Transperineal sonography of a large vulvar hematoma following blunt perineal trauma

Abstract

Vulvar hematomas may result from puerperal or nonpuerperal-related trauma. These perineal injuries, especially the puerperal type, may be life-threatening and require surgical exploration, evacuation, and hemostasis. In the absence of acute hematoma expansion, expectant management may suffice. Experience with transperineal sonography in the assessment of female perineal trauma has been limited to a single case report pertaining to a puerperal vulvar hematoma. We present an unusual case in which the transperineal sonographic appearance of a large vulvar hematoma following a straddle injury to the perineum assisted in the expectant management of this condition.

A case of vulvar hematoma with rupture of pseudoaneurysm of pudendal artery

“…Ultrasound, computed tomography, or magnetic resonance imaging may be appropriate for future studies to investigate the size, site, and expansion of the hematoma. Sherer et al [6] described perineal sonography, which offers objective imaging assessment of the extent of vulvar hematoma at the bedside and negates the need for complex and more expensive imaging modalities. Butori et al [7] proposed that computed tomography should be used as the principal diagnostic imaging modality because it is more specific in diagnosing aneurysms.…”

Non‐obstetric vulval trauma

“…The use of transperineal sonography in determining the extent and resolution of haematomas can assist in expectant management of this condition . Angiographic embolisation of vulvo‐vaginal haematomas has been reported in the post‐partum patient and the non‐obstetric patient with a vulval haematoma .…”

Clinical characteristics, treatment indications and treatment algorithm for post‐partum hematomas

“…Sherer et al . also reported a case of a large vulvar hematoma that did not occur during the post‐partum period that was managed palliatively using transperineal sonography . In the present study, six patients with post‐partum hematomas were managed with observation alone, and no complications occurred.…”

“…17 Sherer et al also reported a case of a large vulvar hematoma that did not occur during the post-partum period that was managed palliatively using transperineal sonography. 18 In the present study, six patients with post-partum hematomas were managed with observation alone, and no complications occurred. Cases requiring conservative treatment are more likely to involve venous bleeding, which either stop spontaneously or can be easily stopped by compression.…”