfunction, and cough. Workup includes a physical exam, complete blood count, coagulation profile, ultrasound, and computed tomography. While most cases are treated conservatively, uncontrolled hemorrhage may be lethal and requires prompt recognition. We discuss a case of RSH which developed in the setting of paroxysmal coughing and platelet dysfunction. The purpose is to highlight the diagnosis and treatment of RSH and emphasize the importance of its inclusion in the differential for acute abdominal pain.
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Affiliation(s)
- Erika Harris
- Department of Family Medicine, Joan C Edwards School of Medicine, Marshall University, Barboursville, WV, United States
| | - Taylor Fleshman
- Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Adam Franks
- Department of Family Medicine, Joan C Edwards School of Medicine, Marshall University, Barboursville, WV, United States
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21
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Noel W, Donahue BB. Cough Causing Abdominal Pain? A Rapid POCUS Diagnosis of Rectus Sheath Hematoma. POCUS JOURNAL 2023; 8:121-123. [PMID: 38099162 PMCID: PMC10721295 DOI: 10.24908/pocus.v8i2.16500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
We present a case of a 59-year-old man who arrived to the emergency department with abdominal pain and bruising after coughing. Point of care ultrasound (POCUS) was used to make the diagnosis of rectus sheath hematoma (RSH). This diagnosis was made within minutes of arrival to the ED and subsequently confirmed on computed tomography (CT) of the abdomen. As abdominal ultrasound is a technically straightforward imaging technique which includes a sensitivity that rises about 90%, its utilization to identify rectus sheath hematoma can reduce the rate of CT imaging and time to diagnosis for this pathology.
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Affiliation(s)
- William Noel
- Emergency Medicine Residency Program, Ascension Resurrection Medical CenterChicago, IllinoisUSA
| | - Brian B Donahue
- Emergency Medicine Residency Program, Ascension Resurrection Medical CenterChicago, IllinoisUSA
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22
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Suja L, Logithasan N, Senthil N, Anil AA. Spontaneous muscle haematoma in a patient with cirrhosis. BMJ Case Rep 2023; 16:e254525. [PMID: 37923333 PMCID: PMC10626913 DOI: 10.1136/bcr-2022-254525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Decompensated liver disease is associated with alterated haemostasis that can either lead to spontaneous bleeding or development of thrombosis. Alcohol consumption coupled with advanced liver disease favours spontaneous bleeding. There have been only few documented cases of spontaneous muscle haematoma (SMH) in patients with cirrhosis. The pathogenesis of SMH is hypothesised to be multifactorial and it has been seen in patients on anticoagulation or with haemostatic disorders. We report a case of alcohol-related cirrhosis presenting with an expanding, voluminous haematoma in the intermuscular plane between the trapezius and the teres major muscles. This patient also had a retroperitoneal haemorrhage, clinically evidenced by the Grey Turner's and Cullen's signs. Haemorrhage was confirmed radiologically by CT. The patient was managed in an intensive care facility and treated with multiple blood products, including packed red blood cells, fresh frozen plasma and cryoprecipitates. However, as his clinical condition deteriorated, he required surgical intervention by incision and drainage, followed by evacuation. Early identification of coagulopathy and aggressive treatment are essential in these cases of cirrhosis to avoid unfavourable outcomes.
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Affiliation(s)
- Lakshmanan Suja
- General Medicine, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Nanthakumar Logithasan
- General Medicine, Sri Ramachandra University Medical College, Chennai, Tamil Nadu, India
| | - Narayanasamy Senthil
- General Medicine, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - Archa Anna Anil
- General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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23
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Hany A, Mansour A, Sediek M, Nabil M. Role of tranexamic acid-soaked gelatin sponge in minimizing rectus sheath hematoma after cesarean section in women treated with warfarin, a simple tool for high-risk cases, a randomized controlled trial. Eur J Med Res 2023; 28:448. [PMID: 37864195 PMCID: PMC10588007 DOI: 10.1186/s40001-023-01434-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND This study aims to illustrate the impact of applying the tranexamic acid impregnated in a gelatin sponge between the anterior rectus sheath and the Rectus Abdominis muscle during Cesarean section (CS) in minimizing rectus sheath hematoma (RHS) in women treated with Warfarin. METHODS A clinical trial was carried out on 63 pregnant women attended for elective CS, who on antenatal warfarin anticoagulation started from 13 weeks gestation to 36 weeks then shifted to low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH), and with an indication for postnatal warfarin anticoagulation. They were randomly assigned on the day of the scheduled CS into three equal groups (21 women for each). Group 1 had two pieces of gelatin sponges soaked with one ampoule of tranexamic acid. Group 2 had two pieces of gelatin sponges not soaked with tranexamic acid. Group 3 (control group) had no gelatin sponge applied. All patients underwent postoperative assessment done for hemoglobin (Hb), hematocrit (HCT), estimated blood loss (EBL), amount and nature of discharge collected from the sub-rectus drain, complications (RHS, wound infection, thromboembolism), need for re-operation, and need for blood transfusion. RESULTS Statistically significant differences were found between Group 1 and Group 2 regarding the postoperative Hb (10.66 ± 1.13 vs. 9.77 ± 0.69, P = 0.009), between Group 1 and Group 2 regarding the postoperative HCT (31.87 ± 3.59 vs. 28.54 ± 1.85, P = 0.001), between Group 1 and Group 2 regarding EBL (442.19 ± 244.46 vs. 744.38 ± 267.05, P = 0.003), between Group 1 and Group 3 regarding EBL (442.19 ± 244.46 vs. 664.29 ± 343.97, P = 0.040), and between Group 1 and Group 3 regarding the discharge amount from the sub rectus drain (190.48 ± 100.77 vs. 307.14 ± 127.76, P = 0.004). CONCLUSION Tranexamic acid-soaked gelatin sponges are safe and effective in reducing postoperative drainage and EBL. CLINICAL TRIAL REGISTRATION At ClinicalTrials.gov in June 2022 (NCT05439694).
