scholarly journals A Case Series of Life-Threatening Hemorrhagic Events in Patients with COVID-19

2021 ◽  
Author(s):  
Abbas Hajian
Keyword(s):  
Bleeding Complication ◽  
Medical Center ◽  
Case Series ◽  
Rectus Sheath ◽  
Surgical Care ◽  
Pulmonary Involvement ◽  
Autopsy Study ◽  
Hemorrhagic Events ◽  
Life Threatening ◽  
Rectus Sheath Hematoma

AbstractSince venous microthrombotic and thromboembolic events in end organs have been pathophysiologically confirmed as a component of thrombo-inflammatory cascade in COVID-19 syndrome, anticoagulant prescription with prophylactic or therapeutic goal is recommended. Different guidelines for the above are introduced; however, there is no general consensus on any neither the type of anticoagulant nor for the dosage and duration of prescription. In our medical center, adopted internal guideline was considered for patients COVID-19. We consulted patients with COVID-19 who suffered from concurrent hematoma. Appropriate surgical approach was considered. Finally autopsy study was performed for patients. In this article, we presented a series of seven SARS-CoV-2 confirmed cases faced with bleeding complication following initiation of anticoagulation protocol. The rectus sheath hematoma with extension to pelvic and/or retroperitoneal space, even involving bowel mesentery was seen most commonly. Despite receiving appropriate surgical care, all seven cases died. Finally, in all cases, autopsy studies revealed no evidence for confirmation of DIC/SIC or organ failure as the reason of death although pulmonary involvement with SARS-CoV-2 and bleeding phenomena were approved. The nature of the COVID-19 syndrome makes patients vulnerable to hemorrhagic events following anticoagulant administration which relatively causes or accelerates patient’s expiration.

scholarly journals Rectus Sheath Haematoma Associated with Low Molecular Weight Heparin: A Case Series

2007 ◽  
Vol 89 (3) ◽  
pp. 309-312 ◽  
Author(s):  
J Donaldson ◽  
CH Knowles ◽  
SK Clark ◽  
I Renfrew ◽  
MD Lobo
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Case Series ◽  
Rectus Sheath ◽  
Low Molecular Weight ◽  
Recent Treatment ◽  
Life Threatening ◽  
Benign Nature ◽  
The Common

A report of three cases of spontaneous rectus sheath haematoma within a 1-month period in a single hospital. The common feature was the recent treatment with low molecular weight heparin. In contrast to the perceived benign nature of the classically-described haematoma, the cases described were life-threatening and required aggressive intervention.

scholarly journals Rectus sheath hematoma in patients receiving subcutaneous enoxaparin: A case series of five patients

2020 ◽  
Vol 8 (12) ◽  
pp. 3432-3439
Author(s):  
Diogo Mendes ◽  
Ana Penedones ◽  
Michele Martins ◽  
Susana Cavadas ◽  
Carlos Alves ◽  
...  
Keyword(s):  
Case Series ◽  
Rectus Sheath ◽  
Subcutaneous Enoxaparin ◽  
Rectus Sheath Hematoma

scholarly journals Hematocrit Sign Elucidates Cause of Abdominal Pain

POCUS Journal ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 8-9
Author(s):  
Jeffrey Lam ◽  
Steven Montague
Keyword(s):  
Point Of Care ◽  
Rectus Sheath ◽  
Point Of Care Ultrasound ◽  
Spontaneous Movement ◽  
Appropriate Care ◽  
Life Threatening ◽  
Catheter Site ◽  
Bedside Diagnosis ◽  
Threatening Situation ◽  
Rectus Sheath Hematoma

A 78-year-old male with chronic kidney disease on peritoneal dialysis developed unprovoked bilateral pulmonary embolisms. He was started on IV unfractionated heparin, but shortly thereafter developed severe pain and a small firm abdominal nodule near his dialysis catheter site. The diagnosis was unknown, and the initial plan was watchful waiting, until point-of-care ultrasound (POCUS) was used. POCUS revealed an ovoid mass with hyperdensity in the gravity dependent regions with spontaneous movement. This appearance was classic for the hematocrit sign. When combined with the clinical presentation, this was concerning for a rectus sheath hematoma. An urgent CT of the abdomen confirmed this several hours later. POCUS allowed for rapid bedside diagnosis, which expedited appropriate care in a potentially life-threatening situation.

Prophylactic unfractionated heparin and hemorrhage in neurocritically ill underweight patients: A case series and review of the literature

2020 ◽  
Vol 77 (19) ◽  
pp. 1571-1577
Author(s):  
Sean M McConachie ◽  
Amy Morin ◽  
Karim Mouabbi ◽  
Ayman O Soubani ◽  
Krista Wahby
Keyword(s):  
Unfractionated Heparin ◽  
Subdural Hematoma ◽  
Obstructive Hydrocephalus ◽  
Case Series ◽  
Stable Condition ◽  
Rectus Sheath ◽  
Chronic Subdural Hematoma ◽  
Underweight Patients ◽  
Medical Histories ◽  
Rectus Sheath Hematoma

