Case Of Retroperitoneal Hematoma Research Articles

The role of laparoscopy in closed abdominal injury

ObjectiveTo investigate the effect of laparoscopy on the diagnosis and treatment of closed abdominal injury. MethodsA total of 26 patients with closed abdominal injury admitted to our hospital from January 2016 to January 2019 were searched. All patients were treated by laparoscopy. All patient reports were made with the informed consent of the patients. ResultsAll patients were diagnosed clearly during operation. Among them, there were 3 cases of gastric perforation, 2 cases of liver rupture, 13 cases of spleen rupture, 3 cases of small intestine rupture, 1 case of liver round ligament laceration, 2 cases of small mesenteric vascular laceration, 1 case of colon liver mesenteric laceration, and 1 case of retroperitoneal hematoma. Of the 26 patients in this group, 23 (88.5%) completed laparoscopically or laparoscopically assisted; 5 cases (19.3%) only performed laparoscopic exploration without special treatment, and 3 cases (11.5%) switched to laparotomy. The blood loss was 50–2000 ml (mean 500 ml), and the operative time was 60–180min (mean 128min). The length of hospital stay was 3–21 d (mean 9 d). There were no complications or deaths related to laparoscopy in the whole group. Conclusion Laparoscopic technique has the advantages of less trauma, high diagnosis rate and fast recovery. It can also be used for surgical treatment in the diagnosis and treatment of closed abdominal injury, so as to achieve the purpose of comprehensive diagnosis and treatment. The limitations of laparoscopy should also be noted.

Efficacy and safety of transcatheter aortic valve replacement in the treatment of severe aortic stenosis

Objective: To investigate the efficacy and safety of transcatheter aortic valve replacement (TAVR) in the treatment of severe aortic stenosis. Methods: The clinical data of patients with severe aortic stenosis who underwent TAVR at the People's Hospital of Xinjiang Uygur Autonomous Region between September 2016 and September 2022 were retrospectively analyzed. Changes in aortic transvalvular pressure gradients, valve orifice area, and activity tolerance of patients before and after the surgery were compared. Moreover, postoperative complications and follow-up results from 30 days to 6 years after the surgery were recorded. Results: A total of 76 patients were included in the study (50 males and 26 females), with an average age of (71.3±7.6) years, including 16 rheumatic valvular diseases, 60 senile degenerative diseases, 46 bicuspid valves and 30 tricuspid valves. The success rate of the operation was 96.1% (73/76). Compared with that before the operation, the mean aortic transvalvular pressure gradients decreased [(8.5±2.8) mmHg vs (68.5±19.2) mmHg (1 mmHg=0.133 kPa),P<0.001], but the valve orifice area increased [(1.91±0.31) cm2 vs (0.65±0.21) cm2, P<0.001]. Likewise, six-minute walking test (6MWT) showed that walking distance was longer after the surgery [(430±13) m vs (201±28) m, P<0.001]. There were 1 case of retroperitoneal hematoma, 1 case of stricture balloon dilatation after femoral artery suture concomitant with postoperative puncture site infection, 1 case of femoral artery surgical incision, 2 cases of valve-in-valve (ViV) and 5 cases of perivalvular leakage (4 cases were mild and 1 case was moderate) after the surgery, respectively. Moreover, acute left main artery occlusion during operation occurred in 1 case, ventricular rupture during operation occurred in 1 case and the patient was transferred to valve replacement surgery and finally dead, delayed coronary artery occlusion and death happened in 1 case, and all of the above-mentioned 3 cases were due to surgical failure. Postoperative pacemaker implantation due to third-degree atrioventricular block was performed in 5 cases. There were 1 case of pulmonary embolism, 1 case of transient right limb disorder, 1 case of gastrointestinal bleeding and 1 case of urethral bleeding after the surgery, respectively. The patients were followed up for (1.0±0.1) years (30 days to 6 years), and the results showed that 2 cases died, including 1 case died suddenly at home (the cause of death was unknown) and 1 case died of acute heart failure 8 months after the surgery. Chronic heart failure occurred repeatedly in 6 cases. The quality of life of other patients improved significantly. Conclusion: TAVR is effective and safe for patients with severe aortic stenosis.

