Rupture Of Hematoma Research Articles

Giant subcapsular hematoma of the liver — a rare complication after laparoscopic cholecystectomy

The article shows a clinical case of an extremely rare complication after laparoscopic cholecystectomy — a giant subcapsular hematoma of the liver. The clinical, laboratory and instrumental data of the patient and the results obtained were analyzed. Analysis of the data from the operated patient did not reveal the main reason that could have caused the development of a giant subcapsular hematoma of the liver. The patient had no bleeding disorders, had not previously suffered any bleeding, and did not take anticoagulants as an outpatient. During the operations, no source of bleeding or damage to the liver parenchyma was identified. In addition, there was no evidence of focal liver lesions according to the preoperative ultrasound scan. Outpatient use of a drug from the group of antiplatelet agents, as well as short-term irregular use of analgesics to relieve periodic pain could provoke the development of this complication. Treatment of subcapsular hematoma of the liver mainly depends on the clinical condition of the patient and the size of the hematoma. With conservative management, the condition of the formed hematoma should be more carefully monitored over time using radiation diagnostic methods. If necessary and according to indications, do not exclude possible repeated laparoscopic intervention, including conversion to laparotomy, taking into account the data of clinical, laboratory and radiological research methods. In most cases, this condition requires conservative treatment. Patients with such a complication require careful hemodynamic monitoring and visual monitoring of the complications development. Probably, preference should be given to magnetic resonance imaging, since this method is the most objective and does not carry a radiation load. The main task is not to miss the moment of hematoma rupture and the development of fatal bleeding.

The endovascular aortic repair for patients with traumatic thoracic aortic blunt injury

OBJECTIVE: Blunt thoracic aortic injury is the second most common cause of death in trauma patients. Traumatic aortic injury is an emergency that patients will face death soonly, even there is no enough time to transport the patient to the hospital. In our center, all patients were treated with thoracic endovascular aortic repair (TEVAR). We retrospectively analyze the therapeutic effects of TEVAR of blunt traumatic aortic injury (BTAI) to get some inspiration for the follow-up treatment and provide valuable guidance. METHODS: We retrospectively reviewed our institutional database to identify all patients treated with TEVAR for traumatic lesions of the aortic isthmus. We have identified 22 patients since 2017. Patients’ charts were analyzed for preoperative characteristics and intraoperative variables. RESULTS: Forty-six patients were included. The median age was 56 years (23–79 years). Sixteen patients were male (73%). Most of them were graded III/IV of aortic injury. All patients were undergone endovascular treatment successfully. Six of 22 patients, showing no chest pain before admission, were presented with classic type B aortic dissection. Moreover, one patient was presented with thoracoabdominal dissection. Emergency surgery (<24 h) was performed in seven patients (32%) who experienced life-threatening injury resulting in hemorrhagic shock and hematoma formation in the mediastinum. All patients were discharged smoothly with no residual symptoms. CONCLUSIONS: Endovascular treatment of traumatic aortic dissection reduces the mortality rate of these patients who cannot tolerate traditional open surgery. According to our experience, patients who presented with simple pseudoaneurysm in enhanced computed tomography were more stable. Therefore, a postponed operation could be recommended after symptomatically hypotensive management. However, emergency surgery was necessary if patients presented with obviously mediastinal hematoma, especially progressive pleural effusion, which could result in hematoma rupture and death.

Preliminary application of contrast-enhanced transcranial color-coded sonography in subacute intracerebral hemorrhage

Objective To observe the ultrasonographic findings of patients with basal ganglia hemorrhage by transcranial color-code sonography (TCCS) and contrast-enhanced transcranial color-code sonography (CE-TCCS), and to evaluate the clinical value of TCCS and CE-TCCS in assessing the cerebral perfusion with basal ganglia hemorrhage. Methods Eighty-two patients with basal ganglia hemorrhage were selected, and hematoma was seen in 58 patients (70.7%). Forty-six cases of bilateral TCCS with clear display of basal ganglia through temporal window were selected. CE-TCCS was used to observe cerebral perfusion of edema zone, edema zone edge and peripheral brain parenchyma. Results The bilateral rate displayed by TCCS was 79.3%. Among 58 cases, 30 cases had ventricular compression, 14 cases had hematoma rupture into ventricle, 8 cases had midline displacement, and 10 cases had no complication change. The cerebral perfusion in edema areas around hematoma was reduced by CE-TCCS, but the degree of reduction was different. There were reduced in a step-like manner in the cerebral perfusion from edema zone and edema zone edge to peripheral brain tissue. Conclusions CE-TCCS is a new method for clinical diagnosis and monitoring the progress of treatments of cerebral hematoma. Key words: Ultrasonography, Doppler, transcranial; Contrast-enhanced ultrasound, transcranial; Cerebral hemorrhage

Haematemesis and acute dysphagia: oesophagogastroduodenoscopy or CT—which one first?

