Pelvic Hematoma Research Articles

CESAREA-HISTERECTOMÍA EN EL HOSPITAL NACIONAL GUILLERMO ALMENARA. LIMA, PERÚ

OBJETIVO: Determinar la incidencia y resultados de la cesárea-histerectomía en un servicio de obstetricia. DISEÑO: Estudio retrospectivo. MATERIAL: 29 pacientes mujeres sometidas a cesárea-histerectomía en el periodo 1991-1998 en el Servicio de Obstetricia del Hospital nacional Guillermo Almenara Irigoyen. RESULTADOS: Hubo 30 851 partos en ese periodo; 8 746 por cesárea, dando una incidencia de 28,3%. Las cesáreas - histerectomías representaron el 0,3% del total de cesáreas realizadas o una incidencia de 0,94 por 1000 partos. La edad promedio fue 34,6 años, 51,7% fueron añosas, grandes multíparas 20,7%, nulíparas 20,7% y paridad promedio 3,6. Hubo predominio de gestaciones pretérmino, cesareadas anteriores en 34,5%. Las indicaciones para cesárea fueron: desprendimiento prematuro de placenta (DPP), placenta previa sangrante (PP), preeclampsiasevera, sufrimiento fetal agudo, deflexión, cesareada dos a tres veces, embarazo prolongado, miomatosis y carcinoma in situ de córvix Las indicaciones para histerectomía fueron: acretismo placentario1, atonía uterina, miomatosis, útero de Couvelaire, corioamnionitis, ruptura uterina y carcinoma in situ. El tiempo operatorio promedio fue 2 horas 28 minutos. Transfusión sanguínea promedio 3,6 paquetes globulares. Fueron complicaciones intraoperatorias: hematoma vesical, laceración vesical, laceración de epiplón, histerorrafia difícil par mioeatosis, hematoma de infundíbulo pélvico y coagulopatía. postoperatorias: anemia, infecciones, fístula vesicocutánea y tromboembolismo pulmonar Las cesáreas de emergencia versus las electivas se diferenciaron en un mayor tiempo operatorio, pérdidas sanguíneas y porcentaje de pacientes transfundidos (p<0,05). Tiempo de hospitalización promedio 10 días (4-62 d). Mortalidad materna 0%. Recién nacidos: 9 óbitos y 20 recién nacidos vivos. Seguimiento y evolución de las pacientes fue favorable. CONCLUSIONES: La técnica quirúrgica y sus indicaciones de la cesárea-histerectomía debe ser dominada por todo ginecoobstetra, pues en alguna ocasión la vida de una paciente va a depender de ello. Es importante contar con un buen banco de sangre y una Unidad de Cuidados Intensivos especializada para lograr resultados satisfactorios.

Retzius space haematoma with retroperitoneal dissection after spontaneous vaginal delivery: an unusual presentation of ruptured paravesical plexus managed by bilateral internal iliac artery ligation

Abstract Introduction Abdomino-pelvic hematomas during pregnancy, labor or postpartum are severe and rare hemorrhagic complication that result from rupture in the pelvic vessels. Principles of surgical management of pelvic hematomas and postpartum hemorrhage are well known and documented and are of high clinical interest. Aim We report a rare case of hematoma following vaginal delivery. Case study A patient with a Retzius space hematoma after vaginal delivery presented with hemodynamic instability and abdominal distension with suprapubic bulge in the postpartum period. Ultrasound examination showed a heterogeneous mass between bladder and uterus suspicious of hematoma with another retroperitoneal one associated with right hydronephrosis. Results Exploratory laparotomy was performed that revealed a hematoma in the Retzius’ space with infiltration of the wall of the bladder with extension to the paracolpos space and the right broad ligament to the retroperitoneal space. The bleeding source was suspected to be the blood vessels in the wall of the bladder that were hemostatically sutured. Bilateral uterine artery ligation with bilateral internal iliac artery ligation were done to control hematoma and atony and vertical vertical compression sutures were done for uterine atony. The hemorrhage was found to be secondary to rupture in the paravesical venous vessels. Discussion Hematoma in the Retzius’ space is a rare complication. It needs urgent diagnoses and management. Few cases were reported in the literature. The condition may pose diagnostic problems, as pelvic bones let only a limited examination, but requires an undelayed handling. This was illustrated by determining a complete extent of the hematoma only intraoperative. The authors made an accurate diagnosis and applied a necessary treatment in an urgent situation. The technique of the vessel ligation was a demanding, but optimal solution. Conclusions This article focuses attention at an uncommon obstetrical situation and delivers actual and practical advice for management.

