Pelvic Hematoma Research Articles

Angiographic embolization for pelvic fractures in older patients.

Old age predicts reliably the presence of pelvic bleeding, requiring angiographic embolization (AE) among blunt trauma patients with major pelvic fractures. Four-year prospective observational study (April 1, 1999, to May 31, 2003). Academic level I trauma center practicing AE liberally. Regardless of hemodynamic stability or the absence of a blood transfusion, patients with major pelvic fractures or significant pelvic hematomas on computed tomography were offered pelvic angiography with the intent to embolize. Angiographically confirmed pelvic bleeding, resulting in AE. Of 92 patients who underwent pelvic angiography, 55 (60%) had bleeding found on angiography and underwent AE. Patients 60 years and older had a higher likelihood than younger patients to have bleeding identified and to undergo AE (16 [94%] of 17 patients vs 39 [52%] of 75 patients; P<.001). An age of 60 years or older was the only independent predictor of the need for AE. Of patients in this age group, two thirds had normal vital signs on hospital admission. Bleeding was controlled by AE in all patients (100% efficacy). Among blunt trauma patients with significant pelvic fractures, those 60 years and older have a high likelihood of active retroperitoneal bleeding. Angiographic embolization should be offered liberally to patients in this age group, regardless of presumed hemodynamic stability.

Bladder Injury after LAVH: A Prospective, Randomized Comparison of Vaginal and Laparoscopic Approaches to Colpotomy During LAVH

Study Objective To compare results of a vaginal approach to colpotomy (type IA) and laparoscopic-assisted abdominal colpotomy (type ID) in performing a laparoscopic-assisted vaginal hysterectomy (LAVH). Design Prospective, randomized study (Canadian Task Force classification I). Setting Tertiary teaching hospital. Patients Five hundred forty-one women, 274 in group 1 (type 1D) and 267 in group 2 (type 1A). Intervention LAVH with follow-up for 3 months to 5 years. Measurements and Main Results There were no statistically significant differences in age, preoperative and postoperative hemoglobin values, or postoperative hospital stay between groups. Operating time and estimated blood loss were significantly reduced in group 2 (p<0.001 and<0.001, respectively). Women in group 1 had nine urinary tract injuries (3.28%), including eight cases of intraoperative bladder injury (2.91%) and one vesicovaginal fistula (0.36%), but no ureteral injury. The bladder injury rate in group 2 was 0.37%, which was significantly lower (p = 0.038). There were no significant differences in ureteral or bowel injuries, pelvic hematomas, or pelvic abscesses. Conclusion LAVH type IA achieved better results than type ID in preventing bladder injury.

Intérêt de la voie d’abord transglutéale sous contrôle tomodensitométrique dans les procédures radiologiques interventionnelles percutanées

Purpose To assess the CT-guided transgluteal approach for percutaneous interventionnal image guided procedures. Materiel and Methods CT guided transgluteal approach through the greater sciatic foramen was used for diagnostic procedure (CT guided needle biopsy of presacral masses n=5) or percutaneous treatment (aspiration n=4, and drainage n=10) in 19 patients, mean age 58 year (age range 20-86). Results No technical failure occurred. A histological diagnostic was obtained in all diagnostic procedures. The success rate for therapeutic procedures was 87% and allowed to postpone surgery in 2 cases. In 2 patients a small pelvic hematoma occurred after catheter placement, but remained without consequence. Recurrences of collection occurred in 2 cases, one treated medically and the other surgically. Two patients suffered from transient deep pelvic pain, which resolved after catheter removal. Conclusion CT-guided percutaneous transgluteal procedures may be successfully performed in patients who cannot undergo trans-perineal, trans-rectal or trans-vaginal approach and is a safe and effective diagnostic and therapeutic option.

Trombosis de la vena ovárica en el puerperio

Postpartum ovarian vein thrombosis is a rare but potentially serious complication that is associated with a variety of pelvic conditions. It most frequently appears after delivery, due to bacterial seeding from puerperal endometritis with secondary thrombosis (pregnancy and puerperium are hypercoagulable states). It is also seen after gynecologic surgery, in pelvic inflammatory disease and, more rarely, with malignant tumors, sometimes in combination with chemotherapy.Although ovarian vein thrombosis is unusual in the puerperium (1:600 to 1:2000 deliveries ), it should be considered in patients with fever and right iliac fossa pain because of the possible complications, which include pulmonary embolism (25%) and a mortality rate of 5%.Clinical diagnosis is not easy and may be confused with more common processes such as pyelonephritis, urolithiasis, appendicitis and pelvic abscess or hematoma. However, imaging techniques, including contrast-enhanced computerized axial tomography, have a diagnostic sensitivity of 100%.Treatment is based on heparin and broad-spectrum antibiotics. Ligation of the involved veins is required to avoid complications in exceptional cases only.

