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Medicina (Kaunas, Lithuania) May 2018: Rectus sheath haematoma (RSH) is an uncommon condition that may vary from contained haematoma to life-threatening bleeding. Timely diagnosis and treatment is crucial... (Comparative Study)
Comparative Study
: Rectus sheath haematoma (RSH) is an uncommon condition that may vary from contained haematoma to life-threatening bleeding. Timely diagnosis and treatment is crucial in this patient population. The aim of the current study was to investigate the results of the different RSH treatment strategies among patients admitted to a surgery department. : A retrospective analysis of 29 patients treated for RSH in surgery departments of two medical centres from 1 January 2007 to 30 September 2017 was conducted. The patient's age, sex, ASA (American Society of Anesthesiologists; physical status classification system), use of anticoagulants, cause of haematoma, radiological data, vital signs, blood investigations, and type of treatment were extracted. The results were analysed according to the type of treatment. : The patients' mean age was 67.6 ± 14.3 years, and the mean duration of in-hospital stay was 10.7 ± 6.7 days. All patients were on anticoagulant treatment, and 82.8% of them had spontaneous haematoma. Nine patients (31%) needed transfusion of packed red blood cells with an average of 2.6 units (range: 1⁻4). Five patients (17.2%) presented with symptoms and signs of hypovolemic shock, and four of them underwent embolisation. Embolisation was successful in all cases. Open surgery was performed in 6 patients, 8 patients underwent percutaneous drainage, and 10 patients were treated conservatively. Two patients (6.7%) died in our series. Both of these patients had type III RSH. Patients in the conservatively treated group had the shortest hospital stay. There were no readmissions due to repeated haematoma or infection. : Embolisation of epigastric arteries is a useful tool to stop bleeding into RSH in patients with unstable haemodynamics. Conservative treatment is comparable to ultrasound (US) drainage of RSH but results in a shorter hospital stay. Type III RSH is associated with a higher death rate.
Topics: Aged; Anticoagulants; Drainage; Embolization, Therapeutic; Epigastric Arteries; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Middle Aged; Muscular Diseases; Rectus Abdominis; Retrospective Studies; Treatment Outcome; Ultrasonography, Interventional
PubMed: 30344269
DOI: 10.3390/medicina54030038 -
Hinyokika Kiyo. Acta Urologica Japonica Mar 2022Subcapsular renal hematoma is a complication of extracorporeal shock wave lithotripsy or percutaneous nephrolithotripsy. Although it can occur after transurethral...
Subcapsular renal hematoma is a complication of extracorporeal shock wave lithotripsy or percutaneous nephrolithotripsy. Although it can occur after transurethral ureterolithotripsy (TUL), there is no consensus on the risk factors, outcomes, and its management. This study aimed to elucidate the clinical courses of patients with subcapsular hematoma after TUL. We retrospectively investigated 1,235 patients who underwent TUL from October 2011 to December 2020 at our hospital and identified cases with subcapsular hematoma diagnosed after surgery. Subcapsular hematoma was diagnosed in 5 of the 1,235 (0.40%) patients, whose median age was 63 (49-69) years. The median operation time, hematoma diameter, and hemoglobin decrease were 66 (35-115) min, 8.2 (5.4-10.5) cm, and 1.6 (0.7-2.6) g/dl, respectively. All patients were conservatively managed without invasive interventions (eg, embolization), although one patient required blood transfusion. In conclusion, this study presented five cases with renal subcapsular hematoma after TUL that could be conservatively managed. It is important not to miss the timing of therapeutic intervention while observing the progress after diagnosis.
Topics: Female; Hematoma; Humans; Kidney; Kidney Calculi; Lithotripsy; Male; Middle Aged; Retrospective Studies
PubMed: 35468699
DOI: 10.14989/ActaUrolJap_68_3_75 -
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 -
Neurosurgical Review Oct 2022Postoperative seizures are a frequently occurring yet not well-understood complication in patients undergoing surgical treatment of chronic subdural haematomas (cSDHs)....