V2-03 PUBOVAGINAL SLING WITH TENSOR FASCIA LATA

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2015V2-03 PUBOVAGINAL SLING WITH TENSOR FASCIA LATA Judy M. Choi, Patkawat Ramart, Diana Kang, Seth Cohen, Lenny Ackerman, and Shlomo Raz Judy M. ChoiJudy M. Choi More articles by this author , Patkawat RamartPatkawat Ramart More articles by this author , Diana KangDiana Kang More articles by this author , Seth CohenSeth Cohen More articles by this author , Lenny AckermanLenny Ackerman More articles by this author , and Shlomo RazShlomo Raz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.328AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of autologous fascia for the treatment of stress urinary incontinence has been well-established, with the most common sites of harvest including the rectus fascia and tensor fascia lata. In the past we preferred the use of rectus fascia for our fascial slings, but due to an increase in patients with elevated BMIs and complicated histories of abdominal surgery, we have transitioned to the use of tensor fascia lata. We describe our surgical technique and outcomes with the pubovaginal sling using tensor fascia lata. METHODS A retrospective review was performed using medical records of patients at our tertiary care center who had undergone pubovaginal slings with tensor fascia lata for stress urinary incontinence from January 2014 to October 2014. With the patient in the lateral position, tensor fascia lata was harvested through a single incision in the lateral thigh, utilizing the Crawford stripper. The patient was then repositioned into the dorsal lithotomy position for standard pubovaginal sling placement. RESULTS Pubovaginal sling with tensor fascia lata was performed in 22 patients. Mean age was 55.8 years, and mean BMI was 29.5. 15/22 (68.2%) had undergone previous abdominal surgery, and 20/22 (91.0%) had undergone prior mesh sling removal. Mean hospital stay was 1.09 days. 2/22 (9.1%) of patients developed complications following the procedure, including one pelvic hematoma and one incisional hematoma at the site of the fascial harvest. None complained of leg pain or difficulties ambulating at their initial post-operative visit, and all reported improvement in continence at their first post-operative visit. CONCLUSIONS Based on our initial experience, we have found the use of tensor fascia lata in autologous fascial slings to be less challenging, especially in patients with elevated BMIs and in those with a history of multiple abdominal surgeries. Pubovaginal slings using tensor fascia lata was found to be safe and well-tolerated in patients requiring treatment for stress urinary incontinence. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e98 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Judy M. Choi More articles by this author Patkawat Ramart More articles by this author Diana Kang More articles by this author Seth Cohen More articles by this author Lenny Ackerman More articles by this author Shlomo Raz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Feasibility, safety, and efficacy of salvage radical prostatectomy after Tookad® Soluble focal treatment for localized prostate cancer

To investigate feasibility, safety, and efficacy of salvage radical prostatectomy (RP) for recurrent prostate cancer (PCa) after focal treatment with TOOKAD(®) Soluble vascular-targeted photodynamic therapy (VTP). Nineteen patients underwent RP after biopsy-proven PCa post-focal VTP. We reported: operation time, blood loss, transfusion, complications, urethral catheterization time, functional outcomes, and short-term oncologic outcomes. Median age was 64 years (58-70). Median PSA before VTP was 6.30 ng/ml (3.20-9.80). Median delay between VTP and RP was 17 months (8-48). Median blood loss was 400 ml (100-1,000). Median operation time was 150 min (90-210), median urethral catheterization time was 7 days (5-18), and median hospital stay was 7 days (4-21). There was no perioperative mortality. Three patients had related per-operative complications: one pelvic hematoma (150 cc) (Clavien IIIa), one per-operative transfusion (900 cc hemorrhage) (Clavien II), and one superficial wound infection (Clavien I). After a median follow-up of 10 months (1-46), 13 were completely continent (68 %), five needed ≤1 pad/day, and one needed 3 pads/day (Clavien I). Severe erectile dysfunction was observed before and after RP (respectively 8 and 18). Ten patients regained potency with appropriate treatment. Median postoperative PSA was 0.02 ng/ml (<0.01-0.38) and remained undetectable for 16 patients (84 %). Nine patients had positive margins and six underwent complementary radiotherapy. Positive margins were significantly associated with bilateral VTP [risk ratio = 4.3, 95 % confidence interval (1.6-11.7), p = 0.003]. Salvage RP after VTP treatment was feasible, safe, and efficient to treat most of the locally recurrent PCa. Short-term oncologic and functional outcomes were promising, but further studies are required.

