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Journal of Visceral Surgery Apr 2010Vascular injury due to penetrating abdominal trauma is a major challenge for trauma teams. Arterial and venous injuries occur with equal frequency. Treatment depends on... (Review)
Review
Vascular injury due to penetrating abdominal trauma is a major challenge for trauma teams. Arterial and venous injuries occur with equal frequency. Treatment depends on the hemodynamic status of the patient: under stable conditions, angiography can be envisioned, whereas instability is an indication for immediate surgery; damage control is the most frequent procedure. As persisting on complete surgical exploration may lead to fatal outcome, the surgeon must be prepared to perform perihepatic or pelvic packing and employ endovascular techniques as appropriate. However, the surgeon has to be prepared to deal with uncontrolled hemorrhage, and explore all central retroperitoneal hematomas, retroperitoneal hematoma located in the flanks except when stable in the hemodynamically unstable patient, and those in the pelvis only if the patient is stable. Since it is more critical to control hemorrhage than to avoid end-organ ischemia, vascular ligation is more commonly used than other techniques. However, survival is very low in these severely wounded patients.
Topics: Abdomen; Abdominal Injuries; Diagnostic Imaging; Hematocrit; Hematoma; Hemoglobins; Hemoperitoneum; Hemorrhage; Hemostatic Techniques; Humans; Laparotomy; Postoperative Complications; Second-Look Surgery; Thoracotomy; Traumatology; Vascular Surgical Procedures; Wounds, Penetrating
PubMed: 20638931
DOI: 10.1016/j.jviscsurg.2010.06.003 -
Current Cardiology Reports Dec 2012Intracranial hemorrhage (ICH) accounts for 10-15 % of all strokes, however it causes 30-50 % of stroke related mortality, disability and cost. The prevalence increases... (Review)
Review
Intracranial hemorrhage (ICH) accounts for 10-15 % of all strokes, however it causes 30-50 % of stroke related mortality, disability and cost. The prevalence increases with age with only two cases/100,000/year for age less than 40 years to almost 350 cases/100,000/year for age more than 80 years. Several trials of open surgical evacuation of ICH have failed to show clear benefit over medical management. However, some small trials of minimal invasive hematoma evacuation in combination with thrombolytics have shown encouraging results. Based on these findings larger clinical trials are being undertaken to optimize and define therapeutic benefit of minimally invasive surgery in combination with thrombolytic clearance of hematoma. In this article we will review some of the background of minimally invasive surgery and the use of thrombolytics in the setting of ICH and intraventricular hemorrhage (IVH) and will highlight the early findings of MISTIE and CLEAR trials for these two entities respectively.
Topics: Cerebral Hemorrhage; Cerebral Ventricles; Drainage; Hematoma; Humans; Intracranial Hemorrhages; Minimally Invasive Surgical Procedures; Neurosurgical Procedures; Suction; Thrombolytic Therapy; Ventriculostomy
PubMed: 22945285
DOI: 10.1007/s11886-012-0316-4 -
Frontiers of Neurology and Neuroscience 2015Spontaneous intracerebral haemorrhage (ICH) is a devastating condition with high mortality and morbidity despite advances in neurocritical care. Early deterioration is... (Review)
Review
Spontaneous intracerebral haemorrhage (ICH) is a devastating condition with high mortality and morbidity despite advances in neurocritical care. Early deterioration is common in the first few hours after ICH onset, secondary to rapid haematoma expansion and growth. Rapid diagnosis and aggressive early management of these patients are therefore crucial. Imaging plays a key role in establishing the diagnosis and the underlying aetiology of ICH, identifying complications and predicting patients who are at high risk for haematoma expansion. In this chapter, we present an evidence-based imaging framework for the management of spontaneous ICH in the acute setting. Non-enhanced computed tomography is long established as the gold standard for ICH diagnosis but has limitations in demonstrating the underlying aetiology in cases of secondary ICH. There is now growing evidence for the ability of non-invasive angiography to establish the underlying aetiology and to predict further haematoma expansion. The presence of small enhancing foci within the haematoma on computed tomography angiography (CTA), the CTA Spot Sign, has been prospectively validated as a predictor of haematoma expansion. Early identification of patients at risk of haematoma expansion allows for the appropriate escalation of care to a neurosurgical team, admission to a neurocritical care unit, appropriate supportive therapy and targeted novel medical and surgical interventions. Catheter angiography, which remains the gold standard for identifying underlying secondary vascular lesions, should be used in selected cases. However, non-invasive vascular imaging should be considered as an important step in the diagnosis and early management of secondary ICH patients. Previous concerns related to the radiation dose, contrast-induced nephropathy and cost are addressed in this chapter. Recently, animal models have enabled the qualitative assessment of haematoma expansion, and our increased understanding of ICH may inform future trials of targeted medical and surgical therapies.
