Severe Postoperative Bleeding Following Minor-to-Moderate Abdominal and Flank Liposuction Performed at a Day Surgery Center: A Case Report

Abstract

Patient: Male, 51-year-old Final Diagnosis: Hemorrhage Symptoms: Abdominal pain • dizziness • edema • palpitations • scrotal pain • weakness Medication: — Clinical Procedure: Liposuction and lipoflling Specialty: Plastic Surgery Objective: Unusual clinical course Background: Liposuction is a one of the most common aesthetic procedures. The super-wet and tumescent techniques are used most frequently. Both serve to reduce collateral blood loss, facilitate the suctioning procedure, and providing local anesthesia. Overall, liposuction is considered safe and effective, with minor adverse effects such as swelling, minute bleeding, contour irregularities, and seroma. Serious complication such as life-threatening bleeding are rare. In this case report, we present a patient with significant postoperative bleeding following minor-to-moderate liposuction performed at a day surgery center. Case Report: A 51-year-old healthy man, 4 days after 1600-cc aspirate tumescent liposuction performed in a day surgery center, was admitted to our ward with tachycardia, weakness, abdominal pain and disseminated hematoma. On admission, laboratory testing showed hematocrit of 20.9% and hemoglobin of 6.9 gr/dl. Immediate abdominal CT angiography was performed to exclude active bleeding, showing diffused hematoma in the subcutaneous fat all over the abdomen and scrotum, with some edema without active bleeding. The patient was treated with blood transfusion to facilitate fast home discharge during the peak of the COVID-19 epidemic that time. Conclusions: We discuss the common work-up and treatment of postoperative hemorrhage. Blood transfusion following minor-to-moderate liposuction is unusual but during the COVID-19 pandemic it can facilitate quick discharge of a patient with postoperative hemorrhage with no active bleeding. Improper patient selection, an inexperienced surgeon, and inadequate operating locale can all result in postoperative complications. We call for the formulation of more detailed guidelines for liposuction setting.

Treatment with selective transcatheter arterial embolization of a ruptured profunda artery perforator after internal thigh liposuction: a case report

“…As described here, massive hemorrhage with active bleeding after liposuction is an infrequent complication with potentially life-threatening consequences if not appropriately addressed [ 9 , 17 ]. Iatrogenic arterial injuries after orthopedic surgery have been well described [ 11 , 18 ], and embolization has been shown to be the safest and most effective treatment [ 19 , 20 ]. However, to our knowledge, only two cases of iatrogenic bleeding after liposuction have been reported in the literature.…”

“…Today, tumescent liposuction has plenty of indications, including breast reconstruction for autologous fat grafting [ 5 ]. However, liposuction is not deprived of complications [ 6 ], and potentially life-threatening issues have been reported, including perforation of viscera [ 7 – 10 ], septic shock [ 9 ], and hemorrhage [ 11 – 13 ].…”

Laser-Assisted Liposuction for Autologous Fat Grafting Following Elective Breast Explant Surgery

“…The main disadvantages of conventional liposuction are blood loss, bruising, postoperative pain, and skin laxity [22][23][24]. Meanwhile, laser surgery generates thermal energy that melts connective tissue and can induce thrombosis of blood vessels, which would explain the better results regarding the patient recovery, the postoperative pain, and minor tissue trauma [25].…”