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Affiliation(s)
- Ayman Hany
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Alkasr Alainy St, Cairo, 11562, Egypt
| | - Ayman Mansour
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Alkasr Alainy St, Cairo, 11562, Egypt.
| | - Mona Sediek
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Alkasr Alainy St, Cairo, 11562, Egypt
| | - Mohamed Nabil
- Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Alkasr Alainy St, Cairo, 11562, Egypt
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24
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Fujimori D, Sakamoto S. Abdominal internal oblique muscle hematoma of an obese middle-aged man induced by cough. J Gen Fam Med 2023; 24:313-314. [PMID: 37727621 PMCID: PMC10506389 DOI: 10.1002/jgf2.639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/02/2023] [Accepted: 06/21/2023] [Indexed: 09/21/2023] Open
Abstract
An obese middle-aged man presented for left abdominal pain. CT scan with contrast medium revealed hematoma in the left abdominal internal oblique muscle.
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Affiliation(s)
- Daisuke Fujimori
- Department of Emergency MedicineAsahi General HospitalChibaJapan
| | - So Sakamoto
- Department of Emergency MedicineAsahi General HospitalChibaJapan
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25
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Kummer T, Mohn KJ, Bardwell AJ, Boyum JH. Evaluation of Soft-Tissue Hematomas With Real-Time, Contrast-Enhanced Ultrasound: A Pilot Study With Preliminary Findings. Ultrasound Q 2023; 39:179-185. [PMID: 36731072 DOI: 10.1097/ruq.0000000000000621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT In this study, we investigated the feasibility of using contrast-enhanced ultrasound (CEUS) to detect active hemorrhage in patients presenting with soft-tissue hematomas. Adult patients with clinically suspected, actively bleeding hematomas were prospectively enrolled. Contrast-enhanced ultrasound was used to assess for contrast extravasation. Ultrasound results were compared with those of multidetector computed tomographic (MDCT) imaging, operative findings, and clinical course. Sixteen patients (9 women, 7 men; mean age, 69 [SD, 13] years) were enrolled. Thirteen patients underwent MDCT imaging during their initial visit, and for 11, CEUS and computed tomography (CT) findings were concordant. The remaining patients had a negative CEUS study that was consistent with their clinical course. In 8 patients, CT imaging showed active extravasation (6 arterial, 1 indeterminate, 1 slow venous). Contrast-enhanced ultrasound and CT findings were concordant for all cases of arterial bleeding. For 1 patient, CEUS provided superior diagnostic information by identifying a pseudoaneurysm. The 2 discrepant patient cases had a ≥3-hour delay between CT and CEUS, and in 1 patient, CEUS was limited by body habitus. The second patient had no active bleeding identified in the operating room. Compared with CT, CEUS had a sensitivity and specificity of 75% and 100%, respectively, and positive and negative predictive values were 100% and 71%, respectively. Diagnostic accuracy was 85% in this limited study. Contrast-enhanced ultrasound is a promising alternative to MDCT in select patients and may sometimes provide superior clinical information. Limiting factors are large hematoma size, unfavorable anatomic location, and body habitus.
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26
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Das S, Prakash S, Singh S, Shaikh O, Balasubramanian G. Spontaneous Rectus Sheath Hematoma. Cureus 2023; 15:e44138. [PMID: 37753012 PMCID: PMC10519645 DOI: 10.7759/cureus.44138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Rectus sheath hematoma (RSH) is one of the surgical emergencies that mimics peritonitis or other causes of acute abdominal pain. It is usually seen in old age, post-trauma, anticoagulation therapy pregnancy, chronic cough, and liver disease. Nevertheless, RSHs can be spontaneous without any underlying predisposing factors. Here, we present a 51-year-old female with sudden onset abdominal pain, abdominal distention, hypotension, and severe pallor. After initial resuscitation, the patient underwent radiological imaging. This suggested an RSH with active bleeding from the inferior epigastric artery or profunda femoris artery. The patient underwent digital subtraction angiography and angioembolization of the profunda femoris branch. After a few days, the patient continued deteriorating and succumbed to acute respiratory distress syndrome (ARDS).
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Affiliation(s)
- Snehasis Das
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sagar Prakash
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Shweta Singh
- Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Oseen Shaikh
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Gopal Balasubramanian
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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27
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Chiu FL, Hsu CH, Yang JR, Hsieh JS. Reappraisal of Multiple Cutaneous Ecchymotic Signs: Coexistence of Grey Turner Sign, Stable Sign, and Fox Sign in Spontaneous Abdominal Wall Hematoma. J Emerg Nurs 2023; 49:510-512. [PMID: 37393077 DOI: 10.1016/j.jen.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 07/03/2023]
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28
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Emekli E, Yıldırım M, Türkkanı MH, Ödemiş Başpınar E. Rectus Sheath Hematoma as a Complication in Patients With COVID-19: Clinical and Imaging Findings. Cureus 2023; 15:e38943. [PMID: 37313085 PMCID: PMC10259751 DOI: 10.7759/cureus.38943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
Objectives This study aims to investigate the frequency of rectus sheath hematoma (RSH), clinical findings, imaging findings, and prognosis in patients admitted to the hospital due to COVID-19. Methods In this retrospective study, the patient's demographic characteristics, known diseases, laboratory values, RSH-related symptoms, the treatment they received, imaging modality used to diagnose RSH, and side and size of RSH were recorded. In addition, the inpatient ward to which the patients were admitted, length of hospital stay, time from the beginning of anticoagulant use to the diagnosis of RSH, and prognosis were noted. Results A total of 9,876 patients were admitted to the hospital due to COVID-19 and started anticoagulant treatment. Of these patients, 12 (0.12%) were determined to have RSH (female/male ratio: 5). The prothrombin time, activated partial thromboplastin time, international normalized ratio, hemoglobin, and hematocrit values of 11 patients were within the reference ranges. The mean length of hospital stay was 12 (4.25-22.5) days, and the duration of anticoagulant use was 5.5 (4-10.75) days. RSH was diagnosed using USG in 10 patients and CT in two patients. Conclusion There has been an increase in the use of anticoagulants due to COVID-19, and accordingly, RSH is now more frequently diagnosed and has a more fatal course. Female gender, advanced age, severe COVID-19 disease, and elevated d-dimer at the time of presentation can be considered risk factors for the development of RSH. All physicians who treat and follow up on patients with COVID-19 should consider the possibility of RSH in the differential diagnosis of patients with acute abdominal pain and palpable masses. USG should be undertaken as the first-line imaging modality for the diagnosis of patients, but CT may also be necessary to detect RSH in some cases.