Topics: Animals; Brain; Cerebral Hemorrhage; Early Diagnosis; Emergencies; Hematoma; Humans; Tomography, X-Ray Computed
PubMed: 26588327
DOI: 10.1159/000437110 -
Annals of Surgery Feb 1990The management of retroperitoneal hematomas remains confusing to many surgeons because the available literature frequently groups patients with blunt and penetrating... (Review)
Review
The management of retroperitoneal hematomas remains confusing to many surgeons because the available literature frequently groups patients with blunt and penetrating etiologies together. Because the underlying injuries and their treatment may differ considerably, the nonoperative or operative approach to the common hematomas is based on mechanism of injury coupled with hemodynamic status of the patient and extent of associated injuries. After blunt trauma, selected retroperitoneal hematomas in the lateral perirenal and pelvic areas do not require operation and should not be opened if discovered at operation. Midline, lateral paraduodenal, lateral pericolonic not associated with pelvic, and portal hematomas are opened after proximal vascular control has been obtained, if appropriate. Retrohepatic hematomas without obvious active hemorrhage are not opened. After penetrating trauma, most retroperitoneal hematomas are still opened. Exceptions include isolated lateral perirenal hematomas that have been carefully staged by CT and some lateral pericolonic hematomas. As with blunt trauma, retrohepatic hematomas without obvious active hemorrhage are not opened.
Topics: Abdominal Injuries; Hematoma; Humans; Retroperitoneal Space; Therapeutic Irrigation; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 2405790
DOI: 10.1097/00000658-199002000-00001 -
The Bone & Joint Journal Jul 2016Our aim was to perform a systematic review of the literature to assess the incidence of post-operative epidural haematomas and wound infections after one-, or two-level,... (Review)
Review
AIMS
Our aim was to perform a systematic review of the literature to assess the incidence of post-operative epidural haematomas and wound infections after one-, or two-level, non-complex, lumbar surgery for degenerative disease in patients with, or without post-operative wound drainage.
PATIENTS AND METHODS
Studies were identified from PubMed and EMBASE, up to and including 27 August 2015, for papers describing one- or two-level lumbar discectomy and/or laminectomy for degenerative disease in adults which reported any form of subcutaneous or subfascial drainage.
RESULTS
Eight papers describing 1333 patients were included. Clinically relevant post-operative epidural haematomas occurred in two (0.15%), and wound infections in ten (0.75%) patients. Epidural haematomas occurred in two (0.47%) patients who had wound drainage (n = 423) and in none of those without wound drainage (n = 910). Wound infections occurred in two (0.47%) patients with wound drainage and in eight (0.88%) patients without wound drainage.
CONCLUSION
These data suggest that the routine use of a wound drain in non-complex lumbar surgery does not prevent post-operative epidural haematomas and that the absence of a drain does not lead to a significant change in the incidence of wound infection. Cite this article: Bone Joint J 2016;98-B:984-9.
Topics: Diskectomy; Drainage; Hematoma, Epidural, Spinal; Humans; Laminectomy; Lumbar Vertebrae; Postoperative Care; Postoperative Complications; Surgical Wound Infection
PubMed: 27365478
DOI: 10.1302/0301-620X.98B7.37190 -
Diagnostic and Interventional Imaging Mar 2019Hemarthroses and muscle bleeds are well-known and well-documented complications in pediatric and young adult hemophilia patients. In contrast, deep bleeds in atypical... (Review)
Review
Hemarthroses and muscle bleeds are well-known and well-documented complications in pediatric and young adult hemophilia patients. In contrast, deep bleeds in atypical locations can be a diagnostic challenge, since clinicians and radiologists are often unfamiliar with their clinical and radiological features. Some atypical bleeds, however, can be life-threatening or severely disabling, highlighting the need for prompt, accurate diagnosis. Rare bleeds include central nervous system bleeds (including intracranial and spinal hematomas), urogenital bleeds, intra-abdominal bleeds (mesenteric and gastrointestinal wall hematomas) and pseudo tumors in unusual locations like the sinonasal cavities. Because clinical assessment can be difficult, clinicians and radiologists should be aware of the possibility of these rare complications in their hemophilia patients, so that they can avoid unnecessary invasive diagnostic and surgical procedures and institute prompt, appropriate treatment. The purpose of this review is to illustrate the imaging features of bleeds that occur in rare locations in young (i.e., children and young adults) patients with hemophilia to make the reader more familiar with these conditions.
