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BMC Urology Jul 2022Following a percutaneous nephrolithotomy (PCNL) procedure, the most common complications are considered to be intraoperative and postoperative bleeding. Many patients... (Review)
Review
BACKGROUND
Following a percutaneous nephrolithotomy (PCNL) procedure, the most common complications are considered to be intraoperative and postoperative bleeding. Many patients with postoperative bleeding can be treated conservatively, causing the perirenal hematoma to resolve spontaneously. The major causes of severe postoperative bleeding are pseudoaneurysms, arteriovenous fistula, and segmental arterial injury. Typically, the first choice of treatment to manage severe bleeding complications is selective angioembolization (SAE) because of the very high success rate associated with this procedure.
CASE PRESENTATION
This clinical case involves a 56-year-old man who underwent dual-channel PCNL treatment after diagnosing a left kidney staghorn stone and urinary tract infection. The operation was successful, with no apparent signs of bleeding. Tests revealed continued decreasing hemoglobin levels following the procedure. After the conservative treatment failed, renal angiography was performed immediately, indicating renal pelvis mucosal artery hemorrhage. In the three hours post-surgery, the SAE still failed to prevent bleeding. Further discussions led to formulating a new surgical plan using a nephroscope to enter the initial channel where hemostasis began. The hemostasis origin was found precisely in the mucosal artery next to the channel during the operation and was successfully controlled.
CONCLUSIONS
This case reveals there is poor communication and inadequate discussions about the potential failures of an SAE procedure. Swift clinical decision-making is imperative when dealing with high-level renal trauma to prevent delays in surgery that can threaten the safety of patients.
Topics: Arteries; Humans; Kidney Diseases; Kidney Pelvis; Male; Middle Aged; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Postoperative Hemorrhage
PubMed: 35820877
DOI: 10.1186/s12894-022-01049-w -
Seminars in Thrombosis and Hemostasis Jun 2017Bleeding complications after cardiac surgery are common and are associated with increased morbidity and mortality. Their etiology is multifactorial, and treatment... (Review)
Review
Bleeding complications after cardiac surgery are common and are associated with increased morbidity and mortality. Their etiology is multifactorial, and treatment decisions are time sensitive. Point-of-care (POC) testing has an advantage over standard laboratory tests for faster turn-around times, and timely decision on coagulation intervention(s). The most common POC coagulation testing is the activated clotting time (ACT), used to monitor heparin therapy while on cardiopulmonary bypass. Viscoelastic coagulation tests including thromboelastometry (ROTEM) and thromboelastography (TEG) have been recommended for the treatment of postoperative bleeding after cardiac surgery because the ROTEM/TEG-guided treatment algorithms reduced the use of blood products. Other POC tests are commercially available, but there is sparse evidence for their routine use in cardiac surgery. These devices include heparin management systems, POC prothrombin time and activated partial thromboplastin time, POC fibrinogen assay, and whole blood platelet function tests. There are multiple confounding elements and conditions associated with cardiac surgery, which can significantly alter test results. Anemia and thrombocytopenia are regularly associated with deviations in many POC devices. In summary, POC coagulation testing allows for rapid clinical decisions in hematological interventions, and, when used in conjunction with a proper transfusion algorithm, may reduce blood product usage, and potentially complications associated with blood transfusion.
Topics: Blood Coagulation; Blood Coagulation Tests; Cardiac Surgical Procedures; Humans; Partial Thromboplastin Time; Point-of-Care Systems; Point-of-Care Testing; Postoperative Hemorrhage; Thrombelastography
PubMed: 28359133
DOI: 10.1055/s-0037-1599153 -
Journal of Hepato-biliary-pancreatic... 2009Intra-abdominal arterial hemorrhage is still one of the most serious complications after pancreato-biliary surgery. We retrospectively analyzed our experiences with 15...
BACKGROUND/PURPOSE
Intra-abdominal arterial hemorrhage is still one of the most serious complications after pancreato-biliary surgery. We retrospectively analyzed our experiences with 15 patients in order to establish a therapeutic strategy for postoperative arterial hemorrhage following pancreato-biliary surgery.
METHODS
Between August 1981 and November 2007, 15 patients developed massive intra-abdominal arterial bleeding after pancreato-biliary surgery. The initial surgery of these 15 patients were pylorus-preserving pancreatoduodenectomy (PPPD) (7 patients), hemihepatectomy and caudate lobectomy with extrahepatic bile duct resection or PPPD (4 patients), Whipple's pancreatoduodenectomy (PD) (3 patients), and total pancreatectomy (1 patient). Twelve patients were managed by transcatheter arterial embolization and three patients underwent re-laparotomy.