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Affiliation(s)
- Emre Emekli
- Radiology, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, TUR
| | - Mesut Yıldırım
- Radiology, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, TUR
| | | | - Emel Ödemiş Başpınar
- Infectious Diseases and Clinical Microbiology, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, TUR
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29
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Mackiewicz-Milewska M, Cisowska-Adamiak M, Szymkuć-Bukowska I, Sakwińska K, Domarecka I, Lewandowska A, Głowacka-Mrotek I. Intramuscular Hematomas in Patients Receiving Prophylaxis or Anticoagulant Treatment after Spinal Cord Injury (SCI)-A Rare Complication: Description of Seven Cases and a Literature Analysis. Biomedicines 2023; 11:biomedicines11041142. [PMID: 37189761 DOI: 10.3390/biomedicines11041142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/07/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
Spinal cord injuries (SCIs) are associated with a high risk of thromboembolic complications (VTE), despite the use of antithrombotic prophylaxis in the form of low-molecular-weight heparin (LMWH). The occurrence of VTE requires, as in other diseases, full-dose antithrombotic treatment. Herein, we describe seven cases of soft tissue hemorrhagic complications in the form of spontaneous intramuscular hematomas (SMHs) in patients after SCI undergoing rehabilitation. Four patients received anticoagulant therapy due to previously diagnosed deep vein thrombosis (DVT), and three patients received anticoagulant prophylaxis. None of the patients had a significant injury immediately before the hematoma appeared, and the only symptom was a sudden swelling of the limb without accompanying pain. The hematomas in all patients were treated conservatively. In three patients, significant decreases in hemoglobin were observed; in one patient, a blood transfusion was required for this reason. In all patients treated via anticoagulation, the anticoagulation treatment was modified at the time of diagnosis of the hematoma; in three patients, oral anticoagulants were changed to LMWH in a therapeutic dose, while in one patient, anticoagulant treatment was completely discontinued. Conclusions: Intramuscular hematomas are rare complications after SCI. Each sudden swelling of a limb requires ultrasound-based diagnostics. At the time of diagnosis of a hematoma, the level of hemoglobin and the size of the hematoma should be monitored. The treatment or anticoagulation prophylaxis should be modified if necessary.
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Affiliation(s)
- Magdalena Mackiewicz-Milewska
- Department of Rehabilitation, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Małgorzata Cisowska-Adamiak
- Department of Rehabilitation, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Iwona Szymkuć-Bukowska
- Department of Rehabilitation, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Katarzyna Sakwińska
- Department of Rehabilitation, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Iwona Domarecka
- Department of Rehabilitation, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Anna Lewandowska
- Department of Rehabilitation, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
| | - Iwona Głowacka-Mrotek
- Department of Rehabilitation, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland
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Bao NVT, Phuoc LV, Tuan NHN, Khoa LV, Tu PD, Hoan DD, Duc NM. Endovascular management of rectus abdominis hematoma: A report of two cases. Radiol Case Rep 2023; 18:1239-1243. [PMID: 36660579 PMCID: PMC9842791 DOI: 10.1016/j.radcr.2022.12.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
Nontraumatic spontaneous hematoma of the rectus abdominis is frequently related to anticoagulation therapy. In most cases, this condition is spontaneously self-limited or can be controlled with conservative therapy. Nevertheless, in some patients, despite early and adequate medical therapy, continuous development of the condition requires rapid and complete hemostasis. Currently, endovascular management by selective transarterial embolization of the bleeding vessel is the most common treatment option. We report 2 cases of endovascular management of rectus abdominis hematoma using a mixture of n-butylcyanoacrylate and lipiodol to embolize the bleeding point of the superior epigastric artery. Clinical symptoms improved without noticeable complications.
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Affiliation(s)
| | - Le Van Phuoc
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Le-Van Khoa
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Pham Dang Tu
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Duong Dinh Hoan
- Department of Radiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 District 10, Ho Chi Minh City, Vietnam
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Transversus abdominis plane (TAP) block for pain management of rectus sheath hematoma in the emergency department (ED). Am J Emerg Med 2023; 63:183.e1-183.e3. [PMID: 36369046 DOI: 10.1016/j.ajem.2022.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/19/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022] Open
Abstract
Peripheral nerve blocks for pain management have historically been discussed in anesthesiology literature but, until recently, have not been considered in emergency medicine contexts. Transversus abdominis plane (TAP) blocks, in particular, have recently been explored in the emergency department for pain control in acute appendicitis but are potentially helpful for managing abdominal pain of other etiologies. One such pathology is rectus sheath hematomas, where conservative management is often necessary as curative treatments often pose more significant risks than are necessary. We report the case of a 57-year-old female presenting to the emergency department with severe abdominal pain following vigorous exercise. She was found to have a large rectus sheath hematoma on computed tomography. An ultrasound-guided transversus abdominis plane block was performed in the emergency department, and the patient had complete resolution of her pain.
