Percutaneous Arterial Embolization in the Management of Rectus Sheath Hematoma

Rimola, Jordi; Perendreu, J.; Falcó, Joan; Fortuño, José R.; Massuet, Anna; Branera, Jordi

doi:10.2214/ajr.06.0861

Cited by 96 publications

(83 citation statements)

References 27 publications

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“…13 Konservatif tedaviye yanıt vermeyen hastalara anjiyografi ve embolizasyon ya da hemostaz ve inferior epigastrik arter ligasyonu yapılabilir. [14][15][16] Olgumuzda, rektus kılıf hematomu için risk faktörlerinden antikoagülan tedavi ve abdominal travma mevcuttur ve gelişen minimal taşikardi, hematokrit düşüşü ve batında ele gelen dolgunluk nedeni ile hematom olabileceği düşünülmüş, tanı USG ile desteklenmiştir. Olgunun kullandığı enoksaparin ve hematokrit düşüşünün devam etmesi, taşikardinin derinleşip hipotansiyon gelişmesi nedeni ile cerrahi yaklaşımın uygun olacağı düşünülmüş-tür.…”

Section: Discussionunclassified

Enoxaparin Associated Rectus Sheath Hematoma Following Laparotomy: Case Report

Çelik¹,

Kala²,

Korkmaz³

et al. 2016

Turkiye Klinikleri J Gynecol Obst

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ntikoagülasyon amaçlı kullanılan ajanlar; heparin, düşük molekül ağırlıklı heparinler ve warfarindir. Heparin domuz barsağı ya da sığır akciğerinden elde edilen doğal antikoagülan olup, değişken uzunluktaki lineer polisakkarid zincirlerinden oluşmaktadır ve ortalama moleküler ağırlığı 12.000-15.000 Dalton (Da)'dur.1 Heparin, antitrombin III ile bağlanarak faktör IIa, IXa, Xa, XIa ve XIIa'yı inhibe ederek antikoagülan etki gösterir. Düşük molekül ağırlıklı heparinler ise heparinin enzimatik veya kimyasal depolimerizasyonu ile oluşurlar ve ortalama molekül ağır-lıkları 4.000-5.000 Da'dır. Düşük molekül ağırlıklı heparinler, antitrombin III ile bağlanarak, molekülün konformasyon değişmesine neden olarak sadece faktör Xa inhibisyonu yaparlar. Bu ajanlar, klinikte hiperkoagülabilite olan (kanser, kalıtsal veya edinsel trombofililer) veya olması muhtemel durumlarda (ortopedik cerrahi, majör cerrahi) sıkça kullanılan, hem hastanede yatan hastalarda hem de poliklinik hastalarında sıkça kullanılan ilaçlardır.

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Section: Discussionunclassified

Enoxaparin Associated Rectus Sheath Hematoma Following Laparotomy: Case Report

Çelik¹,

Kala²,

Korkmaz³

et al. 2016

Turkiye Klinikleri J Gynecol Obst

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“…When active bleeding is identified, patients can be managed with catheter-based arterial embolization, by radiologically guided drainage or by laparotomy with vessel ligation and evacuation of the hematoma. [2,3,5,15] Although the surgical treatment of patients with larger RSH due to anticoagulation therapy is associated with shorter hospital stay and less need for analgesics, patients may also develop abdominal hypertension that may progress to ACS and an increased risk of significant morbidity or death. [16] With early diagnosis and conservative management, surgical intervention can be avoided even with large hematomas.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rectus sheath hematoma in patients on anticoagulation therapy

Dağ¹,

Özcan²,

Türkmenoğlu³

et al. 2011

Ulus Travma Acil Cerrahi Derg

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AMAÇAntikoagülan tedavinin bir komplikasyonu olan ve akut karın kliniği oluşturan rektus kılıfı hematomunun (RKH) klinik özelliklerini, tedavisini ve sonuçlarını sunmayı amaç-ladık. GEREÇ VE YÖNTEMAntikoagülan tedaviye bağlı gelişen 22 RKH olgusu incelendi. Olguların klinik özellikleri, antikoagülan tedavinin şekli ve endikasyonları, radyolojik bulgular, tedavi yön-temleri, nüksetme, morbidite ve mortalite bilgileri incelendi. BULGULAROlguların %72'si kadın olup, yaş ortalaması 60.6 idi. Tüm olgular (%100) antikoagülan tedavisinin en az bir türünü, %72'si varfarin tedavisi almaktaydı. Olguların %45'inde öksürük hikayesi bulunmuştu. En sık karşılaşılan bulgu ve semptomlar karın ağrısı ve kitleydi (%77). Varfarin tedavisi gören olgularda INR (International Normalized Ratio) ortalaması 3'ün üstünde bulunmuştu. Tanılar, abdominopelvik ultrasonografi ve bilgisayarlı tomografi (BT) aracılığıy-la konuldu, BT %100 duyarlılık gösterdi. Olguların çoğu (%87) konservatif tedavi aldı. Üç olgu (%13) ameliyat edildi. İki olgu (%9) RKH sonucu hayatını kaybetti, 2 olgu da bir yıl içinde hastalık tekrarladı. SONUÇAkut karın kliniğiyle gelen, yaşlı, öksüren ve antikoagülan tedavi alan hastalarda RKH den şüphelenilmelidir. Tercih edilen tanı şekli BT'dir. Erken tanı, morbiditeyi ve gereksiz cerrahi müdahaleyi önler.Anahtar Sözcükler: Akut karın; antikoagulasyon; rektus kılıfı hematomu.