A Novel Technique to Control Internal Iliac Artery Back Bleeding

The reported mortality rate following repair of ruptured aorto-iliac aneurysms range from 24–95%. The cause of post-operative morbidity and mortality is multifactorial, including haemorrhage, coagulopathy, cardiac events, renal failure and multi-organ failure. Surgical repair of ruptured abdominal and aorto-iliac aneurysms is technically difficult due to retro peritoneal and pelvic haematomas which obscure the anatomy, making control of the iliac and aortic vessels more difficult. The internal iliac artery lies deep within the pelvis and lies in close proximity to large iliac veins, making it a difficult artery to control in these circumstances. We describe a method of occluding the internal iliac artery with a piece of Polypropylene knitted Non-absorbable Mesh (Prolene, Johnson & Johnson Intl., UK) and Oxidised Regenerated Cellulose (Surgicel, Johnson & Johnson Intl., UK) to control haemorrhage during repair of rupture of an aorto-iliac aneurysm.

Concomitant surgery with tension‐free vaginal tape

To evaluate the efficacy and feasibility of tension-free vaginal tape (TVT) surgery combined with gynecologic surgery using general anesthesia. One hundred and six women with genuine stress incontinence (GSI) diagnosed with a traditional urodynamic examination were prospectively enrolled into this study. All of the 106 women underwent TVT surgery for the treatment of GSI, along with a concomitant hysterectomy procedure, under general anesthesia. We estimated the severity of incontinence symptoms on a visual analog scale (VAS), and used a questionnaire for subjective assessment before and after TVT surgery. The objective assessment of urinary incontinence was carried out with a 1-h pad test and traditional urodynamic examination. Of the 106 patients, 50 had uterine prolapse and underwent transvaginal hysterectomy and anteroposterior colporrhaphy (APC), and another 50 had uterine myoma and underwent laparoscopic-assisted vaginal hysterectomy (LAVH). The follow-up mean interval was 18 months (range 12-36 months). The 50 women undergoing LAVH and TVT surgery had a mean hospitalization of 3.5 days. The subjective success rate was 90.5% and the objective success rate was 86.8%. The other group of 50 women undergoing vaginal total hysterectomy (VTH), APC and TVT surgery had a mean hospitalization of 4.8 days. The subjective success rate was 88.6% and the objective success rate was 84.9%. There were six patients lost to follow-up for several reasons. The rates of complications of bladder perforation, postoperative voiding difficulty and postoperative urinary urgency were 2%, 11% and 10%, respectively; neither pelvic hematoma requiring blood transfusion nor conversion to laparotomy occurred. The results of this study prove that the TVT procedure, performed under general anesthesia without the need for the intraoperative cough provocation test to treat GSI, and carried out concomitantly with other gynecologic surgeries, is safe and effective.

Vaginal Hysterectomy in Nulliparous Women Without Prolapse: A Prospective Comparative Study

Agostine, Aubert; Bretelle, Florence; Cravello, Ludovic; Maisonneuve, Anne Sophie; Roger, Valérie; Blanc, Bernard

Spontaneous Rupture of the Uterine Artery in a Non-Pregnant Woman

Spontaneous rupture of the uterine artery is a rare event. Our Medline search revealed only 4 cases all of which occurred during pregnancy or puerperium. These haemorrhagic events present as acute abdomen with haemodynamic instability. In this report we describe a case of a non-pregnant woman with spontaneous rupture of the uterine artery. The aetiology of the condition is largely speculative. (excerpt)

Radical trachelectomy and pelvic lymphadenectomy with uterine preservation in the treatment of cervical cancer