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PAUWAERT K, FRANÇOIS E, DE VISSCHERE M. Urological symptoms as the initial presentation of a spontaneous rectus sheath hematoma. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wong CL, So CHY. Spontaneous rectus sheath hematoma associated with apixaban in an elderly gentleman with chronic obstructive airway disease - a case report. Thromb J 2022; 20:59. [PMID: 36192770 PMCID: PMC9531369 DOI: 10.1186/s12959-022-00420-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 09/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background Rectus sheath hematoma (RSH) is a relatively uncommon cause of acute abdominal pain and can be mistaken as other surgical causes of acute abdomen. A diagnosis requires high index of suspicion especially in susceptible patients, for example, in patients on anticoagulation. While anticoagulation is the commonest risk factor for RSH, direct-acting oral anticoagulants have only been very recently implicated as a potential cause with fewer than ten cases reported in the literature. Case presentation. An 82-year-old Chinese man with chronic obstructive airway disease, ischemic heart disease, heart failure and atrial fibrillation on apixaban presenting with acute onset of lower abdominal pain. Physical examination showed peritoneal signs with tenderness and guarding over the lower quadrants with hypotension. Computed tomography (CT) of the abdomen confirmed a large rectus sheath hematoma (RSH) without active extravasation. He was given fluid resuscitation and was managed successfully with supportive treatment and cessation of apixaban. A follow-up CT two months later showed resolving hematoma and aspirin was resumed primarily for ischemic heart disease. The patient tolerated anti-platelet therapy without recurrence of RSH. The risk factors, treatment options, prognosis and issue related to anticoagulation resumption after an episode of RSH are discussed. Reported cases of RSH associated with direct-acting oral anticoagulants are reviewed. Conclusions Direct-acting oral anticoagulant-associated rectus sheath hematoma is rare. With increasing use of direct-acting oral anticoagulants in multiple clinical settings, clinicians should remain vigilant of this potentially life-threatening bleeding complication when a patient presents with acute abdominal pain. Conservative treatment with cessation of anti-coagulant and supportive transfusion remains the mainstay of treatment.
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Affiliation(s)
- Cheuk-Lik Wong
- Department of Medicine and Geriatrics, Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Kowloon, Hong Kong SAR.
| | - Clarence Hao-Yu So
- Department of Medicine and Geriatrics, Caritas Medical Centre, 111 Wing Hong Street, Shamshuipo, Kowloon, Hong Kong SAR
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Alzoubi MN, Salameh I, Shahait AD, Al-zyoud A, Raza S. A Case of Spontaneous Multiple Abdominal Wall Hematomas in a COVID-19 Patient. Cureus 2022; 14:e29647. [DOI: 10.7759/cureus.29647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
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Kirkan EF, Ulgur HS, Comert S, Erol C, Yildirak MK, Ozkan OF. Management of Spontaneous Major Rectus Sheath Hematoma in a COVID-19 Patient: A Case Report and Literature Review. Cureus 2022; 14:e29206. [PMID: 36258938 PMCID: PMC9569153 DOI: 10.7759/cureus.29206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
A rectus sheath hematoma, which is mostly encountered due to abdominal traumas or anticoagulant use, can be challenging, and a delayed diagnosis may lead to hypovolemic shock and even death. In this study, we aimed to present the management of a case of rectus sheath hematoma that developed in a patient who was hospitalized and under coronavirus disease 2019 (COVID-19) treatment. A 70-year-old female patient was admitted to the intensive care unit (ICU) due to respiratory failure and developed a sudden onset of tachycardia and hypotension. The patient was then diagnosed with a rectus sheath hematoma and after ensuring hemodynamic stability she was treated with angiographic embolization. Following the treatment, the patient remained hemodynamically stable and a control computed tomography (CT) revealed regression in the hematoma. Rectus sheath hematomas especially accompanied by additional comorbidities or aggressive surgical interventions may result in high mortality rates in the early period. It should also be kept in mind that during the COVID-19 pandemic, which has affected the world in the last two years, rectus sheath hematomas may be the underlying cause of sudden hypotension and abdominal distension, and it should not be forgotten that angiographic embolization performed by experienced interventional radiologists is the mainstay of treatment in cases where hemodynamic stability can’t be achieved.
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36
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Dulberger A, Streiff M, Myers SD, Sanders CS. Hernia Following Rectus Sheath Hematoma. Cureus 2022; 14:e28795. [PMID: 36225418 PMCID: PMC9534222 DOI: 10.7759/cureus.28795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/05/2022] Open
Abstract
Rectus sheath hematomas (RSH) are increasing in prevalence, presumably correlating with increased use of anticoagulation medications and an aging population. Comorbidities such as blood dyscrasias, atherosclerosis, and hypertension are associated with an increased risk of developing an RSH. Iatrogenic origin of RSH, secondary to treatment of various abdominal pathologies, is not uncommon. Due to its exceptionally non-specific array of clinical signs and symptoms, RSH can be challenging to diagnose in the clinical setting without the aid of radiological images. Abdominal computed tomography (CT) is generally the modality of choice through which the RSH can be successfully identified and characterized. CT imaging can play an important role in the planning of RSH management, as effective management varies depending on the size and position of the RSH. Recurrent bleeding, hypovolemic shock, abdominal compartment syndrome, myonecrosis, and infection have been traditionally considered as the more prominent complications of RSH. However, with more cases occurring, more complications are being described in the literature. The following case presents a previously unreported complication of RSH, that of bowel herniation into a potential space created by a previously treated RSH.