Postoperative seizures are a frequently occurring yet not well-understood complication in patients undergoing surgical treatment of chronic subdural haematomas (cSDHs). Therefore, we investigated surgical and non-surgical risk factors that are commonly considered causal in provoking epileptic seizures, paying special attention to the intracranial course of the subdural drain (SDD) and the configuration of the haematoma. Data of patients with a cSDH, that were treated at our neurosurgical department between 2008 and 2014 were analysed. Patients suffering from severe pre-existing conditions and those who have been treated conservatively were excluded. Epidemiologic data as well as relevant clinical data were collected. Pre- and postoperative CT scans were analysed regarding morpho- and volumetric parameters. In order to objectify the influence of the SDD, its intracranial course and localisation (entering angle as well as the angle between drain and brain surface) were measured. For statistical analysis, univariate and multiple logistic regression models as well as Fisher's exact test were used. Two hundred eleven consecutive patients have been included. Mean age was 75.6 years, and 69% were male. Nineteen (9%) patients suffered from postsurgical seizures. Membranes within the haematoma were present in 81.5%. Pre- to postoperative haematoma reduction was significant (mean of difference - 12.76 mm/ - 9.47 mm in coronal/axial CT planes, p = 0.001/ < 0.001). In 77.9%, SDD showed cortical contact with eloquent regions and had an unfavourable course in 30 cases (14.2%). Surgical complications consisted of cortical bleeding in 2.5%, fresh subdural haematoma in 33.5% and wound infections in 1.4% of patients. Neither in univariate nor in multiple regression analyses any of the following independent variates was significantly correlated with postsurgical seizures: pre-existing epilepsy, alcohol abuse, right-sided haematomas, localization and thickness of haematoma, presence of septations, SDD-localization and to-brain angle, subdural air, and electrolyte levels. Instead, in multiple regression analyses, we found the risk of postsurgical seizures to be significantly correlated and increased with left-sided cSDH treated via craniotomy (p = 0.03) and an unfavourable course of the SDD in left-sided cSDH (p = 0.033). Burr hole trepanation should be preferred over craniotomy and care must be taken when placing a SDD to avoid irritating cortical tissue. The configuration of the haematoma does not appear to affect the postoperative seizure rate.
Topics: Aged; Drainage; Electrolytes; Female; Hematoma; Hematoma, Subdural, Chronic; Humans; Male; Postoperative Complications; Risk Factors; Seizures
PubMed: 36097085
DOI: 10.1007/s10143-022-01858-5 -
The Cochrane Database of Systematic... 2004Acute haematoma of the pinna is a condition where a collection of blood forms beneath the perichondrial layer of the pinna. It is usually caused by blunt trauma, and if... (Review)
Review
BACKGROUND
Acute haematoma of the pinna is a condition where a collection of blood forms beneath the perichondrial layer of the pinna. It is usually caused by blunt trauma, and if untreated will ultimately result in a deformity commonly known as 'cauliflower ear' or 'wrestler's ear'. Various treatments are employed to relieve the haematoma but no clear consensus exists on the best way to do so in order to produce the best cosmetic result with the least permanent deformity.
OBJECTIVES
To assess the effectiveness of treatment options in acute auricular haematoma.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2003), MEDLINE (1966 - 2003) and EMBASE (1966 - 2003) with pre-specified terms. The date of the last search was April 2003.
SELECTION CRITERIA
Randomised controlled trials, case controlled trials and cohort studies including children and adults undergoing any intervention for acute auricular haematoma.
DATA COLLECTION AND ANALYSIS
Fifty-nine references were identified from the searches. Forty-eight were retrieved and assessed for eligibility by the authors. None met the inclusion criteria.
MAIN RESULTS
Due to the lack of data from trials fulfilling selection criteria no results could be presented.
REVIEWERS' CONCLUSIONS
There is no clearly defined best treatment for acute auricular haematoma. There are no good quality data to determine either the optimal management strategy or even whether post-drainage intervention (such as splinting or bandaging) is necessary. Further research is required before any specific treatment may be recommended.
Topics: Ear Deformities, Acquired; Ear Diseases; Ear, External; Hematoma; Humans
PubMed: 15106240
DOI: 10.1002/14651858.CD004166.pub2 -
Journal of Neurointerventional Surgery May 2022Evidence is growing to support minimally invasive surgical evacuation of intraparenchymal hematomas, particularly those with minimal residual hematoma volumes following... (Review)
Review
Evidence is growing to support minimally invasive surgical evacuation of intraparenchymal hematomas, particularly those with minimal residual hematoma volumes following evacuation. To maximize the potential for neurologic recovery, it is imperative that the trajectory for access to the hematoma minimizes disruption of normal parenchyma. Flat panel detector CT-based navigation and needle guidance software provides a platform that uses flat panel detector CT imaging obtained on the angiography table to aid reliable and safe access to the hematoma. In addition to providing a high degree of accuracy, this method also allows convenient and rapid re-imaging to assess navigation accuracy and the degree of hematoma evacuation prior to procedural completion. We provide a practical review of the iGuide needle guidance software and the methodology for incorporating its use, and the software of other vendors, in a variety of minimally invasive methods for evacuation of intraparenchymal hematomas.