Topics: Adolescent; Child; Child, Preschool; Female; Female Urogenital Diseases; Gastrointestinal Hemorrhage; Hemarthrosis; Hematoma; Hematoma, Epidural, Spinal; Hematoma, Subdural, Spinal; Hemoperitoneum; Hemophilia A; Hemophilia B; Hemorrhage; Humans; Infant; Intracranial Hemorrhages; Magnetic Resonance Imaging; Male; Male Urogenital Diseases; Muscular Diseases; Tomography, X-Ray Computed; Young Adult
PubMed: 30559038
DOI: 10.1016/j.diii.2018.11.010 -
Spontaneous Haematomas in Anticoagulated Covid-19 Patients: Diagnosis and Treatment by Embolization.Cardiovascular and Interventional... Jul 2022To assess the safety and efficacy of embolization for spontaneous bleeding in anticoagulated patients with COVID-19.
PURPOSE
To assess the safety and efficacy of embolization for spontaneous bleeding in anticoagulated patients with COVID-19.
MATERIAL AND METHODS
Single center retrospective study in 9 patients with COVID-19 who experienced bleeding complications following anticoagulation. The study included 8 men and 1 woman aged from 48 to 80 years (mean 69.7 years), who had a total of 10 soft tissue haematomas: 1 in the thigh, 1 in the anterior abdominal wall, 6 retroperitoneal and 2 thoracic haematomas. All patients were referenced for vascular embolization, mostly with Onyx-18.
RESULTS
A total of 10 haematomas were embolized in 9 patients. Technical success was achieved in all patients. No complications or adverse events were noted. One patient required percutaneous drainage of an infected haematoma 88 days after embolization. The mean hemoglobin level before embolization was 8,64 mg/dL and increased to 9,08 mg/dL after embolization (p = 0,3). After embolization all patients recovered haemodynamic stability and blood pressure levels improved. Seven patients resumed anticoagulation therapy after embolization. There were no recurrences or new bleedings in all treated patients. No patients required any additional invasive therapies or surgery. Mean intensive unit care and hospital stay was 6.7 and 35.2 days, respectively. All patients were discharged and were well at follow-up clinic visits 2-7 months after embolization. Seven patients performed a control CT scan 1-6 months after embolization, showing complete resolution of the haematoma.
CONCLUSION
Embolization is safe and effective to treat spontaneous haematomas in anticoagulated patients with COVID-19, allowing to resume anticoagulation therapy. Level of evidence IV Level 4, case-series.
Topics: Anticoagulants; COVID-19; Embolization, Therapeutic; Female; Hematoma; Hemorrhage; Humans; Male; Polyvinyls; Retrospective Studies; Treatment Outcome
PubMed: 35088137
DOI: 10.1007/s00270-021-03049-z -
Therapeutic Apheresis and Dialysis :... Jun 2014The incidence of acute massive hemorrhage in hemodialysis (HD) patients is thought to be higher than in healthy individuals, and a large, expanding subcutaneous hematoma...
The incidence of acute massive hemorrhage in hemodialysis (HD) patients is thought to be higher than in healthy individuals, and a large, expanding subcutaneous hematoma can result in necrosis of the overlying skin. We evaluated the efficacy of intra-arterial treatment for acute massive subcutaneous hemorrhage in HD patients. Seven HD patients with subcutaneous hemorrhage following minor blunt trauma were treated using superselective transarterial embolization, between July 2005 and October 2012. After examining the site of the hemorrhage using contrast-enhanced computed tomography (CT), embolizations were performed using microcoils, gelatin sponges, or N-butyl cyanoacrylate. Hematoma evacuation or skin grafting was performed as needed. Four men and three women with a mean age of 70 years (range, 63-82 years) comprised the study population. Sites of bleeding were as follows: lower leg (N = 3), upper leg (N = 1), buttock (N = 1), precordia (N = 1), and forearm (N = 1). Blood transfusions were administered to five cases. All patients were successfully salvaged using transarterial embolization. Six patients underwent hematoma evacuation after transarterial embolization, and two patients underwent split-thickness skin grafting for skin necrosis. We established a treatment strategy for HD patients with acute subcutaneous hemorrhage. Immediate confirmation of the site and the degree of bleeding with contrast-enhanced CT and early treatment using the transarterial embolization and as needed, hematoma evacuation are effective for preventing skin necrosis in HD patients with acute subcutaneous hemorrhage.