RESULTS
Patients were divided into two groups according to the site of bleeding: SMA group, superior mesenteric artery (4 patients); HA group, stump of gastroduodenal artery, right hepatic artery, common hepatic artery, or proper hepatic artery (11 patients). In the SMA group, re-laparotomy and coil embolization for pseudoaneurysm were performed in three and one patients, respectively, but none of the patients survived. In the HA group, all 11 patients were managed by transcatheter arterial embolization. None of four patients who had major hepatectomy with extrahepatic bile duct resection survived. Six of seven patients (85.7%) who had pancreatectomy survived, although hepatic infarction occurred in four.
CONCLUSIONS
Management of postoperative arterial hemorrhage after pancreato-biliary surgery should be done according to the site of bleeding and the initial operative procedure. Careful consideration is required for indication of interventional radiology for bleeding from SMA after pancreatectomy and hepatic artery after major hepatectomy with bilioenteric anastomosis.
Topics: Aged; Aged, 80 and over; Angiography; Biliary Tract Neoplasms; Embolization, Therapeutic; Female; Hepatectomy; Humans; Male; Middle Aged; Pancreatectomy; Pancreatic Neoplasms; Postoperative Hemorrhage; Radiography, Interventional; Reoperation; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 19110653
DOI: 10.1007/s00534-008-0012-3 -
Pediatric Critical Care Medicine : a... May 2004
Topics: Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child; Factor VII; Factor VIIa; Hemostatics; Humans; Postoperative Hemorrhage; Recombinant Proteins; Time Factors
PubMed: 15167716
DOI: 10.1097/01.pcc.0000124016.68179.8c -
Best Practice & Research. Clinical... Dec 2012Perioperative anaemia is a common clinical entity. It is usually due to combination of various mechanisms, including: pre-existing anaemia prior to surgery; anaemia due... (Review)
Review
Perioperative anaemia is a common clinical entity. It is usually due to combination of various mechanisms, including: pre-existing anaemia prior to surgery; anaemia due to impaired erythropoiesis, including alterations of metabolism of iron and erythropoietin (EPO); anaemia due to increased destruction of red blood cells (RBCs); and anaemia due to iatrogenic causes. Postoperatively, anaemia resembles anaemia of chronic disease and is probably related to the effects of inflammatory mediators released during and after surgery on the production and survival of RBCs. Pro-inflammatory cytokines, such as tumour necrosis factor, impair erythropoietin-dependent signalling and iron homeostasis. Iatrogenic causes, notably excessive phlebotomies, remain a major cause of perioperative anaemia. With increasing emphasis on restrictive blood transfusion strategies, understanding these mechanisms is important for the clinician.
Topics: Anemia; Blood Transfusion; Erythropoiesis; Humans; Inflammation Mediators; Perioperative Care; Postoperative Hemorrhage
PubMed: 23351230
DOI: 10.1016/j.bpa.2012.11.002 -
Laryngo- Rhino- Otologie Nov 2022In addition to an empirical use of antibiotics for treatment of a peritonsillar abscess (PTA) there is a drainage of pus or the abscess tonsillectomy. Postoperative...
OBJECTIVE
In addition to an empirical use of antibiotics for treatment of a peritonsillar abscess (PTA) there is a drainage of pus or the abscess tonsillectomy. Postoperative bleeding after abscesstonsillectomy (ABTE) is this surgery's most feared complication which can rarely lead to patients' deaths. The objective of this study was to compare bleeding complications of ABTE with and without contralateral tonsillectomy (TE) and to analyze the occurrence of a metachronous PTA at the contralateral side.
METHODS
Retrospective study of n= 655 patients undergoing ABTE with and without TE of the contralateral side from 2004 to 2019. Bleeding complications needing surgical hemostasis were analyzed regarding demographic and surgical parameters. In addition, occurrence of PTA and need for ABTE of the contralateral side after unilateral ABTE were evaluated.