Conservative Management of Uterine Artery Pseudoaneurysm Rupture with Rectal Fistula after Laparoscopic Myomectomy and Review of the Literature

Late uterine hemorrhage caused by uterine artery pseudoaneurysm is a rare but life-threatening complication after uterine surgery. The association of uterine pseudoanerysm rupture causing rectal fistula has not been reported in literature as well as its management. Herein we report a case of massive late uterine bleeding and rectal bleeding after laparoscopic myomectomy. A 43 year old Caucasian nulliparous woman underwent laparoscopic excision of 8 cm posterior intramural myoma. One month later she developed acute abdominal pain and proctorrhagia. A Computer Tomography scan (CT) demonstrated a 10 cm pelvic hematoma. The transvaginal ultrasound (TVU) showed 1 cm aneurism of the uterine artery. Transarterial angiography confirmed the ruptured uterine artery pseudoaneurysm that was successfully embolized. Repeated colonoscopy showed a rectal fistula. Total parenteral nutrition (TPN) and antibiotic prophylaxis were started. During the following month the intensity and frequency of proctorrhagia gradually declined. After four week of TPN colonoscopy confirmed a complete fistula healing. Oral feeding was gradually reintroduced. Two months later an ultrasound scan showed a complete resolution of the pelvic hematoma. To the best of our knowledge this the first described association of two rare complications: a pseudoaneurysm rupture and the subsequent rectal laceration successfully treated with embolization and conservative management.

Subepithelial pelvic hematoma of the kidney (Antopol-Goldman Lesion).

Renal pelvic hematoma (Antopol Goldman lesion) is a rare but significant condition that may clinically mimick a renal or a pelvic neoplasm. Differential diagnosis and optimal treatment are still not known certainly. A 80-year-old male patient admitted to the emergency department with gross hematuria/clot retention and right flank pain. Magnetic resonance imaging (MRI) imaging revealed a filling defect in the right renal pelvis. Diagnostic flexible uretrorenoscopy was performed and a renal pelvic tumor was excluded. A 6 Fr double J (DJ) ureteral catheter was placed for 4 weeks while the patient was under an antifibrinolytic therapy. Filling defect was not detected at 3(rd) month control MRI. During 6 months of the follow-up period, gross hematuria or any abnormal radiological finding was not encountered.

Following the Needles: An Anatomical Study to Evaluate the Postoperative Safety and Symptoms of Patients Receiving a Transobturator Male Sling Implant

Implanting a transobturator male sling is a valid option to manage urinary incontinence after prostatectomy. We evaluated the trajectory of Argus T™ needles blindly introduced into the retropubic space to determine the safety and etiology of postoperative symptoms that can arise from this implant. Needles were implanted and perineal dissection was performed in 20 fixed, adult human male cadavers. The distance was measured from the upper and lower extremities of the needles in the internal pelvic wall upto the obturator neurovascular bundle. Anatomical variations identified in this area proximal to the needles were characterized. The inguinocrural region was also dissected from the needles positioned there. Statistical analysis of the results was done. All needles transfixed the obturator internus muscle. Of the needles 90% were completely immersed in its fibers and not visible in the inner wall of the pelvis. The distance to the obturator neurovascular bundle and anatomical variations were noted. In the inguinocrural region the pectineus and adductor longus muscles were perforated in all cadavers. The needle sling implant preserves the obturator neurovascular bundle and obviates the potential for postoperative pelvic hematoma. The anatomical trajectory of the needles used for this implant account for the groin and perineal pain side effects. Based on similarities between the Argus T and other types of outside-in transobturator male slings the results of the current study could be extrapolated to the latter slings.