We present an uncommon case of a patient presenting at the emergency department for severe vomiting, persisting for at least 12 hours, without nausea or abdominal pain. She initially referred...

Spontaneous liver haematoma rupture associated with pre-eclampsia in a low- to middle-income country: Lessons to be learnt from maternal death assessments

Spontaneous rupture of liver haematoma is a complication of pre-eclampsia (PE) that results in maternal mortality, particularly in the absence of an early diagnosis and appropriate interventions. The aim was to describe cases of maternal deaths due to spontaneous rupture of liver haematoma associated with PE to raise awareness of clinical features suggestive of the diagnosis and to make recommendations regarding a team approach in managing this complication. Maternal deaths due to PE that occurred in health facilities in South Africa between 2014 and 2016 were reviewed and cases due to spontaneous rupture of liver haematoma were analysed. Eight maternal deaths occurred owing to spontaneous rupture of liver haematoma, and in 62.5% (5/8) the diagnosis was established at caesarean delivery. The common presenting features were upper abdominal pain, haemodynamic instability including collapse and haemoperitoneum associated with PE, and haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome. Substandard care was associated with all, except 1 patient, and the principal area of concern was inability to make the diagnosis and failure to seek advice from a referral centre. Preventable factors in these maternal deaths included adherence to clinical guidelines, appropriate clinical and laboratory assessment with regard to the diagnosis of spontaneous rupture of liver haematoma, and management by a multidisciplinary team.

Management of Liver Allograft Trauma Resulting in Massive Subcapsular Hematoma After Living Donor Liver Transplantation: Can We Salvage the Liver Allograft?

BACKGROUND Liver allograft trauma resulting in subcapsular hematoma after living donor liver transplantation (LDLT), although rare, is a life-threatening condition and requires prompt management to avoid any catastrophe. Herein we describe our successful experience in dealing with liver allograft hematoma that developed in the post-operative period after LDLT. MATERIAL AND METHODS From January 2002 to May 2015, a total of 616 recipients underwent LDLT at our institute. The intra-operative and postoperative records of these patients were analyzed to study the cases of liver allograft hematoma. Four patients (n=4) who developed liver allograft subcapsular hematoma during the intra-operative and post-operative periods were included in study. The outcomes of these patients were studied after the administration of the medical, surgical, or combined modalities of treatment. RESULTS Out of 616 LDLT recipients, 4 (0.64%) developed subcapsular hematoma. Patients were managed by a stepwise approach: Initial non-operative management with transarterial embolization (if extravasation of the contrast was noticed during imaging studies) was performed (n=1). Three patients developed hemodynamic instability with signs of hematoma rupture and were successfully treated by surgical exploration. CONCLUSIONS Timely diagnosis and suitable management can successfully salvage a liver allograft even in the presence of massive subcapsular hematoma. Our emphasis is on perihepatic packing rather than open surgical drainage if exploration is required, which can achieve a 100% success rate.

Complicaciones maternoperinatales de la preeclampsia-eclampsia

Objetivos: Identificar las complicaciones materno-perinatales de la preeclampsia y eclampsia. Diseño: Estudio analítico de corte sobre 359 casos de gestantes y sus respectivos productos, con preeclampsia y eclampsia, diagnosticados en el periodo del 1 de julio de 1997 al 30 de junio de 1998 en el Hospital María Auxiliadora. Se revisó las historias clínicas respectivas y se determinó las repercusiones maternoperinatales, según clasificación clínica. Las frecuencias encontradas según esta clasificación, fueron sometidas a una tabla de doble entrada, para compararlas con el grupo control dada, por el resto de las pacientes sin la enfermedad. Se consideró un valor de p < 0,05 como significativo. Resultados: En el intervalo de 5 años la preclampsia aumentó significativamente de 7,0% a 10,6%, mientras que la eclampsia disminuyó de 0,8% a 0,4% Las complicaciones maternas más frecuentes relacionadas a muerte fueron síndrome HELLP, CID, ruptura de hematoma subcapsular hepático y hemorragia cerebral; y las complicaciones perinatales la depresión neonatal, pequeño para la edad gestacional, depresión y asfixia neonatal, distrés respiratorio y prematuridad. Conclusiones: Las complicaciones medicas de la madre y el niño como consecuencia de la preeclampsia-eclampsia son frecuentes. La frecuencia y gravedad de las mismas aumentan con la progresión de la enfermedad. Se sugiere por ello prever la convulsión y el manejo de la enfermedad debe ser oportuno, con protocolos bien establecidos y con dosis completas de los medicamentos, como el sulfato de magnesio.