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Angeramo CA, Méndez P, Eyheremendy EP, Schlottmann F. Rectus sheath hematoma: conservative, endovascular or surgical treatment? A single-center artificial neural network analysis. Eur J Trauma Emerg Surg 2022; 48:2157-2164. [PMID: 35031823 DOI: 10.1007/s00068-021-01854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/02/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Rectum sheath hematoma (RSH) is a rare and often misdiagnosed disease. We aimed to determine outcomes of patients affected by RSH and identify variables associated with the need of prompt intervention. METHODS Patients diagnosed with RSH during the period 2012-2020 were retrospectively identified. Demographics, diagnostic, and therapeutic variables were evaluated. RSH was classified with computed tomography (CT) according to the Berna system. An artificial neural network (ANN) model including 12 variables was used to identify patients that might require a prompt endovascular or surgical treatment. RESULTS A total of 20 patients were included for analysis; mean age was 69 (35-98) years and 14 (70%) were females. Iatrogenic injury and forceful contraction of the abdominal wall were the leading causes of RSH. Eleven (55%) patients were anticoagulated or antiaggregated. There were 3 (15%) grade 1, 5 (25%) grade 2, and 12 (60%) grade 3 RSH; 6 (30%) were treated conservatively, 10 (50%) with artery embolization, and 4 (20%) with surgery. Overall morbidity was 45% and there was no mortality in the series. According to the ANN, patients at high risk of requiring an invasive treatment were those with active extravasation on CT angiography, Berna grade III, age ≥ 65 years, hemodynamic instability, chronic use of corticosteroids, hematoma volume ≥ 1000 mL, and/or transfusion of ≥ 4 units of red blood cells. CONCLUSION Conservative treatment might be effective in selected patients with RSH. Our artificial neural network analysis might help selecting patients who require endovascular or surgical treatment.
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Affiliation(s)
- Cristian A Angeramo
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina.
- Department of Radiology, Interventional Radiology Service, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
| | - Patricio Méndez
- Department of Radiology, Interventional Radiology Service, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Eduardo P Eyheremendy
- Department of Radiology, Interventional Radiology Service, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredon 1640, C1118AAT, Buenos Aires, Argentina
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Moon SN, Seo SH, Jung HS. Successful endovascular embolization for traumatic subcutaneous abdominal wall hematoma via the superficial inferior epigastric artery: a case report. JOURNAL OF TRAUMA AND INJURY 2022; 35:128-130. [PMID: 39381176 PMCID: PMC11309183 DOI: 10.20408/jti.2020.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 11/05/2022] Open
Abstract
Abdominal wall hematoma (AWH) after blunt trauma is common, and most cases can be treated conservatively. More invasive treatment is required in patients with traumatic AWH if active bleeding is identified or there is no response to medical treatment. Herein, we report a case of endovascular embolization for traumatic subcutaneous AWH. Almost endovascular treatment for AWH is done through the deep inferior epigastric artery. However, in this case, the superficial inferior epigastric artery was the bleeding focus and embolization target. After understanding the vascular system of the abdominal wall, an endovascular approach and embolization is a safe and effective treatment option for AWH.
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Affiliation(s)
- Sung Nam Moon
- Regional Trauma Center, Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Sang Hyun Seo
- Regional Trauma Center, Department of Radiology, Wonkwang University Hospital, Iksan, Korea
| | - Hyun Seok Jung
- Regional Trauma Center, Department of Radiology, Wonkwang University Hospital, Iksan, Korea
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Taguchi K, Kamei Y, Kusakabe E, Yamashita M, Noda H, Aoki R, Nishiyama K, Murakami A, Tanaka H, Matsuda M, Kido T, Sato N, Takada Y. Non-traumatic bilateral rectus sheath hematoma during septic disseminated intravascular coagulation. Radiol Case Rep 2022; 17:1737-1740. [PMID: 35360185 PMCID: PMC8960865 DOI: 10.1016/j.radcr.2022.02.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
A non-traumatic abdominal wall hematoma is rare, and occurs occasionally due to coughing, physical activity, or antithrombotic/anticoagulant therapy. The condition is usually unilateral; however, rare bilateral cases have been reported. Here, we report a rare case of a non-traumatic bilateral rectus sheath hematoma. The patient was a 60-year-old woman who was urgently admitted to our hospital due to the occurrence of pneumonia during postoperative chemotherapy for breast cancer. Because she exhibited disseminated intravascular coagulation, a therapy with antibacterial agents, thrombomodulin alpha, and catecholamines was initiated. During hospitalization, hemorrhagic shock due to hematomas in both rectus abdominis muscles was observed without any discernible cause. Subsequent emergency angioembolization was successful, and abdominal computed tomography performed 3 months after the onset of the rectus sheath hematoma confirmed a reduction in the hematoma size.
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40
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Kamimura H, Imai M, Abe H, Yoshioka A, Hirose K, Ishihara N, Ishikawa T, Terai S. Simultaneous muscular hemorrhages in two regions three years after successfully controlling refractory ascites using transjugular intrahepatic portosystemic shunt treatment: a case report. Clin J Gastroenterol 2022; 15:433-440. [PMID: 35038137 DOI: 10.1007/s12328-022-01591-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/06/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Various therapies and drugs have been developed to extend the life expectancy of patients with liver cirrhosis. The prolonged prognosis of cirrhotic patients may change the final cause of death in the future. Deep bleeding into the muscle is an uncommon but potentially life-threatening complication of liver cirrhosis. CASE REPORT A 53-year-old man had undergone transjugular intrahepatic portosystemic shunt treatment for refractory ascites, which successfully controlled it for three years. However, he had started drinking again and experienced acute-on-chronic liver failure. He also had severe back pain. Abdominal computed tomography showed hyperdensities in the retroperitoneum and right pleural cavity. Despite blood infusion, he died from acute-on-chronic liver failure. A pathological autopsy revealed bleeding from the iliopsoas and right diaphragmatic muscle simultaneously, evident from the presence of red blood cells located between the muscle sheaths. Disruption of the small vessels in the skeletal muscle fibers was inferred. CONCLUSION This is a critical case that underscores the significance of improving available knowledge based on the cause of final death of the patients with cirrhosis, who now have a good long-term prognosis owing to the latest medical developments.