Objective: The purpose of this study was to determine whether radical trachelectomy, combined with pelvic lymphadenectomy, can be a feasible method for the treatment of early-stage cervical carcinoma in women who want to preserve their fertility. Study Design: From January 1, 1995, through December 31, 1999, 12 women with stage I carcinoma of the cervix were scheduled to undergo radical trachelectomy and pelvic lymphadenectomy of the intact uterus as treatment. The procedure was abandoned in 2 women because of endometrial extension of the cancer. Surgical margins were clear in all other women. No lymph node metastases were encountered. The proximal cervical remnant was reinforced in 10 women. Results: Hospitalization ranged from 2 to 8 days (mean, 3.2 days). Estimated blood loss averaged 203 mL (range, 50-600 mL). Complications included 2 intraoperative cystotomies and 1 pelvic hematoma. Four pregnancies have occurred, with 2 third-trimester deliveries and 2 preterm losses at 24 and 26 weeks of gestation, respectively. The follow-up period has ranged from 28 to 84 months (mean, 47.6 months). Conclusion: Radical trachelectomy, combined with pelvic lymphadenectomy, can be a feasible method of treatment for early-stage cervical carcinoma in women who want to preserve their fertility. (Am J Obstet Gynecol 2003;188:29-34.)

Safety and efficacy of sacrospinous vault suspension.

The objective of the study was to determine the success rate and complications of sacrospinous vault suspension when performed by an experienced surgeon. Retrospective data collection was performed for 293 women who had undergone sacrospinous vault suspension at Mount Sinai Hospital, Toronto, between November 1993 and 19 December 1998. Primary outcome measures were complication rates (acute and long term) and success rate, with failure defined as any degree of vault prolapse requiring repeat operation, any degree of symptomatic isolated vault prolapse, or any vault prolapse at or beyond the introitus. Statistical analysis was performed using simple descriptive techniques. During the study period, 305 sacrospinous vault suspensions were performed; however, 12 cases were excluded because of inaccessible records. This study therefore comprised the remaining 293 cases: 129 at the time of vaginal hysterectomy, 5 with transvaginal cervical stump excision, 155 for post-hysterectomy vault prolapse, and 4 without hysterectomy. Two hundred had follow-up of 1 year or more, with maximum follow-up 5 years. Of these 200, there were 6 failures (3%). There were no acute hemorrhages and no deaths. There was a complaint of postoperative right buttock pain in 18 of the 293 procedures (6.1%), with this persisting on a chronic basis in 3 patients. Eight patients complained of new-onset postoperative dyspareunia. Nine patients had postoperative stress urinary incontinence, and 14 patients had de novo anal incontinence. Postoperatively, there were 17 patients with a cystocele and 7 with a rectocele. There were three other complications: one pelvic hematoma at the sacrospinous suspension site, one right foot drop which spontaneously resolved, and one case of pain in the right sciatic nerve distribution which spontaneously resolved. Forty-three patients complained of anal incontinence preoperatively, and 38 (88.4%) had the symptoms resolved postoperatively. It was concluded that, when performed by a surgeon experienced in the procedure, sacrospinous vault suspension is safe and effective, with a successful result at 1 year in more than 90% of cases, and rare major complications.

437 Classic Intrafascial Supracervical Hysterectomies in 8 Years

Study ObjectiveTo report technical aspects and practical long-term experience with classic intrafascial supracervical hysterectomy (CISH). DesignRetrospective evaluation (Canadian Task Force Classification II-2). SettingLocal community hospital in rural northwest Alabama. PatientsFour hundred thirty-seven women. InterventionThe procedure was performed as described originally but with slight modifications (vaginal manipulator, ETS stapler). Measurements and Main ResultsFollow-up was 44.7 months (range 3–97 mo). Average operating time was 1 hour 10 minutes (range 46 min–6 hrs, 10 min), average blood loss was 68 ml (range 10–765 ml), average length of hospital stay was 22 hours (range10 hrs–5 days), and average return to work was 14 days (range 3–28 days). Complications were 11 bleeding cervices (7 occurring within 21 days after surgery, and 4 between 2 and 4 yrs after surgery), 1 case of uterine artery bleeding, 1 ileus, 1 pelvic hematoma, and 5 mucoceles between 2 and 27 months postoperatively. There were three conversions, one because of morbid obesity (185 kg) and two because of large uterus:pelvis ratio. ConclusionCISH leaves the pelvic floor intact, has short recuperation and high patient satisfaction, and is cost effective at a low complication rate. It is an advanced laparoscopic procedure, is initially technically challenging, and has a learning curve.