RESULTS
Overall, 10/655 (1.5 %) patients presented with postoperative bleeding after ABTE. In 404/655 an ABTE with contralateral TE was performed. Here, 8/404 (1.98 %) patients showed contra- or bilateral bleeding. Only in 2/251 (0.7 %) patients occurred a bleeding complication after unilateral ABTE. Therefore, bleeding after unilateral ABTE was significantly lower than ABTE with contralateral TE (1.98 % vs. 0.7 %, p= 0.001). In 0.8 % of the patients a contralateral ABTE was necessary due to a metachronous PTA.
CONCLUSION
Overall, the rate of postoperative bleeding after ABTE (1.5 %) was low. Unilateral ABTE showed significantly lower postoperative bleeding rates compared to ABTE with contralateral TE. Consequently, the indication of a contralateral TE must be very strict.
Topics: Humans; Retrospective Studies; Peritonsillar Abscess; Tonsillectomy; Postoperative Hemorrhage; Drainage
PubMed: 35605964
DOI: 10.1055/a-1841-6419 -
The Laryngoscope Jan 2021Postoperative hemorrhage is the most common complication of transoral robotic surgery (TORS), the severity of which can range from minor bleeding treated with... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Postoperative hemorrhage is the most common complication of transoral robotic surgery (TORS), the severity of which can range from minor bleeding treated with observation to catastrophic hemorrhage leading to death. To date, little is known about the incidence, risk factors, and management of post-TORS hemorrhage.
STUDY DESIGN
Systematic Review and Metanlysis.
METHODS
A systematic review of the published literature using the Cochrane Handbook for Systematic Reviews of Interventions was performed and examined TORS, postoperative hemorrhage, and the use of prophylactic transcervical arterial ligation (TAL).
RESULTS
A total of 13 articles were included in the analysis. To date, there have been 332 cases of hemorrhage following a total of 5748 TORS. The pooled median post-TORS hemorrhage rate was 6.47%. The overall incidence of minor and major hemorrhage was 5.29% and 2.90%. Patients with prior radiation (relative risk [RR] = 1.46, 95% confidence interval [CI] = 1.00-2.12), large tumors (RR = 2.11, 95% CI = 1.48-2.99), and those requiring perioperative coagulation (RR = 2.25, 95% CI = 1.54-3.28) had significantly higher relative risks of hemorrhage. There was no significant difference in the relative risk of overall hemorrhage with TAL. Looking at major hemorrhage, patients undergoing TAL had a large but insignificant relative risk reduction in post-TORS hemorrhage (RR = 0.40, 95% CI = 0.15-1.07).
CONCLUSION
The incidence of post-TORS hemorrhage is low (5.78%), and for major hemorrhage requiring emergent embolization, TAL, or tracheotomy to control hemorrhage it is even lower (2.90%). Large tumors, perioperative anticoagulation, and prior radiation were associated with significantly increased risk of post-TORS hemorrhage. TAL does not reduce the overall incidence of post-TORS hemorrhage but may lead to fewer severe hemorrhages.
LEVEL OF EVIDENCE
III Laryngoscope, 131:95-105, 2021.
Topics: Humans; Incidence; Oral Surgical Procedures; Postoperative Hemorrhage; Risk Factors; Robotic Surgical Procedures
PubMed: 32108347
DOI: 10.1002/lary.28580 -
Heart Rhythm Apr 2021There are an increasing number of cardiac electronic device implants and generator changes with a longer patient life expectancy along with concomitant increase in... (Review)
Review
There are an increasing number of cardiac electronic device implants and generator changes with a longer patient life expectancy along with concomitant increase in antiplatelet and anticoagulant regimens, which can increase the incidence of pocket hematomas. We have conducted an in-depth analysis on the relevant literature, which is rife with varying definition of hematomas, on ways to reduce pocket hematomas. We have analyzed studies on periprocedural medication management, intraprocedural use of prohemostatic agents, and postprocedure role of compression devices.
Topics: Defibrillators, Implantable; Global Health; Hematoma; Humans; Incidence; Pacemaker, Artificial; Postoperative Hemorrhage; Risk Factors
PubMed: 33242669
DOI: 10.1016/j.hrthm.2020.11.017 -
British Dental Journal Aug 2013
Topics: Hemostatic Techniques; Humans; Postoperative Hemorrhage; Tooth Extraction; Tooth Socket
PubMed: 23928585
DOI: 10.1038/sj.bdj.2013.747 -
Journal of the American College of... Apr 2017
Topics: Child; Humans; Postoperative Hemorrhage
PubMed: 28343497
DOI: 10.1016/j.jamcollsurg.2017.01.027