Unusual surgical emergency in a patient of dengue haemorrhagic fever: spontaneous rectus sheath haematoma leading to abdominal compartment syndrome

Ghosh, Supradip; Singh, Rajvinder; Ghosh, Sonali; Chawla, Aayush

doi:10.1136/bcr-2018-225936

Cited by 5 publications

(5 citation statements)

References 14 publications

(6 reference statements)

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“…Moreover, surgical complications may be iatrogenic (e.g., abdominal compartment syndrome due to overzealous fluid resuscitation or gastric perforation related to nonsteroidal anti-inflammatory drug [NSAID] use). Some complications may occur because of complications of dengue and also iatrogenically (e.g., abdominal compartment syndrome due to rectus sheath hematoma 116 or due to excessive fluid resuscitation 117 ).…”

Section: Discussionmentioning

confidence: 99%

Dengue Infections and the Surgical Patient

Jayarajah

Lahiru

Zoysa

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Dengue infections are increasing globally and account for significant morbidity and mortality. Severe dengue results in microvascular changes and coagulopathy that may make surgical intervention risky and the overall surgical management challenging. We outline the potential surgical manifestations and complications following dengue infections and describe the clinical, pathogenetic, diagnostic, and treatment aspects of dengue and surgical patients. The main surgical presentations were acute cholecystitis, acute pancreatitis, acute appendicitis, splenic rupture, bowel perforation, gastrointestinal bleeding, and hematomas. Dengue may also mimic an acute abdomen without any true surgical complications. A majority were treated nonoperatively. Misdiagnosis and unnecessary surgical intervention resulted in poor outcomes. Better knowledge of the potential surgical complications would help in early diagnosis, treatment, and referral to specialized centers and thus improve outcomes. A high degree of suspicion of dengue fever is necessary when patients in a dengue-epidemic area present with acute abdomen or bleeding manifestations. In endemic areas, early dengue antigen testing and abdominal imaging before surgical intervention may help in the diagnoses. Multidisciplinary team involvement with case-by-case decision-making is needed for optimal care.

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Section: Discussionmentioning

confidence: 99%

Dengue Infections and the Surgical Patient

Jayarajah

Lahiru

Zoysa

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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“…Previous studies have reported ACS as a rare condition in SD. 21–23 However, we found confirmed ACS in 6/23 (26.1%) patients and probable ACS in 29/78 (37.2%) patients with SD. A recent study by Ranjit et al found ACS in 30% of their SD patients before their implementation of a new guideline similar to ours.…”

Section: Discussionmentioning

confidence: 54%

Mortality Rates of Severe Dengue Viral Infection Before and After Implementation of a Revised Guideline for Severe Dengue

Laoprasopwattana¹,

Khantee²,

Saelim³

et al. 2021

Pediatric Infectious Disease Journal

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Objectives: To compare the mortality rate of severe dengue (SD) before and after implementation of a revised SD guideline. Methods: Medical records of SD patients <15 years of age hospitalized during 1998-2020 were reviewed. The revised SD guidelines were implemented in 2016, including intensive monitoring of vital signs and intraabdominal pressure, the release of intra-abdominal pressure in cases of abdominal compartment syndrome (ACS) and the use of N-acetyl cysteine in cases of acute liver failure. Results: On initial admission, organ failure including severe bleeding, acute respiratory failure, acute kidney injury and acute liver failure was not significantly different between 78 and 23 patients treated in the preand postrevised guideline periods, respectively. After hospitalization, the proportions of patients who developed profound shock (68.8% vs. 41.2%), multiorgan failures (60.4% vs. 73.3%), ACS (37.2% vs. 26.1%) and fatal outcome (33.3% vs. 13.0%) were also not significantly different between the pre-and postrevised guideline periods, respectively. In subgroup analysis, the mortality rates in patients with multiorgan failure (44.1% vs. 15.8%), acute respiratory failure and active bleeding (78.1% vs. 37.5%) and ACS (82.8% vs. 33.3%), respectively, were significantly higher in the pre-than the postrevised guideline periods. The durations of time before the liver function tests returned to normal levels, and the mortality rates in acute liver failure patients treated with and without N-acetyl cysteine were not significantly different. Conclusions: Although following the revised guidelines could not prevent organ failure, the mortality rates in patients with multiorgan failure and/or ACS decreased significantly when following the revised guidelines.

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“…3 Anticoagulation therapy and advanced age are risk factors for traumatic and nontraumatic soft-tissue hemorrhage. 3,14,15 Hematomas can be a direct adverse effect of warfarin therapy, 16 but they are also associated with a broad range of underlying illnesses, including infectious, 17,18 oncologic, 19 hematologic, 3,20 hepatic, 21 and renal 22,23 disease. Identification of active extravasation into a hematoma frequently requires advanced imaging, given the limitations of physically examining often-distorted tissue, and therefore, multiphase CT has become the standard diagnostic tool.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Soft-Tissue Hematomas With Real-Time, Contrast-Enhanced Ultrasound

Kummer¹,

Mohn²,

Bardwell

et al. 2022

Ultrasound Quarterly

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In this study, we investigated the feasibility of using contrastenhanced 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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Unusual surgical emergency in a patient of dengue haemorrhagic fever: spontaneous rectus sheath haematoma leading to abdominal compartment syndrome

Cited by 5 publications

References 14 publications

Dengue Infections and the Surgical Patient

Dengue Infections and the Surgical Patient

Mortality Rates of Severe Dengue Viral Infection Before and After Implementation of a Revised Guideline for Severe Dengue

Evaluation of Soft-Tissue Hematomas With Real-Time, Contrast-Enhanced Ultrasound

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