Conservative laparoscopic treatment of post-caesarean section bladder flap haematoma: two case reports

Abstract

A bladder flap haematoma (BFH) is an unusual complication of caesarean section and results from bleeding at the uterine suture. This haematoma arises between the posterior bladder wall and lower uterine segment. On ultrasonographic examination, it appears as a solid area or a complex mass with clean walls and reinforcement of the distal echoes. No clear and defined protocol exists for clinical management of BFH; in more severe cases, when the blood loss is continuous or if it transforms into an abscess, it needs non-standardized surgical treatment. When surgery is performed, usually the BFH is only drained, reserving hysterectomy for severe uterine necrosis, myometritis or abscess formations. In our experience, we have performed two conservative laparoscopic treatments with drainage of the BFH.

Closure Versus Non-Closure of the Visceral Peritoneum (VP) in Patients with Gestational Hypertension—An Observational Analysis

“…Fluid collections at this site may lead to bladder flap haematoma (BFH), whereas non closure of VP during CS confers the possible formation of free, non-encapsulated pelvic collections (Picture 1). Minor BFH are commonly observed following closure of the VP (20).…”

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“…Cesarean section (CS) is the most frequently utilized intraperitoneal obstetric surgical event, and the two most common techniques used are the Misgaw Ladach technique (or Stark CS) and the traditional method [8]. The difference between these methods is in the of the peritoneum: Stark method does not utilize peritoneal closure while the traditional method sutures the visceral and parietal peritoneum.…”

“…Tinelli, et al described two cases of BFH that developed post CS with suturing of visceral peritoneum [8]. Both were managed by laparoscopic drainage of the hematoma with postop resolution.…”

Conservative management of Retzius space hematoma following spontaneous vaginal delivery in a woman with an unscarred uterus: A case report

“…Decreased vascular resistance, engorgement of the pelvic vessels, and increased cardiac output and blood volume are physiological haemodynamic changes during pregnancy which can be part of the related process [ 1 ]. It can also occur in caesarean section, which will lead to intraabdominal bleeding that may require an urgent surgical intervention [ 3 ].…”

“…Patients who deteriorate while on conservative management will need immediate surgical exploration [ 1 ]. Most of the patients reported required surgical intervention as they were hemodynamically unstable [ [2] , [3] , [4] , 6 , 7 ] and the source of bleeding needed to be identified and hemostatic sutures applied to stop the bleeding.…”