血浆脑钠肽水平对急性脑出血患者转归的预测价值

目的：探讨血浆脑钠肽(BNP)水平与脑出血患者预后的关系。方法：回顾性分析2010年12月~2013年12月治疗的109例脑出血患者，根据转归分为转归良好组和转归不良组。采用酶联免疫吸附法(ELISA)测定血浆BNP。结果：患者卒中病史、吸烟史、血肿体积、格拉斯哥昏迷评分、美国国立卫生研究量卒中量表评分、血肿是否破入脑室及血浆脑钠肽水平均与转归结果有密切关系(X2 = 3.678, 7.096, t = 2.962, 2.361, 3.806, X2 = 4.687, t = 4.962, P < 0.05); Logistic回归分析发现血浆脑钠肽水平与急性脑出血患者的预后相关(P = 0.032, OR = 1.789, 95% CI 1.052~3.043)。结论：血浆BNP是脑出血患者转归的危险因素之一，对患者预后的判断有一定的价值。 Objective: To study brain natriuretic peptide (BNP) levels and prognosis in patients with cerebral hemorrhage. Methods: Retrospective analysis of 109 cases with cerebral hemorrhage from December 2010 to December 2014 for the treatment was divided into 2 groups, according to the outcome of a good outcome group and poor outcome groups. The enzyme-linked immunosorbent assay (ELISA) was used for determination of plasma BNP. Result: There was a close relationship between patient outcomes and a previous history of stroke, smoking history, hematoma volume, Glasgow Coma Scale score, National Research Health Stroke Scale score, rupture of hematoma into the ventricle, plasma brain natriuretic peptide level. (X2 = 3.678, 7.096, t = 2.962, 2.361, 3.806, X2 = 4.687, t = 4.962, P < 0.05); Logistic regression analysis revealed a correlation between the prognosis of brain natriuretic peptide levels in patients with acute cerebral hemorrhage (P = 0.032, OR = 1.789, 95% CI 1.052 - 3.043). Conclusions: Plasma brain natriuretic peptide level is an independent risk factor for patients with cerebral hemorrhage and may be a useful prognostic factor for these patients.

Polyarteritis Nodosa Presenting with Splenic Infarction, Bilateral Renal Infarction, and Hematoma

Polyarteritis nodosa (PAN) is a necrotizing vasculitis and may affect multiple organ systems. Due to the rupture of microaneurysms, perirenal hematomas may occur in both kidneys. Spontaneous perirenal hematoma is an infrequent complication of isolated PAN. Also, involvement of the splenic arteries is a rare occurrence in polyarteritis nodosa. Perirenal hematoma rupture is a serious clinical condition. Patients with life-threatening visceral bleeding must be treated with a selective embolization procedure or radical surgery because nonoperative management has been associated with a significant mortality rate.

Midterm follow-up of penetrating ulcer and intramural hematoma of the aorta.

Most studies on variant forms of aortic dissection--penetrating ulcer and intramural hematoma--have focused on the initial presenting episode, with scant follow-up. This investigation provides midterm follow-up of penetrating ulcer and intramural hematoma to determine whether the aorta shows healing according to radiography, goes on to dilate, or tends to rupture during later follow-up. Forty-five patients with penetrating ulcers (n = 26) or intramural hematomas (n = 19) were treated at our institution. Ten patients with penetrating ulcers were male and 16 were female, and their ages ranged from 54 to 87 years (mean 72 years). Eight patients with intramural hematomas were male and 11 were female, and their ages ranged from 54 to 88 years (mean 74 years). These patients all had symptoms of aortic disease. Patients with incidental imaging findings were not considered. In the group with penetrating ulcers, rupture occurred during the initial admission in 10 (38%) cases, 17 patients (65%) underwent surgery, and 22 patients (85%) survived to hospital discharge. Among those with intramural hematomas, rupture occurred during the initial admission in 5 cases (26%), 7 patients (37%) underwent surgery, and 16 patients (84%) survived to hospital discharge. Follow-up ranged from 1 month to 12.5 years (mean 3.4 years). No ischemic vascular complications occurred. Imaging follow-up was available for 26 of the 45 patients. Of these, 19% of lesions showed resolution, 23% had worsened, 39% had progressed to typical dissection, and 19% were unchanged. Six late deaths were known to be caused by rupture. In the group with penetrating ulcers, aortic diameter increased from 4.8 to 5.1 cm during the course of 14 months. In the group with intramural hematomas, aortic diameter increased from 5.3 to 5.9 cm during the course of 21 months. Overall survivals were 80% at 1 year, 73% at 3 years, and 66% at 5 years. Intramural hematoma and penetrating ulcer are lesions associated with advanced age. Women predominate. Penetrating ulcer and intramural hematoma rupture both early and late. Radiographically documented worsening, improvement, or frank dissection may occur with time. Aortic growth does occur (0.2 cm per year for penetrating ulcer and 0.4 cm per year for intramural hematoma). Vascular ischemic complications do not occur. Because of the high early rupture rate, the frequency of radiographic worsening, and the documented occurrence of late rupture, we now recommend surgical replacement of the aorta for these virulent vascular lesions as long as the patient's comorbidities do not preclude surgical intervention.

