Female-specific traumatic injury patterns have not been well researched and are potentially not well documented. Our aim was to examine the prevalence of breast hematomas (BHs) after blunt chest trauma, and to evaluate if there were risk factors associated with BH requiring intervention. A retrospective review from 2013 to 2018 was performed, identifying female patients ≥18 years sustaining blunt chest trauma. BH was defined as the presence of a collection of blood within the breast parenchyma, and clinically significant breast hematoma (CSBH) as BH requiring blood transfusion, surgical, or interventional radiology intervention. Univariate analysis was performed comparing CSBH with BH in terms of demographics, injury severity, antithrombotic agent use, and body mass index (BMI). Of 871 female patients meeting criteria, 59 (7%) had BH. Of these, 10 (17%) had CSBH (transfusion only, n = 3; angioembolization, n = 4; operation, n = 3). Compared to BH not requiring intervention, CSBH patients were older (mean age, 80 vs 69, P = .006), but had similar rates of motor vehicle crashes (90% vs 78%), seatbelt use (70% vs 71%), antiplatelet use (10% vs 12%), and anticoagulant use (10% vs 6%). Median Injury Severity Scores and median BMI (34 vs 34) were similar between the groups.
Introduction and importance
During gestation, laparoscopic procedures, if needed, are generally considered most ideal within the second trimester. There are less reports of successful laparoscopic procedures in the third trimester of pregnancy due to performance hesitancy with concerns of preterm labor and/or other complications. While it is rare for laparoscopic cholecystectomy to be performed within the third trimester, it should not be delayed if needed, and excellent outcomes can be achieved with proper port placement and procedure.
Case presentation
We present the case of a 22-year-old female thirty-two weeks and six days into gestation who underwent a laparoscopic cholecystectomy with intraoperative cholangiogram after presenting with acute-on-chronic cholecystitis. The procedure was without complications, and both the patient and fetus remained stable following surgery, and were discharged on postoperative day 2.
Clinical discussion
The long-established belief is laparoscopic procedures should ideally be attempted in the second trimester to decrease the risk of preterm labor or spontaneous abortion in obstetric patients. Per SAGES guidelines, when clearly indicated, laparoscopic cholecystectomy should not be avoided in any trimester.
Conclusion
This case highlights the relative safety of a laparoscopic cholecystectomy in the third trimester of pregnancy with emphasis on standard technique and proper port placement based on uterus size.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.