Ultrasound-guided percutaneous drainage of a traumatic abdominal wall hematoma in the emergency department

Trujillo, Laura; Naranjo, Sara; Cardozo, Alejandro; Alvarez, Bryan D.

doi:10.5847/wjem.j.issn.1920-8642.2012.04.013

Cited by 8 publications

(3 citation statements)

References 5 publications

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“…Surgery should be considered in patients with persistent bleeding, in those who are hemodynamically unstable despite blood transfusion, and in those who have compression symptoms and abdominal compartment, as the decrease in the pressure in the hematoma may lead to more severe bleeding. [34] Also, in our study, surgical procedures (bleeding control by vascular ligation) were achieved in three patients (9.6%) who had hemodynamic instability and enlarged hematoma in size.…”

Section: Discussionmentioning

confidence: 50%

Treatment of rectus sheath hematomas: 8 years of single center experience with a review of literature

İliklerden

Kalaycı

2021

Ulus Travma Acil Cerrahi Derg

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BACKGROUND:Rectus sheath hematoma is a rare and frequently misdiagnosed cause of acute abdominal pain. In the management of the patients with rectus sheath hematoma, which are mostly with advanced age and comorbid diseases, positive results can be obtained by avoiding unnecessary surgical procedures with correct diagnosis and treatment approaches. The presented study aims to contribute to the lack of algorithms and optimal treatment strategies in the management of rectus sheath hematoma patients with the description of our experience in their management. METHODS:Patients who underwent treatment with the diagnosis of rectus sheath hematoma between May 2010 and July 2018 were retrospectively analyzed. Demographic characteristics, medical histories, physical and laboratory findings and imaging methods, treatment processes, complications, morbidity, mortality, length of hospitalization and long-term follow-up results were searched. Data were analyzed from patient files, hospital computer registry system and radiology archives. Data analysis was performed using Microsoft Excel and IBM-SPSS-Statistics-24. RESULTS:The mean age of the 31 patients was 63.03 years (24-85 years). The female/male ratio (21/10) was 2.1. The most common presenting sign or symptom was abdominal pain (100%), followed by abdominal wall mass in 25 patients (80.6%). Twenty-five patients (80.6%) were receiving some form of anticoagulation and antiplatelet therapy. Diagnosis was confirmed by Computed Tomography in 11 (45.4%), Ultrasonography in five (16.1%) and Computed Tomography with Ultrasonography in 15 (33.3%). Eight patients (25.8%) were evaluated as Type-1, 10 (32.2%) as Type-2 and 13 (41.9%) as Type-3. Mean International Normalized Ratio (INR) value of patients was 2.59. Bleeding was controlled by surgery in three cases (9.6%). The conservative approach was preferred in 28 cases (90.3%). 29 (93.5%) patients were discharged after an average hospital stay of 7.48 days (4-21). One patient died on the postoperative 5th day and other on the 14 th day of conservative treatment (6.45% mortality). The mortality rate of conservatively and surgically treated patients was 3.5% and 33.3%, respectively. CONCLUSION:Rectus sheath hematoma should be suspected in elderly patients using anticoagulants with acute abdominal pain, severe cough attacks and an umbilical palpable or radiologically supported mass. Computed Tomography and Ultrasonography should be performed in case of clinical suspicion. Early and correct diagnosis ensures successful conservative treatment and prevents unneces-sary surgical procedures. In the management of cases where clinician experience is at the forefront, we are hopeful that a new effective algorithm system and guidelines for the diagnosis will be identified after increasing the presentations of case series and experiences.

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Section: Discussionmentioning

confidence: 50%

Treatment of rectus sheath hematomas: 8 years of single center experience with a review of literature

İliklerden

Kalaycı

2021

Ulus Travma Acil Cerrahi Derg

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“…Surgery should be considered in patients with severe bleeding, in those who are hemodynamically unstable despite blood transfusion, and in those who have compression symptoms and abdominal compartmentalization, because a decrease in pressure in the hematoma can lead to more severe bleeding. [ 12 ] Unfortunately, surgery is mandatory in this group of patients. [ 13 , 14 ] In the present study, three patients (8.6%) with hemodynamic instability and enlarged hematomas underwent surgical procedures (bleeding control by vascular ligation).…”

Section: Discussionmentioning

confidence: 99%

How has the COVID-19 pandemic changed the diagnosis of rectus sheath hematoma and its follow-up?

Kalaycı¹

2022

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: There has been an increased incidence of rectus sheath hematoma (RSH) due to chronic cough attacks and anticoagulant therapy due to the COVID-19 pandemic. The present study aims to determine, in which parameters differ before and during the diagnosis of RSH in COVID-19 patients and what may be expected during diagnosis and follow-up. METHODS: Thirty-five patients diagnosed with RSH were evaluated retrospectively between March 2016 and March 2021. The COVID-19 group comprised 11 patients. Various information including patient history and time of discharge/death were retrieved and compared between the experimental groups. RESULTS: The rates of hypotension on admission (p=0.011) and the rates of defense and rebound (p=0.030) were higher in the patients with COVID-19 than in those without. Although there was no difference in terms of bleeding width, there was a greater decrease in the hemoglobin levels (p=0.009) in the COVID-19 patients and the need for erythrocyte suspension (p=0.040) increased significantly in that group. CONCLUSION: The present study constitutes the first evaluation of RSH in COVID-19 patients. The clinical situation is serious due to high rates of hypotension, defense or rebound, and decreases in hemoglobin levels in COVID-19 patients. This makes the clinical management of RSH more difficult, resulting in longer hospitalization. Despite these difficulties, COVID-19 infection does not increase morbidity or mortality.

