Spontaneous rectus sheath hematoma– cause of acute abdomen in patients on anticoagulant therapy: two case reports

2020 ◽  
Vol 12 (2) ◽  
pp. 71-80
Author(s):  
Dimitar Petreski ◽  
Natalija Cokleska ◽  
Lazar Todorovic ◽  
Marjan Kamiloski ◽  
Shaban Memeti ◽  
...  
Keyword(s):  
Case Reports ◽  
Rectus Sheath ◽  
Sudden Onset ◽  
Epigastric Vessel ◽  
Therapeutic Program ◽  
Good General Condition ◽  
Muscle Tear ◽  
History Of ◽  
Rectus Sheath Hematoma ◽  
Supportive Management

(Spontaneus)  Rectus sheath hematoma ((S)RSH) is an accumulation of blood in the sheath of the rectus abdominis muscle, secondary to rupture of an epigastric vessel or muscle tear. It is defined as spontaneous in patients without history of abdominal trauma. It can be located supra- or infraumbilically. Although the exact incidence is unknown, Klingler et al. observed 23 cases (1.8%) of rectus sheath hematoma among 1257 patients evaluated by ultrasound for acute abdominal disorders.  Ultrasonography can help in the diagnosis, but CT scan is most accurate in its ability to define the lesion. When diagnosed clinically, a conservative therapeutic program can usually be instituted. Only in cases of supportive management failure, progressive and large hematoma or uncontrollable hemodynamic patients, interventional management including surgery or less invasive newer techniques is indicated. Case presentation: We present two cases of SRSH in patients using oral anticoagulant agent (acenocoumarol). Their chief complaint was sudden onset of acute abdominal pain. On admission they were haemodynamically stable. After thorough clinical evaluation a suspicion for SRSH diagnosis was made and then confirmed by ultrasonography and CT. Both of them were successfully treated conservatively and discharged home in a good general condition. Conclusion: These two cases illustrate the accurate diagnosis of SRSH treated conservatively leading to optimal patient outcomes.

scholarly journals Rectus sheath hematoma: three case reports

2008 ◽  
Vol 2 (1) ◽  
Author(s):  
Selin Kapan ◽  
Ahmet N. Turhan ◽  
Halil Alis ◽  
Mustafa U. Kalayci ◽  
Sinan Hatipoglu ◽  
...  
Keyword(s):  
Case Reports ◽  
Rectus Sheath ◽  
Rectus Sheath Hematoma

scholarly journals Usefulness of the Electrocardiogram in a Patient Presenting with Right-Sided Pneumothorax and Presyncope

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1069
Author(s):  
Lavinia Maria Florescu ◽  
Călina-Patricia Țentea ◽  
Csilla-Andrea Eötvös ◽  
Roxana-Daiana Lazar ◽  
Iulia-Georgiana Zehan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Case Reports ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Sudden Onset ◽  
Artery Bypass Graft ◽  
Multivessel Coronary Artery Disease ◽  
Ecg Changes ◽  
History Of ◽  
Artery Disease

We present the case of a 71-year-old man with history of smoking, pulmonary emphysema, hypertension, multivessel coronary artery disease and prior coronary artery bypass graft surgery who presented with spontaneous right-sided pneumothorax associated with phasic changes of the QRS amplitude on the electrocardiogram. While several case reports have described QRS amplitude changes associated with left-sided pneumothorax, reports of phasic ECG changes in right-sided pneumothorax are exceedingly rare. Such changes, when present in a patient with sudden onset chest pain and dyspnea, should prompt a diagnostic workup for possible pneumothorax.

scholarly journals Ultrasound Therapy in Rectus Sheath Hematoma

2005 ◽  
Vol 85 (4) ◽  
pp. 352-357 ◽  
Author(s):  
Juan D Berná-Serna ◽  
Juan Sánchez-Garre ◽  
Manuel Madrigal ◽  
Isabel Zuazu ◽  
Juan D Berná-Mestre
Keyword(s):  
Case Report ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant Therapy ◽  
Rectus Sheath ◽  
Ultrasound Therapy ◽  
Case Description ◽  
Management Intervention ◽  
Computed Tomographic ◽  
History Of ◽  
Rectus Sheath Hematoma

Abstract Background and Purpose. Ultrasound (US) is one of the most common modalities used in intervention for musculoskeletal disorders, although its effectiveness is debated. The purpose of this case report is to describe the intervention, including the use of US, in the management of a large rectus sheath hematoma (RSH) in a patient receiving anticoagulant therapy. Case Description. The patient was a 62-year-old woman with RSH who was receiving oral anticoagulant therapy and had a history of bouts of coughing. Computed tomographic scans verified the diagnosis of RSH. The report describes the patient examination, management, intervention, and outcomes. Outcomes. The intervention, including the use of US therapy, may have enabled a rapid resolution of the hematoma. Discussion. This case report illustrates how US may be a useful modality for complementary management of RSH, helping the reabsorption of the hematoma.