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Affiliation(s)
- Hiroteru Kamimura
- Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Michitaka Imai
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Hiroyuki Abe
- Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Aiko Yoshioka
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Kanae Hirose
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Noriko Ishihara
- Department of Pathology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Toru Ishikawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
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41
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Pant P, Shrestha O, Devkota N, Budhathoki P, Adhikari S, Shrestha DB. Rectus sheath hematoma secondary to acute exacerbation of COPD: A case report. Clin Case Rep 2022. [DOI: 10.1002/ccr3.5520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Prashant Pant
- Department of Anesthesia and Critical Care Unit Karnali Academy of Health Sciences Jumla Nepal
| | - Oshan Shrestha
- Nepalese Army Institute of Health Sciences Kathmandu Nepal
| | - Nebula Devkota
- Department of Emergency Medicine Karnali Academy of Health Sciences Jumla Nepal
| | - Pawan Budhathoki
- Department of Emergency Medicine Karnali Academy of Health Sciences Jumla Nepal
| | - Sanjit Adhikari
- Department of General Surgery Karnali Academy of Health Sciences Jumla Nepal
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Rectus sheath hematoma associated with commencement of therapeutic low molecular weight heparin injections: a case report. J Med Case Rep 2022; 16:87. [PMID: 35227305 PMCID: PMC8886753 DOI: 10.1186/s13256-022-03318-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Subcutaneous low molecular weight heparin is a commonly used anticoagulant. Catastrophic hemorrhage is a known adverse outcome associated with anticoagulant use. Of all potential bleeding sites, hemorrhage into the rectus sheath is a rare and unusual complication. In this case report, we document a patient who developed rectus sheath hematoma following new commencement of therapeutic low molecular weight heparin. Case presentation A 71-year-old New Zealand European woman presented to a peripheral hospital with suspected unstable angina. She was started on therapeutic subcutaneous low molecular weight heparin. While awaiting inpatient transfer to a tertiary hospital for coronary angiography, she developed a large rectus sheath hematoma associated with hemodynamic instability. She required an urgent laparotomy to decompress the hematoma and achieve hemostasis. Postoperatively, her anticoagulation therapy was stopped, and she made a full recovery. Conclusion Rectus sheath hematoma is a condition that is difficult to diagnose. The risk of adverse events must always be considered against the indication and potential benefits of new medications, especially with high-risk medications such as anticoagulants.
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Mahmoudabadi HZ, Hadadi A, Fattahi MR, Kafan S, Ashouri M, Allahbeigi R, Hajebi R. Rectus Sheath Hematoma in COVID-19 Patients as a Mortal Complication: A Retrospective Report. Int J Clin Pract 2022; 2022:7436827. [PMID: 35685571 PMCID: PMC9159132 DOI: 10.1155/2022/7436827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/21/2021] [Accepted: 01/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rectus sheath hematoma is a rare self-limited presentation that has become a concern in hospitalized COVID-19 patients receiving anticoagulant therapies. METHOD A retrospective multicentric study was conducted in referral hospitals affiliated with the Tehran University of Medical Science, Tehran, Iran, between June and August 2021. Patients with a confirmed diagnosis of COVID-19 that were complicated with rectus sheath hematoma during hospitalization were included. Median (lower quartile to upper quartile) was used to report the distribution of the results. RESULT This study was conducted on nine patients with confirmed COVID-19 pneumonia, including eight females and one male. The severity of viral pneumonia was above average in eight patients. The median age and median body mass index were 65 (55.5 to 78) years and 29.38 (23.97 to 31.71) kg/m2. The duration of anticoagulant therapy was 10 (6 to 14) days, and the median length of hospital stay was 20 (10 to 23.5) days. Rectus sheath hematoma occurred after a median reduction of 4 (2.7 to 6.6) units in blood hemoglobin. Although 66.7% received ICU care and all of them were under full observation in well-equipped hospitals, the mortality rate was 55.6%. CONCLUSION In summary, increased levels of inflammatory markers such as lactic acid dehydrogenase along with an abrupt decrease in blood hemoglobin in COVID-19 patients should be considered as predisposing factors for rectus sheath hematoma, especially in patients with moderate to severe COVID-19 pneumonia under anticoagulant therapy. This complication had been considered a self-limited condition; however, it seems to be fatal in patients with COVID-19 pneumonia. Further studies in larger sample sizes should be conducted to find out suitable management for this complication.
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Affiliation(s)
| | - Azar Hadadi
- Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Virology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Fattahi
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Virology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Kafan
- Department of Pulmonary Disease, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ashouri
- Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rashad Allahbeigi
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Hajebi
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Tyagunov AE, Polyaev AY, Stradymov EA, Nechay TV, Trudkov DY, Mosin SV, Tyurin IN, Sazhin AV. [Computed tomography and endovascular occlusion in diagnosis and treatment of spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space in patients with COVID-19]. Khirurgiia (Mosk) 2022:11-19. [PMID: 36469464 DOI: 10.17116/hirurgia202212111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To investigate the results of therapeutic and prophylactic endovascular hemostasis of spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space in patients with COVID-19. MATERIAL AND METHODS We retrospectively studied 35 patients with COVID-19 complicated by spontaneous bleeding into soft tissues of abdominal, chest wall and retroperitoneal space. According to CT data, the volume of hematoma was 1193.4±706.1 ml. In all patients, CT signs of ongoing bleeding were detected. Moreover, contrast agent extravasation in all phases of examination was established in 15 patients. In other ones, extravasation was detected in late phases or study phase was not identified. All patients underwent angiography. Ongoing bleeding was detected in 12 (34.3%) patients (group 1). They underwent embolization of the target vessel. In 23 patients, bleeding was not established during angiography. Of these, 13 ones underwent prophylactic embolization (group 2). No embolization was carried out in 10 patients (group 3). All groups differed in hematoma localization and COVID-19 severity. RESULTS Fourteen (40%) patients died in postoperative period. Mortality was similar in all groups. The most common cause of death was progressive respiratory failure following pneumonia. The last one was established by autopsy in 10 (71.4%) patients. CONCLUSION Angiography confirmed MR signs of contrast agent extravasation in 34.3% of patients. In case of extravasation in all CT phases, ongoing bleeding was confirmed in 66.7% of patients. Endovascular embolization is effective for arterial bleeding into soft tissues. However, large-scale studies are needed to assess the effect of this technique on survival.
