Sonographic demonstration of bladder-flap hematoma.

Abstract

A bladder-flap hematoma is generally thought of as a blood collection in a potential space located between the urinary bladder and lower uterine segment {vesicouterine space}. These collections can also extend over the bladder and uterus beneath the peritoneal reflection. In this study, ten patients with a bladder-flap hematoma were evaluated for fever, mass, or dropping hematocrit after surgery. No one sonographic appeamnce is specific for bladder-flap hematoma; however, the diagnosis can be made by finding a mass in the extraperitoneal pelvic space in the postoperative patient. (Key words: ultrasonogmphy. pelvic; hematoma, bladder· flap; pelvic mass, hematoma; pelvic surgery, postoperative complications)Although the number of hysterectomies and cesarean sections performed is incre asin g. the number of significant complications is relatively low. 1 • 2 Pelvic hematomas and pelvic abscesses account for a small but significant number of the total complications. We report a specific complication~ a bladder-flap hematoma.The bladder has an intimate relationship to the lower uterine segment. To obtain access to the uterus, the parietal layer of peritoneum that re· fleets over the urinary bladder and the fundus of the uterus is incised with careful caudad deflection of the urinary bladder. Trauma or incomplete hemostasis may lead to postoperative hematoma formation predisposing to infection. 3 While bladder-flap hematomas are a well-known entity among obstetricians and gynecologists, relatively little is written about this complication in the radiographic literature. In a recent article, Baker and associates describe seven cases of bladder-flap hematoma. 4 We report an additional ten cases and expand the criteria for diagnosis of bladder-flap hematoma.

Sonographic Imaging of Maternal Complications of Pregnancy

“…32). 24 It may extend laterally along the broad ligaments into the retroperitoneum. The source of bleeding is usually injury of uterine vessels during surgery, although an occult dehiscence may be the underlying cause (Fig.…”

Sonography of subfascial hematoma after cesarean delivery

“…Three series described the bladder-flap hematoma [2,4,5] without mentioning the subfascial hematoma, and a recent study [6] implied that the subfascial hematoma is an extension of the bladder-flap hematoma.…”

Conservative laparoscopic treatment of post-caesarean section bladder flap haematoma: two case reports

“…5 The border of the BFH was sutured with some Vicryl 2-0 singular stitches, for a marsupialization Fig. 6 The final histological examination of the BFH and its borders showed purulent material with an abscess pseudo-capsule A study by Winsett et al implied that the subfascial haematoma is an extension of the BFH [8]; Weiner et al sustained that there was no US evidence of direct extension between the retrovesical BFH and the prevesical subfascial haematomas [9].…”