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“…Özellikle ciddi anemiye yol açan durumlarda, pıhtılaşma bozukluklarının vitamin K, taze donmuş plazma ve protamin sülfat ile düzeltilmesi ve bu hastalara kan replasmanı yapılması önerilir (2,4,11). Hematom lojundaki basıncın azalması daha şiddetli kanamalara yol açabileceğinden cerrahi girişim, kan transfüzyonuna rağmen hemodinamik stabilite sağlanamayan, devam eden kanaması olan hastalarda düşünülmelidir (21). Katater ile damar embolizasyonu, USG eşliğinde drenaj ile hematomun boşaltılması veya laparatomi ile damar ligasyonu uygulanabilecek cerrahi seçenekleri arasında yer almaktadır.…”

Section: Discussionunclassified

Is conservative management of spontaneous rectus sheath hematoma effective?

Kaya¹,

İdiz²,

Yazici³

et al. 2017

Sisli Etfal

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Amaç: Spontan rektus kılıf hematomu akut karın ağısının nadir görülen ve sıklıkla gözden kaçan bir nedenidir. Bu çalışmamızda rektus kılıf hematomu nedeniyle konservatif tedavi uyguladığımız hastalarımıza ait sonuçlarımızı sunmayı amaçladık. Gereç ve Yöntem: Çalışmamızda Ocak 2010 -2016 tarihleri arasında hastanemiz acil servisine karın ağrısı şikayeti ile başvuran, spontan rektus hematomu tanısı konulup konservatif tedavi uygulanan 9 hastanın demografik verileri, başvuru şikayetleri, tıbbı geçmişleri ve uygulanan tedaviye ait veriler retrospektif olarak hasta dosyası, bilgisayar kayıt sistemi ve görüntüleme arşivlerinden tarandı. Bulgular: Çalışmaya katılan 9 hastanın K/E oranı 1/2 olup ortalama yaş 48.8 yıl idi. Hastaların hepsi acil servise karın ağrısı şikayeti ile başvurdu. Özgeçmişlerinde 3 hastada oral antikoagulan kullanımı, 3 hastada hipertansiyon, bir hastada da kronik obstrüktif akciğer hastalığı öyküsü mevcut iken diğer iki hastada herhangi bir predispozan faktör saptanmadı. Toplam 4 hastada şikayetlerinden önce şiddetli öksürük hikayesi olduğu öğrenildi, diğer hastalarda bu duruma neden olabilecek öksürük, travma veya bir operasyon öyküsü yoktu. Rektus hematomu tanısı alan 5 hastaya yatarak, 4 hastaya da ayaktan takip ile konservatif tedavi uygulandı. Hastaların ortalama yatış süresi 3 gündü. Bir hastada taburcu edildikten 2 hafta sonra kalıcı hasar bırakmayan serebrovasküler enfarktüs gelişti. Diğer hastaların hiçbirinde ek morbidite ve mortalite gözlenmedi. Sonuç: Spontan rektus kılıf hematomu özellikle antikoagulan tedavi alan hastalarda, öksürük nöbetinden sonra oluşan karın ağrısı şikayetinde ayırıcı tanıda göz önüne alınmalıdır. Vakaların etyolojiye yönelik yapılan konservatif tedaviye iyi cevap verdiği düşünülmektedir. Anahtar kelimeler: Hematom, konservatif tedavi, rektus ABSTRACT:Is conservative management of spontaneous rectus sheath hematoma effective?Objective: Spontaneous rectus sheath hematoma is a rare and often overlooked cause of acute abdominal pain. In this study, we aimed to present the results of patients with rectus sheath hematoma who received conservative treatment. Materials and Methods: In this study, the demographic data, complaints, medical history, and data pertaining to the treatment provided to 9 patients were retrospectively retrieved from the computerized patient record system and imaging archives. The included patients presented with abdominal pain to our hospital's emergency room between January 2010 and 2016, were diagnosed with spontaneous rectus hematoma, and received conservative treatment. Results: The female/male ratio of the 9 patients who participated in this study was 1:2, and the average age was 48.8 years. All the patients were admitted to the emergency department with abdominal pain. Three patients had a history of oral anticoagulant use, 3 patients had a history of hypertension, and 1 patient had a history of chronic obstructive pulmonary disorder. No predisposing factor was detected in the other 2 patients. There was a history of severe cough in 4 pati...

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Ultrasound-guided percutaneous drainage of a traumatic abdominal wall hematoma in the emergency department

Cited by 8 publications

References 5 publications

Treatment of rectus sheath hematomas: 8 years of single center experience with a review of literature

Treatment of rectus sheath hematomas: 8 years of single center experience with a review of literature

How has the COVID-19 pandemic changed the diagnosis of rectus sheath hematoma and its follow-up?

Is conservative management of spontaneous rectus sheath hematoma effective?

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