Large traumatic vulvar hematoma managed with a simple incision: A case report

Abstract

Introduction and importance Non-obstetric vulvar hematoma is a rare condition. With only few cases reported, no standard consensus exists on the best management of vulvar hematomas. Herein, we report the successful management of a large trauma-induced vulvar hematoma through a simple incision under local anesthesia. Localized large vulvar hematomas can be treated with this simple procedure. Case presentation A 38-year-old woman presented with vulvar pain following a fall. Investigations revealed a large painful hematoma in the right labium majus. Imaging revealed that the hematoma was localized and the pelvic structure was normal. We successfully treated the hematoma by making an incision in the right labium majus under local anesthesia to evacuate the clot and ligate the bleeding points. She was discharged in a good condition after two days. Discussion Non-obstetrics vulvar hematoma is rare particularly the large hematoma. A blunt trauma may cause a large vulvar hematoma. There is no standard management of vulvar hematomas since the incidence is very low. The important step in managing vulvar hematoma is detecting the localization of the hematoma and evaluating other pelvic structures. Most of vulvar hematoma is isolated in the soft tissue around the labium majus and the vagina without further extension. After confirming that the large vulvar hematoma is localized and there are no injuries to the other pelvic structures, a simple incision and bleeding points ligation under local anesthesia can be performed to relieve the pain and prevent pressure necrosis. Conclusion Simple incision under local anesthesia is effective for managing large vulvar hematomas and reduces the recovery time.

Neglected Traumatic Vulvar Hematoma: A Case Report

“…Spontaneous vessel rupture could be considered if no etiology was found. 1,2,7 Warfarin is associated with hemorrhagic events with an estimated 1-year bleeding risk of up to 6.5% affecting soft tissue, gastrointestinal tract, or urinary tract. In severe cases, correction of coagulation disorder using phytomenadione and fresh frozen plasma may be needed.…”

“…Previously, a case in Indonesia also reported an acute vulvar hematoma with etiology of trauma in the vulva with 6.5 cm diameter and onset of 8 h that was managed by incision using local anesthesia and showed a good outcome. 1 If the evacuation of the hematoma, drain, and suture of the bleeding point do not resolve the bleeding, laparotomy to ligate the internal iliac artery can be performed. Arterial embolization is another alternative to the classic surgical approach.…”

“…This is an emergency condition that needs to be treated immediately. 1,2 Our case discussed a patient with severe cases that do not receive proper treatment which can arise from multiple factors. The patient came to our clinic after 1 month of observation in a primary healthcare facility.…”