Preoperative Radiochemotherapy and Sphincter-Saving Resection for T3 Carcinomas of the Lower Third of the Rectum

To evaluate the complications and oncologic and functional results of preoperative radiochemotherapy and sphincter-saving resection for T3 cancers of the lower third of the rectum. Carcinomas of the lower third of the rectum (i.e., located at or below 6 cm from the anal verge) are usually treated by abdominoperineal resection, especially for T3 lesions. Few data are available evaluating concomitant chemotherapy with preoperative radiotherapy for increasing sphincter-saving resection in low rectal cancer. Between 1995 and 1999, 43 patients underwent preoperative radiochemotherapy with conservative surgery for a low rectal tumor located a mean of 4.5 cm from the anal verge (range 2-6); 70% of the lesions were less than 2 cm from the anal sphincter. There were 40 T3 and 3 T4 tumors. Patients received preoperative radiotherapy with a mean dose of 50 Gy (range 40-54) and concomitant chemotherapy with 5-FU in continuous infusion (n = 36) or bolus (n = 7). Sphincter- saving resection was performed 6 weeks after treatment, in 25 patients by using intersphincteric resection. Coloanal anastomoses were associated with a colonic pouch in 86% of the patients, and all patients had a protecting stoma. There were no deaths related to preoperative radiochemotherapy and surgery. Acute toxicity was mainly due to diarrhea, with 54% of grade 1 to 2. Four anastomotic fistulas and two pelvic hematomas occurred; all patients but one had closure of the stoma. Distal and radial surgical margins were respectively 23 +/- 8 mm (range 10-40) and 8 +/- 4 mm (range 1-20) and were negative in 98% of the patients. Downstaging (pT0-2N0) was observed in 42% of the patients (18/43) and was associated with a greater radial margin (10 vs. 6 mm; P =.02). After a median follow-up of 30 months, the rate of local recurrence was 2% (1/43), and four patients had distal metastases. Overall and disease-free survival rates were both 85% at 3 years. Functional results were good (Kirwan continence I, II) in 79% of the available patients (n = 37). They were slightly altered by intersphincteric resection (57 vs. 75% of perfect continence; NS) but were significantly improved by a colonic pouch (74 vs. 16%; P =.01). These results suggest that preoperative radiochemotherapy allowed sphincter-saving resection to be performed with good local control and good functional results in patients with T3 low rectal cancers that would have required abdominoperineal resection in most instances.

Laparoscopic Myomectomy: Technique, Complications, and Ultrasound Scan Evaluations

Study Objective To evaluate the feasibility, limits, and complications of laparoscopic myomectomy, assess time to full recovery, and evaluate uterine wound healing by ultrasound in the early postoperative period. Design Prospective study (Canadian Task Force classification II-2). Setting General hospital. Patients Three hundred sixty-eight women undergoing laparoscopic myomectomy. Intervention Laparoscopic myomectomy and laparoscopic and/or hysteroscopic treatment of associated pathologies. Measurements and Main Results In these women 768 myomas were removed laparoscopically. Mean operating time was 100.78 ± 43.83 minutes, mean decreases in hemoglobin and hematocrit were 1.38 ± 0.93 g/100 ml and 4.8 ± 2.9 g/100 ml, respectively, and mean length of hospital stay was 2.89 ± 1.3 days. Intraoperative complications occurred in 12 patients (3.34%) and intraoperative transfusion of autologous blood was required in 10. Main postoperative complications were continuing hemorrhage requiring blood transfusion in three women and second laparoscopy in two. Pyrexia occurred in 12 patients. Average time to full recovery was 10.58 ± 6.68 days. At 1-month follow-up 12 of 282 women developed further complications: abdominal pain 5, vaginitis 4, metrorrhagia 2, and dysuria 1. Sonographic evaluation of the uterine scar showed a highly echogenic area with ill-defined margins. In 81 women who had sonographic evaluation 30 days postoperatively, the uterine scar was reduced by an average of 44.1% (p <0.001). Of 176 patients screened at day 30, 6 (3.4%) had anechoic areas adjacent to the uterine scar, possibly due to hematoma. A previously unknown myoma, two ovarian cysts, and two pelvic hematoma were also discovered. Conclusion Laparoscopic myomectomy is effective and relatively safe. In skilled hands it has a low risk of complications and appears to be a valid alternative to the open procedure. Sonographic assessment allows detection of alterations in muscular echotexture, but its effectiveness in identifying women at risk of uterine rupture or dehiscence has to be proved.