A case of retroperitoneal hematoma and hemorrhagic shock caused by spontaneous intraparenchymal renal artery aneurysm rupture

article: A case of retroperitoneal hematoma and hemorrhagic shock caused by spontaneous intraparenchymal renal artery aneurysm rupture - Italian Journal of Emergency Medicine 2021 December;10(3):165-7 - Minerva Medica - Journals

Spontaneous rupture of the ovarian vein in association with nutcracker syndrome: a case report

BackgroundNutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in renal vein pressure and certain symptoms. We report a very rare case of retroperitoneal hematoma caused by the rupture of varicose veins of the left ovary.Case presentationA 77-year-old Japanese woman, para 7, experienced sudden left lower abdominal pain. She had no history of trauma or treatment complications. Computed tomography revealed a left retroperitoneal hematoma, but her abdominal pain subsided quickly; thus, urgent treatment was not required. We then scheduled her for an assessment regarding the cause of her bleeding. However, 6 days after the pain onset, abdominal pain symptoms recurred, confirming hematoma regrowth. Magnetic resonance imaging and three-dimensional computed tomography revealed an abnormal vascular network from the left side of the uterus to the left adnexa. Subsequent angiography revealed that the retroperitoneal bleeding originated from rupture of the distended left ovarian vein, which caused blood reflux from the left renal vein to the left ovarian vein. Although angiography confirmed a passage between the left renal vein and inferior vena cava, computed tomography showed obvious stenosis in the left renal vein. In accordance with these findings, we diagnosed the cause of the distention and rupture of the left ovarian vein as nutcracker syndrome. She underwent embolization of the left ovarian vein as hemostasis treatment, and had a good course thereafter.ConclusionsThis is the first report of a spontaneous rupture of the left ovarian vein caused by nutcracker syndrome. Nutcracker syndrome is not yet well known to clinicians and should be considered as part of the differential diagnosis when an abnormal vascular network in the pelvis is found.

The prevention and management of approach-specific complications of abdominal aortic balloon occlusion in pelvic and sacral surgery

Objective: To investigate the causes,prevention and treatment of femoral artery puncture related complications caused by the application of resuscitative endovascular balloon occlusion of the aorta (REBOA) in the resection of pelvic and sacral tumors. Methods: Clinical data of 23 patients with femoral artery puncture related complications who received REBOA in the resection of pelvic and sacral tumors from August 2010 to August 2018 at the Musculoskeletal Tumor Center,Peking University People's Hospital were retrospectively analyzed.There were 8 males and 15 females,with the an age of (37.0±16.2) years (range:15 to 65 years).Arterial access via the Seldinger technique for REBOA was obtained in the right common femoral artery of 18 cases,and in the left of 6 cases.An arterial sheath with a diameter of 11 to 12 F(1 F≈0.33 mm) was used for the patient.The occurrence and treatment of postoperative complications were analyzed. Results: Acute femoral arterial thrombosis occurred in 18 patients,which was managed by open repair 48 hours postoperatively.Among the 349 patients admitted before 2015 who received hemostasis by compression after femoral artery sheath removal,12 patients (3.4%) developed acute femoral artery thrombosis.While the 476 patients admitted after 2015 who used a vascular stapler to close the femoral artery wound,6 patients (1.3%) developed acute femoral artery thrombosis.One case of retroperitoneal hematoma and 1 case of femoral pseudoaneurysm were found and surgically fixed.Postoperative follow-up was (40±18) months (range:13 to 108 months).Three cases with chronic lower extremity ischemia were confirmed by Doppler ultrasonography during 1 to 5 years follow-up.Two of them had minimal symptoms and denied further treatment,while the other one received femoral-femoral artery bypass surgery to restore distal flow for pain and numbness relief. Conclusions: Acute femoral arterial thrombosis was the most common femoral artery puncture.Technique refinement of REBOA,the use of percutaneous suture device and close follow-up can reduce the approach-specific complications,and help to detect and treat the complications timely,which may popularize the clinical application of REBOA.

Clinical spectrum, risk factors, management and outcome of patients with retroperitoneal hematoma: a retrospective analysis of 3-year experience

ABSTRACT Objective Retroperitoneal Hematoma (RPH) is an underdiagnosed and overlooked disease entity and has a high mortality rate if not diagnosed in a timely manner. This study aims to analyze the clinical characteristics, risk factors, treatment and the outcome of RPH cases at our medical center. Methods In this retrospective study, all cases who presented to the emergency room (ER) and/or admitted to our center with the diagnosis of RPH from Jan 2016 to Dec 2018 were included (3-year data). Results A total number of 78 RPH cases were included including both the traumatic and spontaneous bleed. The most common setting was spontaneous bleeding with no concurrent use of anti-thrombotic agents. Zone 3 (pelvic hematoma) bleed was the most common type of RPH. Most patients were successfully managed medically alone (59%). Others required surgical intervention, either laparoscopy, laparotomy or through the interventional radiological approach. There was a significant association between the need for vasopressors (OR-5.65, P-value of 0.039), spontaneous bleed (P-value of 0.001), bleed without antithrombotic agents (P-value of 0.002) with prolonged hospital stay (> 5 days). On follow-up, 83% of cases were reported to be alive. Only 2 patients died secondary to hemorrhagic shock. Conclusion Most cases of RPH had an excellent outcome with conservative management alone.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