Spontaneous rupture of iatrogenic intramural hematoma of esophagus during endoscopic sclerotherapy

Endoscopic injection sclerotherapy (EIS) is commonly used in the management of acute variceal bleeding and prevention of variceal bleeding.1,2 Many complications of EIS have been described.3,4 We herein describe a patient who developed an intramural hematoma immediately after undergoing EIS for prevention of variceal bleeding. This report focuses on the sequential endoscopic findings and the spontaneous rupture of the hematoma within a few minutes after sclerotherapy.

Delayed splenic hematoma rupture

The diagnosis of splenic hematoma can be clinically challenging. A case of delayed rupture of an atraumatic splenic hematoma is described, illustrating how unusual the presentation of this entity can be.

Traumatic rupture of the aortic isthmus: an emergency?

The objectives of this study were to explore the hypotheses that: (1) patients with traumatic rupture of the aortic isthmus (TRA) who have not exsanguinated into the pleural cavity upon hospital presentation are unlikely to develop rupture of the hematoma during the time necessary to investigate all injuries and attend to those of more immediate danger; and (2) appropriate medical therapy can prevent free rupture of the hematoma. The medical records of 112 patients who were proved to have TRA at the isthmus resulting from injury within the preceding 7 days were reviewed. Fifty of these patients received medical treatment aimed at decreasing aortic wall stress; 46 were managed under a formal protocol. The available English language and European literature for the past 15 years was surveyed for evidence of the effects of delay between injury and aortic repair. Eight patients died before aortic repair, six of aortic exsanguination (all within 4 hours of injury). Of 77 patients for whom the time of injury was recorded and the aorta was repaired, 36 were repaired within 12 hours of injury and 41 between 12 hours and 24 weeks; none developed aortic hemorrhage. No patient receiving adequate medical therapy died of rupture of the hematoma. Other major surgery preceded aortic repair in 33 patients. We conclude that the concept that traumatic rupture of the aorta should always take priority over other injuries is incorrect. Pharmacologic reduction of wall stress appears to decrease the probability of rupture of the periaortic hematoma.

High resolution real time sonography in sports specific muscle injuries. Sonomorphologic-anatomic correlation and diagnostic criteria

In 250 examinations of 86 patients, high resolution real time sonography with a 7.5 MHz linear transducer proved to be a readily available, low-cost and significantly relevant imaging method in diagnosis and follow-up of muscular lesions in sportsmen. The method offers a high measure of safety in excluding rupture or in enabling differential diagnosis between partial muscular rupture and muscular spasm, so that the choice of treatment can be decisively influenced by sonography. Hence, rapid rehabilitation, which is so essential in competitive sport, is speeded up even further. In extensive ruptures or rupture haematoma, therapeutic ultrasound-guided puncture can be performed or indication for surgery can be facilitated in subtotal or complete tears of a muscle that is important for high-level performance.