Temporal trends and morbidities of vacuum, forceps, and combined use of both

Objective: To assess trends over time of operative vaginal delivery and compare delivery-related morbidity between vacuum delivery, forceps delivery, or combined use of both in California.Methods: California ICD-9 discharge data from 2001 to 2007 were used to identify cases of forceps and vacuum delivery.Results: There was a decline in all operative delivery types (9.0% in 2001 to 7.6% in 2007), with the decline in the use of forceps most pronounced (7.26/1000 deliveries in 2001 to 3.85/1000 in 2007). Higher rates of third/fourth degree lacerations, postpartum hemorrhage, manual extraction of placenta, pelvic hematoma requiring evacuation, cervical laceration repair, and thromboembolic events were noted in forceps compared to vacuum deliveries. When both instruments were used, rates of third/fourth degree lacerations and postpartum hemorrhage were increased. Operative delivery failure was highest in combined use compared to forceps or vacuum alone.Conclusion: The incidence of operative vaginal delivery in California is declining, with decreasing use of forceps most notable. Several maternal morbidities are increased in forceps and combined deliveries compared to vacuum deliveries. There is a significantly higher risk of failure when two operative delivery methods are employed. These findings may be contributing to the declining willingness of providers to perform operative vaginal delivery.

The Value of Vaginal Packing in Pelvic Floor Surgery

The objective of this study was to evaluate the effect of vaginal packing following pelvic floor surgery with regard to post-operative pain, bleeding and infection. This was a double-blind randomised study of women undergoing vaginal hysterectomy and/or pelvic floor repair at a tertiary urogynaecology unit. The primary outcome of day 1 post-operative pain was assessed using the short-form McGill Pain score. Secondary outcomes were haematological and infective morbidity, evaluated using changes in full blood count, and cultures of midstream urine and high vaginal swabs. A transvaginal ultrasound scan to exclude pelvic haematoma was performed at 6 weeks in all women who underwent vaginal hysterectomy with or without a pelvic floor repair. In total, 190 women were recruited: mean age 58.3 years (27–91 years), mean body mass index 27.4 kg/m2 and median parity 3. Women were randomised into the ‘pack’ (n = 86) and ‘no pack’ (n = 87) arms with no demographic differences between the groups. No statistically significant differences in the post-operative pain scores or secondary outcome measures were demonstrated. Incidence of haematoma formation (14.8 % no pack, 7.3 % pack, p = 0.204) was not statistically significant. There were three clinically significant complications in the no pack group and none in the pack group. This is the first study to examine pain in association with post-operative vaginal packing. There is no evidence to suggest that packing increases pain scores or post-operative morbidity. A trend towards increased haematoma and significant complications was seen in the no pack group. As vaginal packing does no harm and may be of some benefit it may be argued that packing should be recommended as routine clinical practice.

Delayed bleeding and pelvic haematoma after low-energy osteoporotic pubic rami fracture in a warfarin patient: an unusual cause of abdominal pain.

Introduction. Acute abdominal pain may be the presenting symptom in a wide range of diseases in the elderly. Acute abdominal pain related to a delayed bleeding and pelvic haematoma after a low-energy pubic rami fracture is rare and can have important consequences; to the best of our knowledge, only one case has been previously described. Case Report. We present an unusual case of an 83-year-old woman taking warfarin for atrial fibrillation, admitted to the Emergency Department (ED) with acute abdominal pain and progressive anemia related to a delayed bleeding and pelvic haematoma 72 hours after a low-energy osteoporotic pubic rami fracture. Warfarin was withheld, anticoagulation was reversed by using fresh frozen plasma and vitamin K, and concentrated red blood cells were given. Haemoglobin level gradually returned to normal with a progressive resorption of the haematoma. Conclusion. Delayed bleeding and pelvic haematoma after osteoporotic pubic rami fracture should be considered in the differential diagnosis of acute abdominal pain in the elderly. This case indicates the need for hospital admission, careful haemodynamic monitoring, and early identification of bleeding in patients with “benign” osteoporotic pubic rami fracture, especially those receiving anticoagulants, to provide an adequate management and prevent severe complications.