BACKGROUND CONTEXT Minimally invasive oblique lateral lumbar interbody fusion (MIS-OLIF) using a tubular retractor and pre-psoas approach has recently been gaining popularity because of its potential for minimizing para-spinal muscle damage and reducing recovery time. However, the published literature has not characterized the surgeon's learning curve with the technically demanding technique of a minimally invasive oblique lateral lumbar interbody fusion (MIS-OLIF). PURPOSE The purpose of this study is to define and analyze the learning curve for MIS-OLIF with a single spine surgeon's experience based on intra- and perioperative parameters. STUDY DESIGN/SETTING This study is retrospective analysis of single surgeon's consecutive case series in a single institution. PATIENT SAMPLE Fifty-seven consecutive patients with single or multilevel degenerative lumbar diseases who were treated by MIS-OLIF were included in the study. Surgeries were performed using oblique pre-psoas approach with a tubular retractor, and a cage was inserted using an orthogonal maneuver by a single surgeon. The corresponding segments were fixed with additional percutaneous pedicle screws. MIS-OLIF without posterior decompression was performed in 33 cases and MIS-OLIF plus posterior decompression was performed in 24 cases. OUTCOME MEASURES Corrected operative time per level, operative blood loss, postoperative drainage, transfusion rate, and ambulation recovery time were measured. Intraoperative and postoperative complication incidences were also identified. Clinical results were assessed using the visual analogue scale (VAS). METHODS The learning curve was assessed using a logarithmic curve-fit regression analysis. In the single-level OLIF group (n=21), 12 patients were defined as the “early” group (among the first 30 cases of the series), and the subsequent 9 cases were defined as the “late” group for comparison. RESULTS Corrected operative time gradually decreased as the series progressed, and an asymptote was reached after about 30 cases. Average VAS scores for lower back pain and radiating pain also significantly decreased from an average of 6.9-3.8 and 7.6-2.5, respectively. In the single-level OLIF series, operative time was significantly shorter in the late group (99±54 minutes) than the early group (141±21 minutes) and blood loss during the operation was significantly reduced in the late group (482±269 mL) compared with the early group (542±157 mL). Ambulation recovery time and VAS scores for back and leg pain did not differ between the two groups. There were two cases of retroperitoneal hematoma in the early second group requiring revision surgeries CONCLUSIONS The MIS-OLIF is a technically difficult procedure to the practicing spine surgeon with regard to unfamiliar retroperitoneal approach. Although it is not easy to master this minimally invasive technique, operative time and blood loss improved with the surgeon's experience. After the initial learning curve, this technique could be an effective and reliable option for the surgical treatment of lumbar degenerative disease. Further studies are warranted to delineate the methods to minimize the complications associated with the learning curve.

Laparoendoscopic single-site nephrectomy for hemodialysis patients with dialysis-related renal tumors

Purpose: The purpose of this study is to assess the efficacy of laparoendoscopic single-site (LESS) nephrectomy in hemodialysis patients, we compared outcomes between LESS nephrectomy and conventional laparoendoscopic nephrectomy in hemodialysis patients with dialysis-related renal tumors.Material and methods: A total of 16 hemodialysis patients who underwent LESS nephrectomy (LESS-N; n = 8) or conventional laparoendoscopic nephrectomy (C-N; n = 8) between November 2003 and July 2012 were retrospectively evaluated. Outcomes were compared between the two groups.Results: Patient and tumor characteristics were similar between the LESS-N and C-N groups. The mean operative duration was longer in the LESS-N than in the C-N group (231.0 ± 26.7 min versus 188.6 ± 36.4 min; p = .025). The mean estimated blood loss was lower in the LESS-N compared with the C-N group (26.4 ± 14.4 ml versus 65.6 ± 45.2 ml; p = .047). Postoperative complications were observed in three cases, comprising one case of retroperitoneal hematoma in the LESS-N group and one case each of peritoneal hematoma and retroperitoneal abscess in the C-N group. Surgical scarring was minimal in the LESS-N group.Conclusions: Although there is a little extension of the operating time, LESS nephrectomy in hemodialysis patients is a feasible procedure compared with the conventional method.