被殻出血および視床出血の予後に関する研究 予後規定因子等の比較検討

The prognosis and factors affecting prognosis of 66 putaminal hemorrhage (PH) and 48 thalamic hemorrhage (TH) cases were compared. All patients were diagnosed by CT scan and treated palliatively. They were studied for six months. Functional prognosis was classified into four groups as follows according to activities of daly living (ADL): ADL1 almost full recovery, ADL2 partially dependent, ADL3 almost completely dependent, ADL4 bedridden.The results were as follows:1) The mortality rate for PH sufferers, 44.5%, was almost the same as for TH sufferers, 46.8%. 21 (58%) out of PH survivors were classified as ADL1 which was significantly higher than the percentage of ADL1 (23%) in the TH group (p<0.05).2) Age was one of the major factors affecting prognosis in both the PH and TH groups. For patients in their forties and fifties functional prognosis was favourable. For those in their sixties and seventies ADL was generally poor. Patients in their eighties had an extremely poor prognosis.3) Deterioration or improvement in consciousness level from admission to the third day of illness occurred more frequently in the PH group than in the TH group. A deterioration in consciousness level indicated a poor prognosis.4) Anisocoria with a dilated pupil on the same side as hematoma was the worst prognostic ocular sign in both groups. The second worst sign was a non-reactive pupil.5) None of the TH patients with a severe motor inability on admission advanced to the ADL1 category.6) In both the PH and TH groups, the patients with bilaterally positive Babinski reflexes had a poor prognosis.7) A close correlation between CT classification and prognosis was found in both the PH and TH groups. P1 and T1 showed a good prognosis. In patients of P2a and T2a, prognosis depended on their age. However no T2a cases advanced to the ADL1 category. In P2b, T2b, P3 and T3, prognosis was poor.8) The estimated hematoma volume on CT had a close correlation with the prognosis in PH and TH. The maximum hematoma volume of ADL1 in the PH group was 18 ml and 3 ml in the TH group. Over 80ml was fatal in the PH group, and over 10 ml in the TH group resulted in ADL4 or death.9) Hematoma rupture into the ventricular system occurred in cases of PH when the hematoma volume was over 25 ml, 4 ml in cases of TH. PH and TH cases with a ventricular rupture generally had a poor prognosis. None of rupture cases in PH became ADL1. A rupture into the 3rd and /or 4th ventricle resulted in an extremely poor prognosis in both the PH and TH groups. However the prognosis of rupture cases was considered to depend more on the degree of brain damage than the ventricular rupture itself.10) The mean survival time of fatal TH cases was shorter than that of PH (5.4 days vs 9.8 days).

Management of hypertensive intracerebral hemorrhage--based on the natural course of the hematoma observed by repeated CT scan (author's transl)

A consecutive series of 112 cases of hypertensive intracerebral hematoma from June 1976 to April 1978 were studied with repeated scanning by CT of EMI model 1010 and ACTA model 0100. Ninety-four cases were diagnosed as basal ganglionic bleeding and 9 were subcortical bleeding in this series. Fifty-four of basal ganglionic bleeding were operated and 50 were not operated. These 103 cases of supratentorial hematomas were analyzed by CT based on density of hematoma and perifocal low density area surrounding hematoma chronologically. It was suggested that indication and timing for surgery of hypertensive intracerebral hemorrhage should be decided on hematoma factors (namely, hematoma size, midline shift and ventricular rupture) and chronological change of perifocal area surrounding hematoma on CT. 1. A progressive and concentric diminution in density of hematoma always occurred from the periphery. The high density in the center of hematoma did not change for a certain period until the area of the density decreased to 1-1.5 cm in size. Then, the high density area of 1-1.5 cm in size started to decrease its density and reached isodensity with the surrounding brain parenchyma during 18-20 days. As could be predicted, the larger the hematoma the longer the resolution time, but the general pattern of resolution as described above can be identified. 2. The rim of lucency surrounding hematoma probably represented secondary changes of edema, degeneration and necrosis of the adjacent parenchyma. So, the perilucent area varied according to the age of intracerebral hematoma. The area surrounding hematoma was small within 6 hours from onset and then increased greatly until the 4th day. The peak of perilucent area ranged between the 4th and the 15th day. The area was noted to decrease after the 15th day and to disappear within a month after. 3. Mortality of patients with basal ganglionic hematoma correlated with hematoma size, midline shift and ventricular rupture. Thirteen of our 33 non-operative cases with hematoma of less than 2.5 cm in diameter and midline shift of less than 5 mm were all alive. Fourteen cases fell between 2.5 and 4.5 cm in diameter and within 10 mm in shift. In 3 of these 14 cases, rupture of the intracerebral hematoma into the ventricular system was observed. One of them died and the others survived. The other 6 cases showed hematoma of more than 4.5 cm in diameter and/or shift of more than 10 mm and rupture of the hematoma into the ventricular system. All of these cases died. 4. Positive contrast enhancement in non-operative cases was observed first on the 14th day from the onset and frequently had a ring formed configuration contrast enhancement after the 20th day. Ratio of positive contrast enhancement changed according to hematoma size. Large hematoma was accompanied by contrast enhancement of longer duration. Four types of configurations of contrast enhancement; namely, ring, ring with inside high density, incomplete ring, and spot form, were observed in these cases.