The Post-cystectomy Pseudotumour Sign: MRI Appearances of a Modified Chronic Pelvic Haematoma due to Retained Haemostatic Gauze

The magnetic resonance imaging (MRI) findings of five men who had incidental similar pelvic masses identified after radical cystectomy are presented. In all patients the haemostatic agent Kaltostat had been used. In one patient, surgical resection of the mass was performed and histological evaluation showed a foreign body inflammatory reaction within a chronic haematoma. The differentiation between this lesion and other post-operative collections or tumours is discussed.Naik, K.S. (2000). Clinical Radiology55, 970–974.

Early catheter removal in 100 consecutive patients undergoing radical retropubic prostatectomy.

To investigate the outcome of 100 consecutive patients selected for early catheter removal after radical retropubic prostatectomy (RRP), where urethral catheter drainage is used routinely for 2-3 weeks. The study included 129 consecutive patients with clinically localized prostate cancer who underwent RRP. Catheters were removed in the clinic (with no radiographic studies) 8-9 days after RRP provided there was no evidence of urine leak, pelvic haematoma, rectal injury or severe obesity. The follow-up (mean 21 months) results were available for 118 patients, 100 of whom were candidates for early catheter withdrawal. Their records were reviewed for evidence of complications, including urinary retention, anastomotic stricture formation and urinary incontinence. Urinary retention developed in two of the 100 patients, requiring simple catheter replacement. Nine patients developed bladder neck contracture requiring dilatation or incision. No patients developed anastomotic disruption, urinary tract infection or pelvic abscess. At the mean follow-up of 21 months, 76% of patients were continent and did not require pads; 19% of patients had mild stress urinary incontinence requiring the use of </= 1 pad/day, 4% of patients had incontinence requiring 2-4 pads/day, and 1% of patients required > 4 pads/day. With appropriate patient selection as described, catheters can be removed in the clinic (with no radiographic studies) 8-9 days after RRP, with no increased incidence of complications, including anastomotic stricture, retention or incontinence.

PUBOVAGINAL SLING: 4-YEAR OUTCOME ANALYSIS AND QUALITY OF LIFE ASSESSMENT

Stress urinary incontinence is a common disease with a devastating impact on patient quality of life. Needle suspension procedures, which produce disappointing long-term results for type II stress incontinence, are being replaced by pubovaginal slings which previously were reserved solely for the treatment of type III stress incontinence. We report the long-term outcomes of pubovaginal slings for the treatment of types II and III stress urinary incontinence, and assess its quality of life impact. From January 1993 until December 1996, 247 females 10 to 84 years old (mean age 54.5) with type II (54%) or III (46%) stress urinary incontinence diagnosed by fluoroscopic urodynamics received a pubovaginal sling. Concomitant urge incontinence was present in 109 patients (44%). Quality of life was assessed with the Urogenital Distress Inventory short form. At a mean followup of 51 months (range 22 to 68) the continence rates were 88% overall, 91% for type II and 84% for type III. Preoperative urge incontinence resolved in 81 of 109 patients (74%), while de novo urge incontinence developed in 10 (7%). Intermittent urethral catheterization duration averaged 8.4 days, with 5 women undergoing urethrolysis for a hypersuspended urethra. Secondary procedures were required in 9 patients with type II and 5 with type III incontinence, and included transurethral collagen injections in 6 and repeat pubovaginal slings in 8. There was a 4% complication rate due to pelvic hematoma in 2 cases, incisional hernia in 2, deep venous thrombosis in 1 and pulmonary embolus in 1. Of the 247 patients 235 (95%) completed the quality of life questionnaire with 92% reporting a high degree of satisfaction with low (less than 20 of 100 points) symptom distress scores. Pubovaginal slings are effective and durable, and significantly improve quality of life in patients with types II and III stress urinary incontinence.