Abstract Purpose Three cases of major bleeding associated with thromboprophylactic unfractionated heparin (UFH) therapy in underweight neurocritically ill patients are reported. Summary Three underweight patients (body mass index of <18.5 kg/m2) were treated in the intensive care unit with major bleeds associated with UFH thromboprophylaxis. Two of the patients, a 76-year-old female and a 56-year-old female, had hemorrhages on presentation; the third patient, a 29-year-old male, developed bleeding during his admission. All 3 patients had past medical histories consisting of acute neurologic conditions within 6 weeks of presentation, including subdural hematoma, subarachnoid hemorrhage, and obstructive hydrocephalus secondary to a brain mass. All hemorrhages developed following the receipt of prophylactic UFH at doses of 5,000 units every 8 to 12 hours, which translated to high weight-based dosages (>300 units/kg/d). Additionally, hemorrhages were associated with prolonged activated partial thromboplastin time, which declined following heparin discontinuation. The major bleeds following UFH administration included an acute on chronic subdural hematoma, acute rectus sheath hematoma, and cerebellar hematoma. Stabilization of the subdural hematoma was achieved without the use of protamine and the patient was discharged in stable condition. The other 2 patients expired secondary to their hemorrhagic events. Naranjo nomogram scores for the patients indicated that heparin was the probable cause of bleed in 2 cases and a possible cause in 1 case. Conclusion Three major hemorrhages developed following the administration of UFH. Underweight patients with neurologic injury may require increased clinical vigilance, reduced doses, and pharmacodynamic monitoring to improve safety outcomes associated with thromboprophylaxis.

scholarly journals Wandering Fibroid: An Unusual Complication Arising from an Unusual Location

2018 ◽  
Vol 01 (01) ◽  
pp. 065-068
Author(s):  
Nilu Malpani Dhoot ◽  
Gobindo Pramanick ◽  
Manash Saha ◽  
J Kishor Gupta ◽  
Milan Chetry ◽  
...  
Keyword(s):  
Anterior Abdominal Wall ◽  
Uterine Fibroids ◽  
Rectus Sheath ◽  
Unusual Complication ◽  
Solid Mass ◽  
Inferior Epigastric Artery ◽  
Epigastric Artery ◽  
Life Threatening ◽  
Rectus Sheath Hematoma ◽  
Artery Branch

AbstractWandering fibroids are exceedingly uncommon extrauterine neoplasms. They occur in unusual locations that can confound imaging and diagnosis. We present a case of a woman, with a lump in the abdomen, whose imaging revealed uterine fibroids and an apparently unrelated solid mass adherent to the anterior abdominal wall. Guided biopsy resulted in the unusual complication of an inferior epigastric artery branch injury for which embolization was done. Post embolization, the size of the mass reduced. Iatrogenic inferior epigastric artery injury is rare and can result in a large rectus sheath hematoma. Active bleeding is life threatening and warrants immediate intervention.

scholarly journals Rectus sheath hematoma associated with apixaban

2017 ◽  
Vol 7 (3) ◽  
Author(s):  
Kulothungan Gunasekaran ◽  
Amanda R. McFee Winans ◽  
Swetha Murthi ◽  
Mudassar Raees Ahmad ◽  
Scott Kaatz
Keyword(s):  
Computed Tomography ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Early Recognition ◽  
Rectus Sheath ◽  
Factor Xa ◽  
Bleeding Complications ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Rectus Sheath Hematoma

Apixaban is an oral anticoagulant that directly inhibits Factor Xa and is indicated for the prophylaxis and treatment of deep venous thrombosis and stroke prevention in non-valvular atrial fibrillation. Rectus sheath hematoma is a rare, life-threatening complication of anticoagulant treatment. We describe a case of an elderly patient on apixaban for the treatment of deep venous thrombosis who developed severe abdominal pain during hospitalization. Computed tomography of the abdomen revealed left rectus sheath hematoma. Apixaban was discontinued and the patient was monitored for extension of the hematoma. After 2 days she was discharged home. Outpatient computed tomography 1 month later showed complete resolution of the rectus sheath hematoma. We recommend that clinicians become aware of the potential for rare and serious bleeding complications of anticoagulants and identify the need for early recognition and prompt management.

Presentation and Management of Giant Fibrovascular Polyps of the Hypopharynx and Esophagus

2016 ◽  
Vol 126 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Julina Ongkasuwan ◽  
C. Lane Anzalone ◽  
Esperanza Salazar ◽  
Donald T. Donovan
Keyword(s):  
Surgical Management ◽  
Medical Center ◽  
Case Reports ◽  
Case Series ◽  
Surgical Approaches ◽  
Airway Compromise ◽  
Endoscopic Removal ◽  
Lateral Pharyngotomy ◽  
Institutional Experience ◽  
Life Threatening

Objective: Fibrovascular polyps of the hypopharynx and esophagus are rare, with few case reports in the literature. In this article, we present our institutional experience with a focus on airway and surgical management. Study Design: Case series. Setting: Tertiary academic institution. Methods: A retrospective review was conducted of 4 patients that presented to a tertiary medical center with fibrovascular polyps between 1990 and 2012. Patient demographics, clinical presentation, diagnostic studies, and surgical approaches were reviewed. A review of the published literature was also performed. Results: The average age at presentation was 72 years (range, 59-85 years). Among the 4 patients, 2 presented with airway compromise requiring tracheotomy. All patients had removal of the polyp shortly after presentation; 2 underwent transcervical approaches with lateral pharyngotomy/esophagotomy, and the other 2 had endoscopic removal. The polyps arose from the hypopharynx in 3 patients and upper esophagus in 1. Three patients had complete resolution of their symptoms and remained disease free. One patient had recurrence of the polyp 2 years later and is currently being observed. Conclusion: Fibrovascular polyps are rare tumors of the hypopharynx/esophagus that present in older adults. Although benign, they can cause life-threatening airway compromise that may necessitate tracheotomy. We present 4 cases of fibrovascular polyps and discuss our evolving surgical management, including endoscopic removal.

Sign in / Sign up

Export Citation Format

Share Document