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Affiliation(s)
- A E Tyagunov
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - A Yu Polyaev
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia
| | - E A Stradymov
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - T V Nechay
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - D Yu Trudkov
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia
| | - S V Mosin
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia
| | - I N Tyurin
- Moscow Multidisciplinary Clinical Center «Kommunarka», Moscow, Russia
| | - A V Sazhin
- Pirogov Russian National Research Medical University, Moscow, Russia
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Salem N, Sharpe T, Singh A, Bhandari M. Formation of a Rectus Sheath Hematoma Secondary to COPD Exacerbation While Taking Dual Antiplatelet Therapy. Cureus 2021; 13:e18821. [PMID: 34804678 PMCID: PMC8592797 DOI: 10.7759/cureus.18821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2021] [Indexed: 11/05/2022] Open
Abstract
Rectus sheath hematomas can occur due to nontraumatic increases in abdominal pressure from respiratory disease such as chronic obstructive pulmonary disease (COPD). This case study describes a 59-year-old male who was on dual antiplatelet therapy after a right coronary percutaneous intervention for acute coronary syndrome. He developed abdominal pain and ecchymosis on dual antiplatelets and was found to have a rectus sheath hematoma. The hematoma resolved with conservative care and did not require surgical intervention. The etiology of rectus sheath hematoma is thought to be due to coughing spells from chronic obstructive pulmonary disease exacerbation while taking dual antiplatelet therapy. Cases of rectus sheath hematomas continue to emerge in the literature with similar patient histories, and we should be cognizant of this possible complication in patients with chronic coughing.
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Affiliation(s)
- Nicholas Salem
- Cardiology, Campbell University School of Osteopathic Medicine, Fayetteville, USA
| | - Taylor Sharpe
- Cardiology, Campbell University School of Osteopathic Medicine, Fayetteville, USA
| | - Arminder Singh
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Manoj Bhandari
- Cardiolgy, Cape Fear Valley Medical Center, Fayetteville, USA
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46
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Samadov E, Ibrahimli A, Mamishov S. Rectus Sheath Hematoma Secondary to Domestic Violence. Cureus 2021; 13:e17058. [PMID: 34522536 PMCID: PMC8428324 DOI: 10.7759/cureus.17058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Abstract
Rectus sheath hematoma (RSH) is an infrequent condition that occurs when epigastric arteries bleed into the rectus sheath and sometimes acts like an acute abdomen. In view of the fact that it is a rare case without specific clinic signs, misdiagnosis and use of invasive manipulations for patients are possible. A 27-year-old woman applied to our clinic with abdominal pain, weakness, and nausea. Acute abdominal pain was in the periumbilical region and physical examination revealed tenderness, rebound phenomenon, and local mass in the right periumbilical region. Rectus sheath hematoma was identified by magnetic resonance imaging. The cause in this case was abdominal trauma due to domestic violence. After the legal procedures, symptomatic treatment was prescribed to the patient. Interestingly in this case, we did not get to the diagnosis through history, we reached the history after diagnosis. Besides the treatment of the patient, maybe our team prevented further violence against a woman.
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Affiliation(s)
- Elgun Samadov
- Department of Surgery, Leyla Medical Center, Baku, AZE
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Mahamad Arif ANF, Syed Alwee Al’Aidrus SS. Fatal rectus sheath hematoma: a rare autopsy phenomenon. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2021. [DOI: 10.1186/s41935-021-00237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Rectus sheath hematoma is a condition where blood is accumulated within the sheath of the rectus abdominis muscle. It is caused by the rupture of either the superior or inferior epigastric artery or from a direct tear of the rectus muscle itself. This condition is usually self-limiting and most of the time, the hematoma is small, non-expanding and can be reabsorbed spontaneously over time. However, certain underlying pathology may lead to the expansion of the hematoma or even a recurrence, and without any medical treatment or intervention, this condition can even be fatal. Due to its rarity, only a few published cases of fatality associated with rectus sheath hematoma are reported worldwide.
Case presentation
We present a case of non-traumatic fatal rectus sheath hematoma in the presence of underlying lung infection. The deceased complained of abdominal pain 2 days prior to death with a history of prolonged cough. The autopsy revealed the presence of a hematoma within the rectus sheath of the left lower quadrant of the abdomen extending down into the left pelvis and a multitude of small yellow-tan firm lesions scattered throughout the parenchyma of the right lung, suggestive of a lung infection which was later confirmed histologically.
Conclusions
The case serves to increase awareness of fatal rectus sheath hematoma as a cause of death given its rarity in forensic medicine practice. The importance of a thorough post-mortem examination is the key to noticing the fatal hematoma since its enclosed location within the rectus sheath may be obscured to the eye of an inexperienced prosector.