ベバシズマブ併用化学療法施行中に後腹膜血腫をきたした進行直腸癌の１例

進行・再発結腸直腸癌に対するベバシズマブ併用化学療法施行中に後腹膜血腫をきたした１例を経験したので報告する．症例は60歳女性．下血を主訴に当院受診し諸検査にてT3N2M1 Stage Ⅳ直腸癌と診断された．XELOX＋ベバシズマブによる化学療法を３コース施行後，低位前方切除術を行い，その後再度XELOX＋ベバシズマブ療法を開始した．４コース目投与後８日目に頭痛と左側腹部痛を認め，CTにて左後腹膜血腫と診断された．入院の上保存的に加療し投与後15日目に退院となった．ベバシズマブ併用化学療法による合併症として重篤な出血は国内で0.6～1.4％，海外で３～６％と報告されているが，後腹膜血腫の報告はなく海外も含めて本症例が初報告例となる．出血の程度により重篤となりえるため留意すべき合併症と考えられる．

Retroperitoneal hematoma following hysteroscopic removal of levonorgestrel intrauterine system: a case report

Long acting reversible contraceptive (LARC) devices such as the levonorgestrel intrauterine system (LNG-IUS) have increased in use. Care should be taken with insertion and removal of the device as, although rare, serious complications can occur. We present a case of retroperitoneal hematoma following hysteroscopic removal of LNG-IUS.

Most accurate definition of a high femoral artery puncture: Aiming to better predict retroperitoneal hematoma in percutaneous coronary intervention

Retroperitoneal hematoma (RPH) increases morbidity and mortality in percutaneous coronary intervention (PCI). High femoral arteriotomy is an independent predictor of RPH, but the optimal angiographic criterion for defining a high puncture is unknown. We retrospectively identified 557 consecutive PCI cases with femoral angiograms. Arteriotomy sites were categorized as high based on three angiographic criteria: at or above the proximal third of the femoral head (criterion A), at or above the most inferior border of the inferior epigastric artery (criterion B), and at or above the origin of the inferior epigastric artery (criterion C). Cases of RPH were then identified. Of the 557 PCI patients, 26 had a high femoral arteriotomy by criterion A, 17 by criterion B, and 6 by criterion C. Among these patients with a high arteriotomy, RPH occurred in four with criterion A, in three with criterion B, and in one with criterion C. Of the three criteria, criterion A most strongly correlated with RPH (odds ratio [OR] 96, 95% confidence interval [CI] 10.3-898.4; p < 0.0001) compared with criterion B (OR 58, 95% CI 8.9 to 372.6; p < 0.0001) or C (OR 27, 95% CI 2.6 to 290.1; p = 0.053). All criteria had high specificity (A, 96%; B, 97%; C, 99%), but the sensitivity was higher with criterion A (80%) than criterion B (60%) or C (20%), and statistically, the use of criterion A led to the most accurate risk-stratification for RPH (A, κ = 0.79; B, κ = 0.59; C, κ = 0.19). Among the three common definitions of high arteriotomy, femoral artery puncture at or above the proximal third of the femoral head is the landmark that most accurately risk stratifies PCI patients for development of RPH.

A case of retroperitoneal hematoma caused by left ovarian artery rupture following mild blunt trauma

A case of retroperitoneal hematoma caused by left ovarian artery rupture following mild blunt trauma

Angimiolipoma renal como causa de shock hemorrágico agudo

Kidney Angiomyolipoma as Aetiology of Haemorragic ShockThis is a case of retroperitoneal hematoma and hypovolemic shock as a presentation of renal angiomyolipoma, a rarely benign and asymptomatic tumor.The massive and spontaneous bleeding of the tumor was diagnosed by an abdominal ecography and confirmed by an abdominal computer tomography in the emergency room.Although that kind of tumor needs non-aggressive treatment, as a general rule, because of the size and severity of the following symptoms, the patient has been submitted to a selective embolization of the renal mass when he was hemodinamically stabilized.The evolution was favorable; it was not necessary to do more aggressive surgical handling neither to urgently remove the angiomyolipoma.

中結腸動脈瘤破裂による後腹膜血腫の１手術例

腹部血管造影にて中結腸動脈破裂と診断し, 緊急手術を行った症例を経験したので報告する.症例は52歳の男性で, 腹痛を主訴に当院の救急外来を受診した. 急性腸炎と診断されいったん帰宅するが, 腹痛が治まらず翌日に再来した. CTにて後腹膜出血と診断され, 血管造影検査を施行すると中結腸動脈に血管外漏出像を伴う動脈瘤を認めた. 経カテーテル的動脈塞栓術での止血は困難であったため緊急手術を行った. 開腹すると後腹膜に著明な血腫を形成しており, 中結腸動脈に発生した動脈瘤破裂による血腫と診断し動脈瘤を摘除した. 病理組織学的には内膜, 中膜の壊死を認め, segmental arterial mediolysis (SMA) の関与が考えられた. 本疾患はまれな病態であり, 診断, 治療を同時に行えるinterventrial radiologyが第1選択であるが, 状況に応じて開腹術に移行すべきであると考えられた.