Bladder Entrapment after External Fixation of Traumatic Pubic Diastasis: Importance of Follow-Up Computed Tomography in Establishing Prompt Diagnosis

A 30-year-old male was an unrestrained driver in a high-speed motor vehicle crash. On presentation, the patient was profoundly hypotensive with multiple injuries, including a 20-cm-deep perineal laceration with avulsion of the rectum, a diffusely tender abdomen, an unstable open-book pelvic fracture, and multiple rib fractures. Blood noted at the urethral meatus prompted a retrograde urethrogram and cystogram, which were within normal limits. A Foley catheter was placed with the return of clear urine. Closed reduction and external fixation of the pelvic fracture were performed emergently without difficulty. Postoperative computed tomography of the abdomen and pelvis revealed a retrovesical pelvic hematoma and entrapment of the bladder in the reduced pubic symphysis diastasis. Lower abdominal exploration revealed an intact bladder without evidence of gross bladder wall injury. On release of the external fixator, the bladder was easily reduced into the normal retropubic location. Definitive internal fixation of the pubic diastasis was performed. No urologic sequelae were noted postoperatively.

Percutaneous fixation of pelvic ring disruptions.

Percutaneous pelvic fixation is possible because intraoperative fluoroscopic imaging and other technologies have been refined. Anterior and posterior unstable pelvic ring disruptions are amenable to percutaneous fixation after closed manipulation or open reduction. Stable and safe fixation is achieved only after an accurate reduction. Anterior pelvic external fixation remains the most common form of percutaneous pelvic fixation; however, percutaneously inserted medullary pubic ramus, transiliac, and iliosacral screws stabilize pelvic disruptions directly while diminishing operative blood loss and operative time. These percutaneous techniques do not decompress the pelvic hematoma allowing early definitive fixation without the risk of additional hemorrhage. Complications associated with open posterior pelvic surgical procedures are similarly avoided by using percutaneous techniques. A thorough knowledge of pelvic osseous anatomy, injury patterns, deformities, and their fluoroscopic correlations are mandatory for percutaneous pelvic fixation to be effective.

Functional Results in Patients with Coloanal Pouch after Low Anterior Resection of the Rectum

Functional results after low anterior resection of the rectum and straight end-to-end coloanal anastomosis are often poor. Patients are frequently troubled by the so called „anterior resection syndrome“ which comprises fecal incontinence, urge, frequency and fragmentation.To investigate the potential functional benefit of a coloanal pouch reconstruction we conducted a prospective study. Some 42 patients (23 men; median age 65 years [30 to 85]) underwent low anterior resection of the rectum followed by coloanal J-pouch reconstruction. Pouch size was 5 to 7 cm, a temporary stoma was fashioned in 32 patients. Indications for the operation were: 1. rectal cancer n = 38,2. recurrent adenoma n = 2, 3. recto-vaginal fistula n = 1 and 4. severe non-specific proctitis n = 1. We observed 5 anastomotic leakages of which 2 patients required reoperation. A pelvic abscess was encountered in 3 patients as well as 1 pelvic hematoma. Micturition was impaired in 4 patients. To date 35 patients have completed 12 months follow-up after reversal of the ileostomy. Patients were seen at 3-monthly intervals. Mean stool frequency/day was 3.9 after 3 and 2.2 after 12 months. After 3 months 24 patients (69%) reported complete continence which increased to 86% at 1 year. Nine patients (26%) complained of urge defecation initially, which decreased to 9% after 1 year. Fragmentation was observed in 40% and 20% at 3 and 12 months, respectively. In conclusion, our initial experience with colonic J-pouch reconstruction shows good functional results.

Hemorragia subepitelial de pelvis renal (lesión de antopol-goldman). presentación de cuatro casos y revisión de la literatura

ObjetivosThe subepithelial hematoma of renal pelvis (Lesion of Antopol-Goldman) is a rare entity that preferably is diagnosed clinically as a neoplasic lesion. MethodsWe present four new cases of subepithelial hematoma of renal pelvis diagnosed in our hospital from 1989. ResultsOur cases presented clinically whith hematuria and flanc pain, preferably in the left side (3 out of 4). After nephrectomy, all the cases showed a subepithelial hematoma of variable extension that can occupy the renal pelvis and calices, associated to hidronefrosis, cortical infartion, renomegaly or renal angioma. Additionally, two of our patients presented with dilation of the pielocalicial system, and a third one presented with urotelial carcinoma of the ureter, being therefore the lesion of Antopol-Goldman an incidental discovery. In the remaining case, the presence of multiple renal hemangiomas was identified as cause of the renal pelvic hematoma. ConclusionsThe preoperatore diagnosis of the lesion of Antopol-Goldman is difficult although it should be included as differential diagnosis in those cases with hematuria and alterations of renal pelvis in the image techniques, because an early diagnosis could imply a conservative treatment with pieloplastia or partial nephrectomy.