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“…However, the mortality rate of elderly patients who undergo surgery is high. Recent advances in intervention radiology have facilitated successful hemostasis in RSH patients using TAE of feeding arteries that show contrast extravasation under radiological guidance (7,8). Digital subtraction angiography with arterial embolization is an important tool in modern interventional radiology because of its diagnostic and therapeutic properties.…”

Section: Discussionmentioning

confidence: 99%

Expanding refractory rectus sheath hematoma: a therapeutic dilemma

Tseng

Liau²,

Shyu³

et al. 2011

Diagn Interv Radiol

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Rectus sheath hematoma (RSH) is a rare pathology. RSH is often misdiagnosed because its symptoms vary. Conservative management, including bed rest, analgesia, and intravenous fluid replacement, has long been the standard treatment for RSH, and problematic cases are rarely described (1). We report a case of two expanding refractory RSHs without evidence of active bleeding on contrast-enhanced computed tomography (CECT) and angiography. The patient was successfully treated by empiric transcatheter arterial embolization (TAE) of the inferior epigastric artery. Case reportAn 87-year-old woman with a history of hypertensive cardiovascular disease was admitted because of an acute cerebral infarction. She was initially treated with aspirin and dipyridamole. On the day of admission, she developed an excessive cough secondary to recurrent choking episodes. A nasogastric tube was then inserted to facilitate feeding. Antiplatelet agents were discontinued because material with a coffeeground appearance was present in the nasogastric effluent on the second day after admission. An upper gastrointestinal panendoscopy confirmed that she had active gastric ulcers. Her hemoglobin level was 13.3 g/dL. On the eighth day after admission, she experienced a paroxysm of coughing that lasted several minutes and was followed by severe abdominal pain and hypotension (blood pressure, 93/44 mmHg). Physical examination revealed a large tender mass in the lower left quadrant of the abdomen and the absence of rebound tenderness or muscular rigidity. Her hemoglobin level decreased to 8.3 g/dL, but her platelet count and coagulation profile were normal. Urgent CECT of the abdomen and pelvis revealed a 9.8×7.2×10.3 cm left RSH and a 3.2×2.3×5.9 cm right RSH. Ecchymosis developed in the periumbilical region and expanded into the bilateral inguinal regions by the thirteenth day after admission. Despite conservative treatment and transfusion of four units of erythrocyte, the size of the masses gradually increased, and persistent hemodynamic instability was present by the twenty-fourth day after admission. A repeat CECT scan was conducted on suspicion of continued bleeding and expanding hematomas. The left RSH measured 10.5×8.2×13 cm, extending into the pelvis, and the left inferior epigastric artery was engorged; the right RSH measured 4.5×2.8×7 cm (Figs. 1 and 2). Interventional radiology was conducted because of the patient's instability and poor response to conservative treatment. On angiography with selective catheterization of the left external iliac artery, the main trunk and branches of the vessel appeared normal, and there was no obvious contrast extravasation (Fig. 3). Because of the engorged left inferior epigastric artery and the patient's vigorous tussive efforts, the risk of microhemorrhage and coughinduced intermittent bleeding could not be disregarded. Consequently, INTERVENTIONAL RADIOLOGY CASE REPORT Expanding refractory rectus sheath hematoma: a therapeutic dilemmaGuo-Shiang Tseng, Guo-Shiou Liau, Hann-Yeh Shyu, Shi-Jye Chu, Fu-Ch...

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Percutaneous Arterial Embolization in the Management of Rectus Sheath Hematoma

Abstract: Selective transcatheter embolization is effective hemostatic treatment of patients with large, clinically relevant rectus sheath hematoma.

Cited by 96 publications

References 27 publications

Enoxaparin Associated Rectus Sheath Hematoma Following Laparotomy: Case Report

Enoxaparin Associated Rectus Sheath Hematoma Following Laparotomy: Case Report

Spontaneous rectus sheath hematoma in patients on anticoagulation therapy

Expanding refractory rectus sheath hematoma: a therapeutic dilemma

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