Topics: Cerebral Hemorrhage; Hematoma; Humans; Minimally Invasive Surgical Procedures; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 34635580
DOI: 10.1136/neurintsurg-2021-017903 -
Journal of the American Veterinary... Mar 2021To characterize the clinical features, treatment, and outcome of aural hematomas in horses.
OBJECTIVE
To characterize the clinical features, treatment, and outcome of aural hematomas in horses.
ANIMALS
7 horses with 1 or 2 aural hematomas (8 ears in total) treated at a veterinary teaching hospital in 2008 through 2019.
PROCEDURES
Data retrieved from medical records included signalment, pertinent historical information, clinical signs, diagnostic procedures (including dermatologic assessment), and treatments. Case outcome was determined from documentation in the medical record or via telephone communication with owners or referring veterinarians.
RESULTS
3 horses were presented after recurrence of aural hematoma following treatment by the referring veterinarian. Four horses had a history of allergic skin disease prior to aural hematoma development. Most (6/7) horses were unilaterally affected. Diagnostic assessments included otoscopic evaluation (3 horses), ultrasonography (3 horses), cytologic examination of ear canal swab samples (3 horses), and histologic examination of a pinnal biopsy specimen (1 horse). Of the 8 pinnae, 2 were treated by nonsurgical needle drainage (1 with concurrent corticosteroid injection) and the remaining 6 underwent surgical incision and placement of compressive sutures. Follow-up information was available for 6 horses, and all affected pinnae were fibrotic with 4 horses having permanent drooping of the pinna. One horse developed a hematoma in the contralateral pinna 1 year after hospital discharge.
CONCLUSIONS AND CLINICAL RELEVANCE
Equine aural hematoma is a rare condition. The main principle of treatment is drainage, and treatment options commonly used in small animal practice can be successfully applied in horses. Permanent changes in the cosmetic appearance of the pinna are likely to develop owing to secondary fibrosis.
Topics: Animals; Ear Diseases; Hematoma; Horse Diseases; Horses; Hospitals, Animal; Hospitals, Teaching; Neoplasm Recurrence, Local; Retrospective Studies; Treatment Outcome
PubMed: 33683965
DOI: 10.2460/javma.258.6.654 -
JAMA Network Open Feb 2024Intracerebral hemorrhage (ICH) associated with direct oral anticoagulant (DOAC) use carries extremely high morbidity and mortality. The clinical effectiveness of...
IMPORTANCE
Intracerebral hemorrhage (ICH) associated with direct oral anticoagulant (DOAC) use carries extremely high morbidity and mortality. The clinical effectiveness of hemostatic therapy is unclear.
OBJECTIVE
To compare the clinical and radiological outcomes of DOAC-associated ICH treated with prothrombin complex concentrate (PCC) vs conservative management.
DESIGN, SETTING, AND PARTICIPANTS
In this population-based, propensity score-weighted retrospective cohort study, patients who developed DOAC-associated ICH from January 1, 2016, to December 31, 2021, in Hong Kong were identified. The outcomes of patients who received 25 to 50 IU/kg PCC with those who received no hemostatic agents were compared. Data were analyzed from May 1, 2022, to June 30, 2023.
MAIN OUTCOMES AND MEASURES
The primary outcome was modified Rankin scale of 0 to 3 or returning to baseline functional status at 3 months. Secondary outcomes were mortality at 90 days, in-hospital mortality, and hematoma expansion. Weighted logistic regression was performed to evaluate the association of PCC with study outcomes. In unweighted logistic regression models, factors associated with good neurological outcome and hematoma expansion in DOAC-associated ICH were identified.
RESULTS
A total of 232 patients with DOAC-associated ICH, with a mean (SD) age of 77.2 (9.3) years and 101 (44%) female patients, were included. Among these, 116 (50%) received conservative treatment and 102 (44%) received PCC. Overall, 74 patients (31%) patients had good neurological recovery and 92 (39%) died within 90 days. Median (IQR) baseline hematoma volume was 21.7 mL (3.6-66.1 mL). Compared with conservative management, PCC was not associated with improved neurological recovery (adjusted odds ratio [aOR], 0.62; 95% CI, 0.33-1.16; P = .14), mortality at 90 days (aOR, 1.03; 95% CI, 0.70-1.53; P = .88), in-hospital mortality (aOR, 1.11; 95% CI, 0.69-1.79; P = .66), or reduced hematoma expansion (aOR, 0.94; 95% CI, 0.38-2.31; P = .90). Higher baseline hematoma volume, lower Glasgow coma scale, and intraventricular hemorrhage were associated with lower odds of good neurological outcome but not hematoma expansion.