Mesh-related and intraoperative complications of pelvic organ prolapse repair.

IntroductionTo evaluate the rates of complications of pelvic organ prolapse repair and to determine their risk factors.Material and methodsThe study included 677 patients operated for pelvic organ prolapse with trocar guided Prolift mesh. Patients were followed up within 1 and 3 months. A phone interview was conducted and patients with complaints were invited and evaluated in office settings.ResultsMean age was 60 years. For the phone interview, 86.5% of patients were available. Overall complication rates were 22.5% (152/677). Fifteen patients (2.2%) developed bleeding over 500 cc; pelvic hematomas – 5.5%; perineal hematomas – 2.5%; urethral injuries – 0.3%; bladder injury in 1.6%; rectal damage in 0.7% and ureteral trauma in 0.2%.Mesh related complications included: erosions in 4.8%; vaginal synechiae – 0.3%; protrusion of mesh into the bladder – 0.15%; vesicovaginal fistula with mesh protrusion – 0.3%; mesh shrinkage – 1%; dyspareunia and pain in 2.4% cases. Pelvic abscess was found in 0.6% including one case of lethal necrotizing fasciitis. The risk factors of complications were assessed via logistic regression analysis.ConclusionsYounger age, less prominent prolapse, hematomas and concomitant hysterectomies are associated with higher risk of complications.

Postoperative Pelvic Hematoma an Unusual Case After Surgical Treatment of Ectopic Pregnancy

Aim: Postoperative pelvic hematoma is almost a universal consequence of gynaecologic surgery. It occurs especially after vaginal or abdominal hysterectomy. To our knowledge, so far no case of pelvic hematoma after surgical treatment of ectopic pregnancy was described in the literature. Case report: This case report describes a pelvic hematoma that occurred after surgical treatment of ectopic pregnancy. The hematoma was infected and resolved spontaneously. The patient, a North African woman, was given antibiotic treatment for two weeks. During 4 months of follow-up, the size of the hematoma decreased down to 59.5% of the initial size. Monitoring of the patient is still continuing. Conclusion: Postoperative pelvic hematoma can be diagnosed in the early postoperative period of gynaecologic surgery. Sometimes it resolves spontaneously.

Pelvic Hematoma Due to Anticoagulant Therapy Causing Urethro-Vesical Anastomosis Disruption After Radical Prostatectomy: A Case Report

Pelvic hematomas can form as a consequence of anticoagulant therapy after pelvic surgeries such as radical prostatectomy (RP). This can cause a significant disruption of the urethro-vesical anastomosis. We report a case of a 58-year-old male who presented with prostate cancer (PC) and underwent RP. Post-operatively, he developed deep vein thrombosis (DVT) and pulmonary embolism (PE). He was started on anticoagulant therapy which caused a pelvic hematoma resulting in the urethro-vesical anastomosis (UVA) disruption. World J Nephrol Urol. 2014;3(3):134-136 doi: http://dx.doi.org/10.14740/wjnu183w

