Non-obstetric traumatic vulvar hematoma: Conservative or surgical approach? A case report

Alcalde, María Victoria Lapresa; Hernández, Estrella Hernández; Alfonso, Sandra Bustillo; Sánchez, María José Doyague

doi:10.1016/j.crwh.2019.e00109

Cited by 15 publications

(23 citation statements)

References 13 publications

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“…However, the size of the haematoma was less than that of the present study and they also advised the patient to perform warm soaks to improve local circulation and reabsorption of the haematoma which was not done in the present study. However, surgical evacuation was the modality applied by Alcalde et al in the management of a non obstetric traumatic vulva haematoma of about 10 × 5 cm in a 44 year old Caucasian woman [8]. The patient has an accelerated recovery and was discharged within 24 hours.…”

Section: Discussionmentioning

confidence: 99%

Large Vulva Haematoma Following Spontaneous Vaginal Delivery: Successful Conservative Management in Enugu, South East Nigeria

Nnaji¹,

Nwankwo²,

Aniebue³

et al. 2020

ARSci

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Background: Vulva haematoma is an uncommon complication of childbirth that can cause maternal death if not properly managed. We present a case of large vulva haematoma managed conservatively with good outcome in UNTH Enugu. Clinical Presentation: This was a case of an unbooked 24 years old primiparous woman referred from a private hospital to UNTH, Enugu on account of left-sided vulva swelling of four hours duration following a spontaneous vaginal delivery of a live male baby that weighed 3.6 kilogrammes. She was given episiotomy which was repaired. Vaginal examination showed a swelling involving left labia majora and minora and extending to the perineal region and vagina. It measured 12 cm × 10 cm, firm and mildly tender. She was resuscitated with intravenous fluid, transfused with two units of blood and commenced on antibiotic and analgesic. The vulva haematoma was monitored and it remained the same size for two days, and then progressively regressed. She was discharged home on the 9th day. Conclusion: Conservative management of large vulva haematoma involving good counseling, correction of anaemia, institution of antibiotics, analgesic and close monitoring leads to effective resolution, reduced cost, scarring, pain and dyspareunia.

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Section: Discussionmentioning

confidence: 99%

Large Vulva Haematoma Following Spontaneous Vaginal Delivery: Successful Conservative Management in Enugu, South East Nigeria

Nnaji¹,

Nwankwo²,

Aniebue³

et al. 2020

ARSci

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“…Non-obstetric vulvar haematomas are not common and there are no guidelines for their management. However, the principle of management in obstetric haematomas can be applied by analogy to the haematomas post gynecologic surgery (28,29). Thus, due to size and discomfort symptoms reported by the patient, we opted for drainage in order to reduce the pain, accelerate the recovery, and prevent secondary infection and necrosis.…”

Section: Discussionmentioning

confidence: 99%

Challenges in Management of Bartholin gland Leiomyoma: A Case Report

Vinturache

Ismail

Damato

et al. 2020

Preprint

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Abstract Background: Leiomyomas are uncommon vulvar neoplasms often misdiagnosed as other Bartholin gland pathology. Due to their rarity and the absence of guidelines, their diagnosis and management remain challenging, largely based on expert opinion and evidence from case reports. Case Presentation: This case report describes a 44-year-old woman presenting with accelerating growth of a vulvar mass. Based on clinical signs and symptoms, the initial diagnosis was Bartholin cyst. Surgical excision was provided for symptom control and aesthetic reasons. The histopathologic diagnosis was vulvar leiomyoma. The postoperative recovery was complicated by secondary haematoma and dehiscence of the surgical site. There was no recurrence at two years follow up. Therefore, we discuss the dilemma posed by physical examination of a vulvar mass, the challenges of the management, and report on secondary morbidity and long-term follow up, aspects of care for patients with vulvar pathology not commonly addressed in the literature. Conclusions: Bartholin gland neoplasms are rare tumors, commonly misdiagnosed as Bartholin’s cysts. Excision is the treatment of choice. Short time follow up allows prompt management of potential postoperative complications. Continuing long term follow up is recommended due to recurrence risk.

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“…Conservative management is advocated for small haematomas with no acute expansion [8,11,12]. Patients who are managed conservatively are more likely to spend more days in admission, need more antibiotics and blood transfusion [13].…”

Section: Discussionmentioning

confidence: 99%

“…As pressure builds within the haematoma, the tissue becomes necrotic, necessitating debridement and prevention of infection [1]. Surgical intervention is recommended if haematoma keeps increasing and the pain persists, usually marking the failure of the conservative method [6,11]. In our second case, the haematoma was rapidly increasing and eventually ruptured, it was absolutely necessary for us to carefully remove all clots and assess for pressure necrosis.…”

Section: Discussionmentioning

confidence: 99%

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Non-obstetric vulva haematomas in a low resource setting: two case reports

Mangwi¹,

Ebasone²,

Aroke³

et al. 2019

Pan Afr Med J

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Vulva haematomas are uncommon outside the obstetric population, with an incidence of 3.7% and represent only 0.8% of all gynaecological emergencies. The first case is a 24-year-old G2P1011 referred after the failure of conservative management of a progressively increasing right labia majora swelling. Vulva incision, exploration and relieve of hematoma were done under local anaesthesia. The second case is a 17-year-old G1P1001, a student who presented with spontaneous pain and swelling of the left labia majora. The swelling was rapidly increasing, tense and tender. It spontaneously ruptured, clots were drained and the wound was packed. Vulva hematomas are not very common hence necessitating careful assessment, right diagnosis and management. Management could be conservative (analgesics, local compression) as well as surgical in cases of hemodynamic instability, rapidly increasing size of hematoma and pain intensity. Prompt surgical management reduces the risk of infection and longer hospital stays, which is important in low resource settings like ours.

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Non-obstetric traumatic vulvar hematoma: Conservative or surgical approach? A case report

Cited by 15 publications

References 13 publications

Large Vulva Haematoma Following Spontaneous Vaginal Delivery: Successful Conservative Management in Enugu, South East Nigeria

Large Vulva Haematoma Following Spontaneous Vaginal Delivery: Successful Conservative Management in Enugu, South East Nigeria

Challenges in Management of Bartholin gland Leiomyoma: A Case Report

Non-obstetric vulva haematomas in a low resource setting: two case reports

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