Two cases of retroperitoneal hematoma caused by combination of anticoagulant therapy and 5-fluorouracil

We reported two cases of retroperitoneal hematoma in patients who received a combination of anticoagulant therapy and 5-fluorouracil (5-FU). We should be aware of the possible interaction of this combination therapy and monitor prothrombin time (PT) prolongation. CT is useful for evaluation of the disease.

RETROPERITONEAL HEMATOMA DUE TO RUPTURE OF A PSEUDOANEURYSM CAUSED BY ACUPUNCTURE THERAPY

Acupuncture, an ancient technique using needle insertion at specific points on the body for a specific therapeutic effect, has now become a major alternative treatment. Approrrimately 1 million patients visited an acupuncture professional in the United States in 1994.' However, several complications have been reported, including spinal cord injury, needle migration in the medulla oblongata, fatal cardiac tamponade, pneumothorax, spinal epidural hematoma and subcutaneous pseudoaneurysm.'Z3 To our knowledge we report the first case of retroperitoneal hematoma caused by acupuncture therapy. CASE REPORT A 72-year-old Japanese woman with essential hypertension underwent acupuncture therapy performed by a physician for relief of persistent lumbago. Several needles were inserted into the right loin region, followed by electroacupuncture stimulation. Four hours later the patient visited another hospital complaining of nausea and right flank pain. Abdominal computerized tomography (CT) demonstrated a large retroperitoneal mass around the right kidney (fig. 1, A). The patient was referred to our hospital due to hypotension with tachycardia. Selective right renal arteriography revealed 3 sections of pseudoaneurysm with rupture, presumably caused by acupuncture therapy (fig. 2). Subsequent selective arterial embolization by metallic coil resulted in good function of the affected kidney (fig. 1, B). DISCUSSION Various complications due to acupuncture therapy have been reported, including spinal cord injury (acute transverse myelopathy), perineal nerve palsy, embedded type needle migration in the medulla oblongata, fatal cardiac tamponade, pneumothorax, spinal epidural hematoma and pseudaneury~m.~,~ A huge retroperitoneal hematoma requiring a subsequent hemostatic procedure is a rare and serious complication of acupuncture therapy. The diagnosis is easy to establish in cases of embedded needle, since the needle may be identified on radiography. However, a detailed patient

Retroperitoneal hematoma from spontaneous rupture of renal neoplasia

The authors describe 4 recently observed cases of retroperitoneal hematoma from spontaneous rupture of renal neoplasia. The aim of this report is to underline the problems concerning the pathogenesis, diagnosis, staging and therapy.

Thrombolysis with intravenous human recombinant tissue-type plasminogen activator in acute myocardial infarction: The European experience

The initial studies in Europe with tissue-type plasminogen activator (rt-PA) have been coordinated by a European Cooperative Study Group. By February 1987, 258 patients had been entered into comparative coronary patency trials of rt-PA versus streptokinase and rt-PA versus placebo (trials completed and published); 123 patients had entered a coronary patency trial of prolonged rt-PA infusion versus short-term rt-PA infusion (trial completed but results not yet published); and greater than 500 patients had been recruited for left ventricular function and infarct size trials comparing rt-PA with placebo and rt-PA alone with rt-PA plus immediate coronary angioplasty (studies still in progress). The first three studies used two chain rt-PA, 0.75 mg/kg, for the rt-PA versus streptokinase and rt-PA versus placebo studies and 40 or 80 mg for the short-term versus long-term study. The current studies are using single chain rt-PA in a dose of 100 mg (20 mg bolus, 40, 20 and 20 mg in succeeding hours). Coronary patency at angiography 90 minutes after the start of treatment was 70% for rt-PA and 55% for streptokinase, 1.5 million units, in the plasminogen activator versus streptokinase study (p = 0.054), 61% for rt-PA and 21% for placebo in the rt-PA versus placebo study (p less than 0.001). In the first three studies (251 patients allocated to rt-PA) there was one case of retroperitoneal hematoma, one of hematemesis and no cases of cerebral hemorrhage; 38 patients (15%) had a hematoma or bleeding related to arterial catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)