scholarly journals Spontaneous giant rectus sheath hematoma in patients with COVID-19: two case reports and literature review

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Behzad Nematihonar ◽  
Shohra Qaderi ◽  
Jaffer Shah ◽  
Javad zebarjadi Bagherpour
Keyword(s):  
Literature Review ◽  
Physical Examination ◽  
Case Reports ◽  
Anticoagulation Therapy ◽  
Clinical Manifestations ◽  
Rectus Sheath ◽  
Global Public Health ◽  
Abdomen Ct ◽  
Tender Mass ◽  
Rectus Sheath Hematoma

Abstract Introduction Coronavirus disease 2019, COVID-19, as a global public health emergency, has come with a broad spectrum of clinical manifestations and complications. In this study, we present a unique complication of this disease. Presentation of cases (A) A 65-year-old woman with a known case of COVID-19; on the second day of admission, the patient presented sudden tachycardia and hypogastric pain; on abdomen physical examination, a huge lower abdominal tender mass was noticed. (B) A 50-year-old woman with COVID-19, 4 days after admission, started complaining of tachycardia, pain, and mass in the lower abdomen. On abdomen physical examination, a huge lower abdominal tender mass was noticed. Both of the patients underwent an abdomen CT scan which confirmed a huge rectus sheath hematoma (RSH). Both of the patients underwent angioembolization of the inferior epigastric artery. The patient recovered completely and no evidence of further expansion was seen after 2 weeks of follow-up. Discussion Hemorrhagic issues in COVID-19 patients remain poorly understood. Physicians should discuss risks of RSH in patients where continuous anticoagulation therapy will be reinstated. With increased clinician awareness of the need for RSH screening in COVID-19 patients with acute abdominal pain, the interprofessional team of healthcare providers can maximize patient safety and reduce hospitalization time, especially in high-risk patients at risk for unnecessary surgery. Conclusions These two reports and literature review demonstrate the need of active surveillance for possible hemorrhagic complications in patients with COVID-19 infection.

scholarly journals SAT-214 Steroid Induced Pheochromocytoma Crisis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Danielle Eagan ◽  
Juan Munoz Pena ◽  
Diana Barb
Keyword(s):  
Orthostatic Hypotension ◽  
Case Reports ◽  
Adrenal Adenoma ◽  
Sudden Onset ◽  
Volume Depletion ◽  
Target Organs ◽  
High Clinical Suspicion ◽  
History Of ◽  
Slight Elevation ◽  
Urine Metanephrines

Abstract BACKGROUND: The factors triggering adrenergic crisis in pheochromocytoma are most often related to induction during anesthesia or manipulation of tumor during surgery. A variety of drugs have also been reported to be associated with adrenergic crisis, however there are only scarce case reports on pheochromocytoma crisis induced by steroids. Here we present a case of steroid induced pheochromocytoma crisis. Clinical Case: 58 year-old female with history controlled hypertension on Lisinopril 10 mg daily, presented to hospital with two day history of fatigue, shortness of breath, and abdominal pain. A CT chest and abdomen showed emphysema and an indeterminate right adrenal gland nodule. Due to patient symptoms and findings of emphysema patient was started on Prednisone 40 mg daily. Home Lisinopril was restarted and patient was placed on sodium restriction. Ten hours after the start of prednisone the patient developed sudden onset hypertension with BP >200/100 mmHg for which she was given labetalol intravenously. The patient developed orthostatic hypotension hours after with BP readings as low as 50s/40s. Due to labile BP a work-up for adrenal adenoma was started. Plasma and urine metanephrines and noremetanephrines returned 7–11 times and 4–15 times above upper limit of normal (ULN) respectively. Plasma and urine metanephrines were repeated when patient was off steroids and normotensive and still returned abnormally high (about 2–3 times ULN) along with elevated urine catecholamines (epinephrine 6.5 times ULN and with only a slight elevation in norephinephrine and normal dopamine levels). A dedicated adrenal scan showed a 2.2 cm right adrenal mass with homogeneous enhancement, 130 HU, with an absolute and relative washout of 65% and 44% respectively, not consistent with a benign adenoma. Patient was placed on a high salt diet along with fluids and doxasozin. Once appropriately alpha blocked, metoprolol was added prior to surgery. Clinical lessons: In the setting of labile BP, one should keep a high clinical suspicion for pheochromocytoma. Orthostatic hypotension here was related to epinephrine predominance pattern of secretion and volume depletion. Steroids should be avoided in patients with known pheochromocytoma or in those with an adrenal adenoma without a negative biochemical workup for a pheochromocytoma as it could precipitate an adrenergic crisis possibly by inducing catecholamine synthesis and release and sensitizing target organs to the effects of catecholamines. Reference: 1. Rosas AL, et al. Pheochromocytoma crisis induced by glucocorticoids: a report of four cases and review of the literature. European Journal of Endocrinology (2008) 158 423–429.