Ejaculatory System Cysts: A Case Report

Male pelvic floor cysts are a rare clinical entity that include: Wolffian duct remnants, Müllerian duct remnants, cysts of the seminal vesicles, prostate and ejaculatory duct/vas deferens cysts. We report the clinical case of a 21-year-old male patient with a history of previous surgery in childhood and more precisely: partial colectomy for congenital megacolon, removal of dysplastic right kidney and subsequent surgical adhesiolysis for bowel obstruction. At 17, the patient was submitted to MRI for groin pain with an incidental finding of a cystic mass at the level of the right seminal vesicle. Consequently, a TUR-ED was performed at another urology unit, for a suspected seminal vesicle ectasia, without resolution of pain symptoms. The patient was referred to us for persistent genitourinary infections, ejaculation disorder and episodes of gross hematuria. An additional MRI confirmed the presence of a cystic mass of 5,5 cm with a suspected opening into prostatic urethra. Urethrocystoscopy and urethrocystography retrograde confirmed this anatomical communication. For the persistence of the symptoms we performed retropubic surgical exeresis of the mass, with a histopathological finding of benign cyst of the vas deferens. Two major postoperative complications were reported: a pelvic hematoma that required surgical exploration and a urinary extravasation at the level of prostatic urethra, which resolved with prolonged urethral catheterization. Male pelvic floor cysts are a rare disease with a complex clinical and therapeutic management. A correct diagnosis is based on clinical signs and symptoms together with imaging studies of the pelvic region. The high risk of erectile dysfunction and ejaculatory disorders correlated to a surgical approach, recommend a treatment of these lesions only for symptomatic cases.

The value of vaginal packing in pelvic floor surgery: a randomised double-blind study

The objective of this study was to evaluate the effect of vaginal packing following pelvic floor surgery with regard to post-operative pain, bleeding and infection. This was a double-blind randomised study of women undergoing vaginal hysterectomy and/or pelvic floor repair at a tertiary urogynaecology unit. The primary outcome of day 1 post-operative pain was assessed using the short-form McGill Pain score. Secondary outcomes were haematological and infective morbidity, evaluated using changes in full blood count, and cultures of midstream urine and high vaginal swabs. A transvaginal ultrasound scan to exclude pelvic haematoma was performed at 6 weeks in all women who underwent vaginal hysterectomy with or without a pelvic floor repair. In total, 190 women were recruited: mean age 58.3 years (27-91 years), mean body mass index 27.4 kg/m(2) and median parity 3. Women were randomised into the 'pack' (n = 86) and 'no pack' (n = 87) arms with no demographic differences between the groups. No statistically significant differences in the post-operative pain scores or secondary outcome measures were demonstrated. Incidence of haematoma formation (14.8 % no pack, 7.3 % pack, p = 0.204) was not statistically significant. There were three clinically significant complications in the no pack group and none in the pack group. This is the first study to examine pain in association with post-operative vaginal packing. There is no evidence to suggest that packing increases pain scores or post-operative morbidity. A trend towards increased haematoma and significant complications was seen in the no pack group. As vaginal packing does no harm and may be of some benefit it may be argued that packing should be recommended as routine clinical practice.

Blood Type, Lymphadenectomy and Blood Transfusion Predict Venous Thromboembolic Events Following Radical Prostatectomy with Pelvic Lymphadenectomy

Venous thromboembolic events are the most common nonoperative complication after radical prostatectomy and they represent the most common cause of death within 30 days of surgery. While effective mechanical and chemoprophylaxis exists, such prophylaxis may also be associated with increased complications. To identify venous thromboembolic event risk factors and, thereby, facilitate targeted prophylaxis we characterized clinicopathological variables associated with these events in patients undergoing radical prostatectomy. We reviewed the records of 18,472 consecutive patients who underwent radical prostatectomy with pelvic lymphadenectomy for prostate cancer at our institution from 1987 to 2010. Patients were followed postoperatively for complications. Venous thromboembolic events within 30 days of surgery were recorded. Logistic regression models were used to analyze clinicopathological variables associated with venous thromboembolic events. We identified symptomatic venous thromboembolic events in 271 patients (1.4%). This diagnosis was not associated with preoperative body mass index, prostate specific antigen, Gleason score or cancer recurrence. However, the diagnosis was significantly associated with nonO blood type (OR 1.98, p = 0.004), an increasing number of lymph nodes removed (OR 1.05, p = 0.035) and blood transfusion (OR 1.30, p = 0.02). Patients with venous thromboembolic events were significantly more likely to die within 30 days of surgery (3.0% vs 0%, p <0.001). Blood type, pelvic lymphadenectomy extent and blood transfusion are significant risk factors for symptomatic venous thromboembolic event before radical prostatectomy plus pelvic lymph node dissection. These data should be used for patient counseling, particularly in regard to obviating lymphadenectomy in patients at low risk and for individualizing prophylaxis for venous thromboembolic event in patients at higher risk.

