A Rare Case of Hemorrhagic Shock: Morel-Lavallée Lesion

Claassen, Lieke; Franssen, Myriam Anna; Loos, Erik R. de

doi:10.5811/cpcem.2019.9.43674

Cited by 12 publications

(14 citation statements)

References 14 publications

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“…In one report of a posterior trunk MLL, supine positioning and compression using the patient’s body weight successfully tamponaded the lesion. 14 The risk of pressure ulceration secondary to continuous bedrest should be considered with this approach. Additionally, observation carries a risk of vascular compromise to overlying tissue if there is pressure-related ischemia from the accumulated fluid.…”

Section: Discussionmentioning

confidence: 99%

Practical Review of the Comprehensive Management of Morel-Lavallée Lesions

Molina

Ghazoul

Janis

2021

Plastic and Reconstructive Surgery - Global Open

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Background: Morel-Lavallée lesions have been described in the literature since the mid-19th century, yet contemporary clinical management continues to be challenging and remains variable. These closed degloving injuries are usually seen in the setting of blunt trauma and are due to shearing forces, creating a space for the collection of hemolymphatic fluid. These fluid collections can be persistent despite conservative treatment attempts and can require staged surgical interventions. Methods: A literature search of peer-reviewed articles pertaining to Morel-Lavallée lesions was performed. Articles relating to the pathophysiology, clinical presentation, diagnosis, treatment, and management of complications of Morel-Lavallée lesions were included to formulate recommendations for clinical management. Results: Fifty-six relevant articles were included in the review. Recognition of these lesions may be delayed and the use of imaging is important in diagnosis. Initial attempts at conservative management may be appropriate for smaller, uncomplicated Morel-Lavallée lesions. Surgical interventions such as open debridement, techniques to close dead space, negative pressure wound therapy, and skin grafts or flaps are critical to managing complex or recurring lesions. An algorithm for the treatment of Morel-Lavallée lesions is proposed based on review of the literature. Conclusions: Plastic and reconstructive surgeons are frequently involved in more complex Morel-Lavallée lesions such as those exhibiting delayed healing or super-infection. The skillset needed for successful management of patients with Morel-Lavallée lesions is well within the armamentarium of plastic and reconstructive surgeons.

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Section: Discussionmentioning

confidence: 99%

Practical Review of the Comprehensive Management of Morel-Lavallée Lesions

Molina

Ghazoul

Janis

2021

Plastic and Reconstructive Surgery - Global Open

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“…Unless a delayed diagnosis may cause devastating consequences like a hemorrhagic shock which is a rare complication and only four cases have been described in the literature. Classen et al [ 5 ] reported a case of MLS situated in the lumbar region treated with conservative treatment based on compression using the patient’s own body weight. Hefny et al [ 6 ] reported a case of MLS in the flunk treated by percutaneous suction drainage.…”

Section: Discussionmentioning

confidence: 99%

Morel-Lavallée lesion as an unusual cause of hemorrhagic shock: Case report and review of literature

Daghmouri¹,

Ismail²,

Ouesleti³

et al. 2020

International Journal of Surgery Case Reports

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Introduction Morel-Lavallée syndrome (MLS) is considered as a rare entity and hemorrhagic shock as a complication is uncommon. Presentation of case We report the case of a 56-year- old man who presented to the emergency department after a road traffic accident. Initially, the patient was hemodynamically unstable (heart rate 160 beats/min and blood pressure 65/30). Physical examination revealed multiple lacerations on his back and a gradually expanding large subcutaneous hematoma on the left flank extending to the hip and left leg. Fluid resuscitation was rapidly initiated. After stabilizing his hemodynamic status, a full-body computed tomography was performed revealing, apart from a small unilateral pneumothorax and a stable pelvis fracture, an extensive Morel-Lavallée lesion in the lumbar region extending to the hip and both legs. The patient was then transferred to a surgical intensive care unit for further resuscitation and surgical drainage of the collection followed by continuous suction was performed. Even though rare, Hemorrhagic shock is one of the threatening complications of Morel-Lavallée lesions and should be kept in mind by every traumatologist and emergency doctor. Conclusion We report a case about a rare complication of MLS which is hemorrhagic shock in order to highlight the importance of making the diagnosis, which can be unrecognized, and initiate an adequate treatment on time.

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“…• In the absence of a specific guideline/protocol for the management of soft tissue compartment bleeding, treatment should be individualized based on the hemodynamic status of the patient. Hefny et al [6] Extensive hematoma between the subcutaneous fat and the paraspinal muscles in the back Percutaneous suction drain Discharged Yumoto et al [7] Large hematoma in the lower back with lumbar vertebrae fractures with active contrast extravasation at multiple sites located close to the bilateral lumbar and internal iliac arteries Gel foam embolization Discharged Mao et al [8] Left flank to thigh NOM but later required open drainage for infected collection Discharged Claassen et al [9] Lower lumbar region in the back NOM Discharged Daghmouri et al [10] Lumbar region extending to hips and both legs Surgical drainage Discharged NOM, nonoperative management.…”

Section: Learning Pointsmentioning

confidence: 99%

Soft tissue compartment bleed—the iceberg phenomenon: a case report

Dar

Bagaria

Gupta

2023

Emerg Crit Care Med

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IntroductionHemorrhage control is the essence of trauma care. Conventional teaching is 1 on the floor (ie, external bleeding) and 4 more (thoracic cavity, abdomen, retroperitoneum, and long bones). In this case report, we present a unique case with concealed bleeding into the soft tissue compartment leading to shock. This case triggered to consider the soft tissue compartment as the sixth potential bleeding site in trauma patients in hemorrhagic shock.Case presentationWe present the case with concealed bleeding into the soft tissue compartment posing a challenge in management. On presentation, he had a pulse rate of 117 beats/min, a blood pressure of 90/60 mmHg, and a Glasgow Coma Scale (GCS) score of 9. During resuscitation, the patient's blood pressure dropped to 70/46 mmHg with a GCS of 7 of 15. He was then intubated and reevaluated. Contrast-enhanced computed tomography of the torso revealed a right scapular fracture with a large soft tissue hematoma along the right side of the neck and chest wall, extending up to the right lumbar region.ConclusionWe suggest that the soft tissue compartment is the sixth potential site of internal bleeding in trauma patients, which should not be overlooked after having ruled out the other 5 sites.

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A Rare Case of Hemorrhagic Shock: Morel-Lavallée Lesion

Cited by 12 publications

References 14 publications

Practical Review of the Comprehensive Management of Morel-Lavallée Lesions

Practical Review of the Comprehensive Management of Morel-Lavallée Lesions

Morel-Lavallée lesion as an unusual cause of hemorrhagic shock: Case report and review of literature

Soft tissue compartment bleed—the iceberg phenomenon: a case report

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