Topics: Aged; Aged, 80 and over; Blood Transfusion; Embolization, Therapeutic; Female; Hematoma; Hemorrhage; Humans; Male; Middle Aged; Necrosis; Renal Dialysis; Retrospective Studies; Skin; Skin Transplantation; Tomography, X-Ray Computed; Treatment Outcome; Wounds, Nonpenetrating
PubMed: 24118763
DOI: 10.1111/1744-9987.12106 -
Scandinavian Journal of Pain Apr 2017Bleeding into the vertebral canal causing a spinal haematoma (SH) is a rare but serious complication to central neuraxial blocks (CNB). Of all serious complications to... (Review)
Review
BACKGROUND
Bleeding into the vertebral canal causing a spinal haematoma (SH) is a rare but serious complication to central neuraxial blocks (CNB). Of all serious complications to CNBs, neurological injury associated with SH has the worst prognosis. Around the turn of the millennium, the first guidelines aiming to reduce the risk of this complication were published. These guidelines are based on known risk factors for SH, rather than evidence from randomized, controlled trials (RCTs). RCTs, and hence meta-analysis of RCTs, are not appropriate for identifying rare events. Analysing data from a significant number of published case reports of rare complications may reveal risk factors and patterns undetectable in reports on occasional cases, and can thereby help to improve management of CNBs. The aims of the present review were to analyse case reports of SH after CNBs published between 1994 and 2015 with regard to diagnosis, treatment, and outcome of SH after CNB.
METHODS
MEDLINE and EMBASE were utilized to find case reports published in English, German, or Scandinavian languages between 1994 and end of 2015, using appropriate search terms. Reference lists were also scrutinized for case reports. We documented initial and worst symptoms and signs of SH, diagnostic methods, treatment, and outcome of the SH. We calculated occurrences in per cent using the number of informative reports as denominator.
RESULTS
One hundred and sixty-six case reports on spinal hematomas after CNB published during the years between 1994 and 2015 were identified. Eighty per cent of the patients had severe neurological symptoms (paresis or paralysis). When compared over time, outcomes have improved significantly. Among patients subjected to surgical evacuation of the hematoma, outcomes were best if surgery was performed within 12hours from the first sign of motor dysfunction. However, even patients operated after more than 24hours had relatively favourable outcomes. Whereas the outcomes after surgical evacuation of the epidural haematomas were quite satisfactory, only one of the operations for subdural haematoma (SSDH) resulted in a favourable outcome.
CONCLUSIONS AND IMPLICATIONS
Suspicion of a spinal hematoma calls for the consultation of an orthopaedic or neurological surgeon without delay. MRI is the recommended diagnostic tool. Surgical evacuation within 12h from the first sign of motor dysfunction seems to lead to the best outcome, although many patients operated as late as after more than 24hours did regain full motor function. Despite the poor prognosis after surgical evacuation of SSDH, the outcomes after post-CNB spinal haematoma in general have improved significantly over time.
Topics: Anesthesia; Diagnosis, Differential; Hematoma; Humans; Spinal Cord Diseases
PubMed: 28850336
DOI: 10.1016/j.sjpain.2016.11.009 -
BMJ Case Reports Feb 2020Spontaneous rupture of an intercostal artery is exceptionally rare. It can be complicated by haemothorax, haematoma and/or retroperitoneal haemorrhage, which contributes...
Spontaneous rupture of an intercostal artery is exceptionally rare. It can be complicated by haemothorax, haematoma and/or retroperitoneal haemorrhage, which contributes to its morbidity and mortality. The authors report a case of a 76-year-old patient who was referred to the emergency department for pain associated with the appearance of a mass with progressive growth for 2 days in the right subscapular region. The patient had no previous history of trauma, ecchymosis or noticeable skin changes. History included the use of acetylsalicylic acid and a history of heart failure, as well as haemodialysis due to stage 5 chronic renal disease. CT scan showed an active haemorrhage from an artery in the fifth intercostal space. Embolisation was performed with microspheres and microcoils. No complications or recurrent bleeding was observed. Spontaneous rupture of an intercostal artery is rare, but it is an emergency requiring immediate diagnosis and intervention.
Topics: Aged; Computed Tomography Angiography; Embolization, Therapeutic; Hematoma; Hemorrhage; Hemothorax; Humans; Male; Microspheres; Rupture, Spontaneous; Thoracic Arteries; Treatment Outcome; Vascular Diseases
PubMed: 32060114
DOI: 10.1136/bcr-2019-233242