An Unusual Presentation and Surgical Repair of a Postpartum Pelvic Hematoma

Background: Postpartum hematomas for the most part can be treated conservatively but if there is an open wound or it is expanding rapidly or causing hemodynamic instability then surgical intervention is required. The available resources and the practitioner's surgical experience then becomes key in order to minimize morbidity in the management of complex hematomas. A 29 year old primipara, after a vacuum assisted vaginal delivery developed an expanding labial hematoma, surprisingly extending from the mons pubis to the perirectal space and inwards to the ischio rectal fossa. The patient initially had incision and drainage followed by packing of the 10cm hematoma. The pt was then transferred to Cooper. A second complex surgical intervention with complete evacuation of the hematoma and layered closure was required. Traditional surgical intervention involving complete evacuation and layered closure is still essential in the management of open postpartum pelvic hematomas.

Pelvic hematoma following transrectal ultrasound-guided prostate needle biopsy: A case report and literature review

Transrectal ultrasound-guided prostate (TRUS-P) needle biopsy is a common procedure for detection of prostate cancer. Complications associated with TRUS-P biopsy are almost always minor and do not require hospitalization. Pelvic hematoma following TRUS-P biopsy is an extremely rare complication. Only a few cases have been reported in the past. Here we report the case of a 67-year-old man diagnosed with pelvic hematoma following TRUS-P biopsy who presented with tenderness in the lower abdomen and ecchymosis in the paraumbilical region, lower abdomen, and scrotum. To our knowledge, no other case has been reported in Taiwan. Therefore, we discuss this case report and review the literature associated with complication of TRUS-P biopsies.

English

At bedside ultrasound, the mass resulted to have fluid content, with an active flow, confirmed by colour Doppler. A contrast-enhanced computed tomography scan was performed, showing a large pelvic haematoma with the femorofemoral graft within. The patient was urgently brought to the operatory room. The hematoma was evacuated, and a new bypass graft was placed. Conclusion Bedside ultrasound made it possible to recognize the fluid nature of a large slowly growing abdominal mass that resulted to be the consequence of the detachment of the distal end of a Femorofemoral crossover bypass, and thus to address and speed up diagnostic workout and treatment.

Single-port vs. conventional multi-port access laparoscopy-assisted vaginal hysterectomy: comparison of surgical outcomes and complications

ObjectiveTo compare surgical outcomes and complications between single-port access (SPA) and multi-port access (MPA) laparoscopy-assisted vaginal hysterectomy (LAVH). Study designA retrospective review of medical records was performed in patients who underwent LAVH for non-malignant gynaecological diseases at Eun Hospital between April 2010 and April 2012. One hundred and twenty women underwent SPA LAVH using a transumbilical three-channel single-port system and 130 women underwent conventional MPA LAVH. Surgical outcomes and complications were compared between the two groups. ResultsThe outcomes of the SPA-LAVH group vs. the conventional MPA-LAVH group were as follows: mean±standard deviation total operative time (73.1±24.3 vs. 70.3±22.1min, p=0.349), largest dimension of uterus (10.7±2.3 vs. 10.8±2.8cm, p=0.847), weight of extirpated uterus (311±185 vs. 339±234g, p=0.298) and change in haemoglobin (1.7±0.8 vs. 2.0±0.9g/dl, p=0.025). The incidence of complications was similar in each group (20 vs. 16 patients, p=0.327). Unplanned intra-operative laparotomy was not necessary in either group, and there were no cases of bowel injury or main vessel injury in either group. In total, there were three bladder injuries: one in the SPA-LAVH group and two in the MPA-LAVH group. The postoperative course was uneventful in most patients, but six patients had a transient paralytic ileus (four in the SPA-LAVH group and two in the MPA-LAVH group) and 10 patients had a pelvic haematoma (five in each group), all of whom recovered following conservative management. Port-related complications were rare, but one patient in the SPA-LAVH group had a port-site umbilical hernia. ConclusionUse of SPA and MPA LAVH has similar results in terms of surgical outcomes and complications.