CONCLUSIONS AND RELEVANCE
In this cohort study, Chinese patients with DOAC-associated ICH had large baseline hematoma volumes and high rates of mortality and functional disability. PCC treatment was not associated with improved functional outcome, hematoma expansion, or mortality. Further studies on novel hemostatic agents as well as neurosurgical and adjunctive medical therapies are needed to identify the best management algorithm for DOAC-associated ICH.
Topics: Humans; Female; Aged; Male; Conservative Treatment; Cohort Studies; Retrospective Studies; Factor IX; Hemostatics; Cerebral Hemorrhage; Hematoma; Anticoagulants; Blood Coagulation Factors
PubMed: 38319661
DOI: 10.1001/jamanetworkopen.2023.54916 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2020In this study, we aimed to review spontaneous rectus sheath hematoma (RSH) and the results of endovascular therapy in patients presenting with a rare acute abdomen.
BACKGROUND
In this study, we aimed to review spontaneous rectus sheath hematoma (RSH) and the results of endovascular therapy in patients presenting with a rare acute abdomen.
METHODS
We evaluated the patients with RSH because of acute abdominal pain and applied endovascular embolization treatment who were admitted to our hospital emergency department retrospectively between December 2016 and December 2018.
RESULTS
Rectus muscle sheath bleeding is an extremely rare and urgent emergency intervention. In the etiology, chronic severe cough crises and trauma may be the cause of haemorrhage in the elderly patient group; spontaneous bleedings may be seen with the increase in the use of anticoagulants. In this study, a total of six patients, 53-95 years old (mean 75.5) endovascular embolization treatment was administered on who were admitted to our hospital with the diagnosis of RSH and long-term anticoagulant use. In our series, physical examination findings, laboratory values, computed tomography (CT), CT angiography and digital subtraction angiography (DSA) findings were presented. The findings showed an active extravasation from the superficial circumflex iliac artery in two patients and the inferior epigastric artery in three patients. We had no bleeding focus in only one patient. An ultrasound-guided 5 Fr arterial sheath was placed on the side of the hematoma in the procedure. Then, the inferior epigastric artery and deep circumflex arteries were selectively catheterized using the Vertebral Diagnostic Catheter (5 Fr or 4 Fr). Superselective catheterization, with the help of microcatheter from the existing diagnostic catheter, was used to embolize the arteries and branches with active extravasation using a detachable coil. In the control angiographies performed after embolization, pathological staining disappeared, and complete embolization was achieved. There were no complications associated with the endovascular procedures. No active extravasation was detected in angiography examination, and inpatient follow-up, blood transfusion, antibiotics and analgesic support were performed in only one patient. However, it was ex as a result of reasons related to advance heart failure.
CONCLUSION
RSH is a life-threatening condition that may cause acute abdominal pain, and endovascular embolization is a safe and effective treatment option that can be applied quickly in this patient group.
Topics: Abdomen, Acute; Aged; Aged, 80 and over; Embolization, Therapeutic; Endovascular Procedures; Hematoma; Humans; Middle Aged; Rectus Abdominis
PubMed: 32185764
DOI: 10.14744/tjtes.2019.44015 -
BMJ Case Reports Dec 2023Epidural anaesthesia is widely used in major thoracic and abdominal surgery for postoperative analgesia. Spinal haematoma after epidural anaesthesia in patients without...
Epidural anaesthesia is widely used in major thoracic and abdominal surgery for postoperative analgesia. Spinal haematoma after epidural anaesthesia in patients without risk factors is very rare. Most of the reported spinal haematomas arose in the epidural space, whereas the subdural localization seen in this case is very uncommon.We report a case of spinal subdural haematoma after difficult and repeated placement of an epidural catheter for postoperative analgesia. As no sensorimotor deficit of the lower limb arose, we refrained from immediate neurosurgical decompression and the patient recovered fully in the course. Nevertheless, any kind of spinal haematoma is a serious complication we should always be aware of. Prompt detection of clinical symptoms such as sensory or motor deficit is most important. Further diagnostic steps and treatment should not be delayed to avoid permanent neurological deficits.
Topics: Humans; Hematoma; Hematoma, Subdural; Anesthesia, Epidural; Risk Factors
PubMed: 38160037
DOI: 10.1136/bcr-2023-255104