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Nematihonar B, Qaderi S, Shah J, Bagherpour JZ. Spontaneous giant rectus sheath hematoma in patients with COVID-19: two case reports and literature review. Int J Emerg Med 2021; 14:40. [PMID: 34301186 PMCID: PMC8300980 DOI: 10.1186/s12245-021-00366-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019, COVID-19, as a global public health emergency, has come with a broad spectrum of clinical manifestations and complications. In this study, we present a unique complication of this disease. PRESENTATION OF CASES: (A) A 65-year-old woman with a known case of COVID-19; on the second day of admission, the patient presented sudden tachycardia and hypogastric pain; on abdomen physical examination, a huge lower abdominal tender mass was noticed. (B) A 50-year-old woman with COVID-19, 4 days after admission, started complaining of tachycardia, pain, and mass in the lower abdomen. On abdomen physical examination, a huge lower abdominal tender mass was noticed. Both of the patients underwent an abdomen CT scan which confirmed a huge rectus sheath hematoma (RSH). Both of the patients underwent angioembolization of the inferior epigastric artery. The patient recovered completely and no evidence of further expansion was seen after 2 weeks of follow-up. DISCUSSION Hemorrhagic issues in COVID-19 patients remain poorly understood. Physicians should discuss risks of RSH in patients where continuous anticoagulation therapy will be reinstated. With increased clinician awareness of the need for RSH screening in COVID-19 patients with acute abdominal pain, the interprofessional team of healthcare providers can maximize patient safety and reduce hospitalization time, especially in high-risk patients at risk for unnecessary surgery. CONCLUSIONS These two reports and literature review demonstrate the need of active surveillance for possible hemorrhagic complications in patients with COVID-19 infection.
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Affiliation(s)
- Behzad Nematihonar
- Department of General Surgery, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani Street, Tehran, 161776341 Iran
| | - Shohra Qaderi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Jaffer Shah
- Drexel University College of Medicine, Philadelphia, PA USA
| | - Javad zebarjadi Bagherpour
- Department of General Surgery, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Madani Street, Tehran, 161776341 Iran
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Cocco G, Ricci V, Boccatonda A, Stellin L, De Filippis G, Soresi M, Schiavone C. Sonographic demonstration of a spontaneous rectus sheath hematoma following a sneeze: a case report and review of the literature. J Ultrasound 2021; 24:125-130. [PMID: 32621122 PMCID: PMC8137746 DOI: 10.1007/s40477-020-00493-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/09/2020] [Indexed: 12/27/2022] Open
Abstract
Spontaneous rectus sheath hematoma (SRSH) is an uncommon cause of acute abdominal pain characterized by bleeding within the rectus sheath; it is a benign condition and, in most cases, it is treated conservatively. Bleeding of the abdominal wall is an unusual condition that is quite challenging to identify promptly and can be easily overlooked during a routine physical examination. In daily practice, anticoagulant therapy is one of the main risk factors for hemorrhagic events. In this respect, we report a rare case of spontaneous hematoma of the abdominal wall (diagnosed and monitored through an ultrasound examination) that arose after sneezing in a patient receiving anticoagulant treatment.
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Affiliation(s)
- G Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy.
| | - V Ricci
- Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopedic Institute, Bologna, Italy
| | - A Boccatonda
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - L Stellin
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
| | - G De Filippis
- Radiology Department, "M.G. Vannini Hospital", Rome, Italy
| | - M Soresi
- Internal Medicine and Medical Specialties (PROMISE), Department of Health Promotion Sciences, Maternal and Infant Care, University of Palermo, Palermo, Italy
| | - C Schiavone
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. d'Annunzio" University, Chieti, Italy
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Albuquerque TVC, Monsignore LM, de Castro-Afonso LH, Elias-Junior J, Muglia VF, Abud DG. Transarterial embolization with n-butyl cyanoacrylate for the treatment of abdominal wall hemorrhage. ACTA ACUST UNITED AC 2021; 26:216-222. [PMID: 32209512 DOI: 10.5152/dir.2019.19348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE We aimed to evaluate the effectiveness and safety of n-butyl cyanoacrylate (n-BCA) in the context of the transarterial embolization (TAE) of abdominal wall hemorrhage in an urgent scenario. METHODS A retrospective study of cases admitted from January 2008 to December 2017 in the emergency unit of our institution revealed 11 patients with abdominal wall hemorrhage who underwent digital subtraction angiography and TAE with n-BCA. We analyzed the sex, age, hemorrhagic risk factors, etiology, embolized vessel, technical success (no rebleeding in the embolized area), clinical success (hemoglobin level control and hemodynamic stability after the procedure), complications inherent to the procedure, and clinical outcome (mortality in 30 days). RESULTS The mean age was 63.4 years (52-83 years), with a predominance of the female sex (64%). The majority (91%) of patients presented hemorrhagic risk factors (chronic hepatopathy and anticoagulation drug usage). Spontaneous hemorrhage was present in 18% of patients, and the other 82% had an iatrogenic etiology. Technical success was achieved in 100% of the patients, which required the embolization of inferior epigastric artery in 10 patients (91%), circumflex iliac artery in 2 (18%), and superior epigastric artery in 1 (9%). Five patients were hemodynamically unstable, and despite achieving technical success, 4 (36%) died in less than 30 days due to decompensation of their clinical comorbidities caused by the acute phase. There were no complications inherent to the procedures. CONCLUSION The present study concludes that TAE with n-BCA is a safe and effective treatment for abdominal wall hemorrhage in an urgent scenario, with high rates of technical and clinical success.
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Affiliation(s)
- Tales Vieira Cavalcanti Albuquerque
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
| | - Luis Henrique de Castro-Afonso
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
| | - Jorge Elias-Junior
- Division of Abdominal Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
| | - Valdair Francisco Muglia
- Division of Abdominal Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Radiology, Department of Radiology, Hematology and Oncology, São Paulo University Ribeirão Preto School of Medicine, São Paulo, Brazil
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