scholarly journals Fatal rectus sheath hematoma: a rare autopsy phenomenon

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Akma Nurain Fairuz Mahamad Arif ◽  
Sharifah Safoorah Syed Alwee Al’Aidrus
Keyword(s):  
Rectus Sheath ◽  
Rectus Muscle ◽  
Lung Infection ◽  
Lower Quadrant ◽  
Case Presentation ◽  
Epigastric Artery ◽  
History Of ◽  
The Right ◽  
Rectus Sheath Hematoma ◽  
Underlying Pathology

Abstract Background Rectus sheath hematoma is a condition where blood is accumulated within the sheath of the rectus abdominis muscle. It is caused by the rupture of either the superior or inferior epigastric artery or from a direct tear of the rectus muscle itself. This condition is usually self-limiting and most of the time, the hematoma is small, non-expanding and can be reabsorbed spontaneously over time. However, certain underlying pathology may lead to the expansion of the hematoma or even a recurrence, and without any medical treatment or intervention, this condition can even be fatal. Due to its rarity, only a few published cases of fatality associated with rectus sheath hematoma are reported worldwide. Case presentation We present a case of non-traumatic fatal rectus sheath hematoma in the presence of underlying lung infection. The deceased complained of abdominal pain 2 days prior to death with a history of prolonged cough. The autopsy revealed the presence of a hematoma within the rectus sheath of the left lower quadrant of the abdomen extending down into the left pelvis and a multitude of small yellow-tan firm lesions scattered throughout the parenchyma of the right lung, suggestive of a lung infection which was later confirmed histologically. Conclusions The case serves to increase awareness of fatal rectus sheath hematoma as a cause of death given its rarity in forensic medicine practice. The importance of a thorough post-mortem examination is the key to noticing the fatal hematoma since its enclosed location within the rectus sheath may be obscured to the eye of an inexperienced prosector.

Herpetic Whitlow of the Hand in Infants

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Nada G. AlQadri ◽  
Ghada AlHayaza
Keyword(s):  
Bacterial Infection ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Senior Author ◽  
Secondary Bacterial Infection ◽  
Clinical Appearance ◽  
History Of ◽  
Mode Of Transmission ◽  
Time Of Presentation

Abstract Introduction Herpetic whitlows in infants are rare. Previous authors only reported individual case reports. We present a case series of six infants. Materials and Methods This is a retrospective study of six cases of herpetic whitlows in infants seen by the senior author (MMA) over the past 23 years (1995–2017 inclusive). The following data were collected: age, sex, digit involved in the hand, mode of transmission, time of presentation to the author, clinical appearance, presence of secondary bacterial infection, presence of other lesions outside the hand, method of diagnosis, treatment, and outcome. Results All six infants initially presented with classic multiple vesicles of the digital pulp. In all cases, there was a history of active herpes labialis in the mother. Incision and drainage or deroofing of the vesicles (for diagnostic purposes) resulted in secondary bacterial infection. Conclusion The current report is the first series in the literature on herpetic whitlows in infants. We stress on the mode of transmission (from the mother) and establishing the diagnosis clinically. In these cases, no need for obtaining viral cultures or polymerase chain reaction; and no medications are required. Once the vesicles are disrupted, secondary bacterial infection is frequent and a combination of oral acyclovir and intravenous antibiotics will be required.

Acute Limb Ischaemia Following Elective Left Upper Lobectomy for Early NSCLC: A Rare but Serious Complication Arising from the Pulmonary Vein Stump

2020 ◽  
pp. 1-2
Author(s):  
James Elliott ◽  
Anand Iyer ◽  
James Elliott
Keyword(s):  
Pulmonary Vein ◽  
Ct Angiography ◽  
Mediastinal Lymph Node ◽  
Case Reports ◽  
Common Femoral Artery ◽  
Sudden Onset ◽  
Leg Pain ◽  
Limb Ischaemia ◽  
Left Upper Lobectomy ◽  
Acute Limb Ischaemia

Patients undergoing Left Upper Lobectomy (LUL) appear to be at risk of a unique post-operative complication that is not well-documented: Pulmonary Vein (PV) stump thrombosis +/- systemic arterial embolisation [1-3]. We describe the details of a rare case from our institution, present a review of this subject from the limited literature available, and suggest potential strategies to anticipate, detect and manage this entity. A 70 year old female patient underwent left upper lobectomy and mediastinal lymph node sampling via repeat left thoracotomy. The procedure was unremarkable apart from some adhesions. She progressed well post-operatively on the ward. On post-operative day 2 the patient developed sudden-onset left leg pain and paraesthesia and CT-Angiography confirmed the diagnosis of left common femoral artery embolus and left superior PV stump thrombosis. The patient returned to theatre for femoral embolectomy, continued systemic anticoagulation, and made an excellent recovery thereafter. The aetiology of this complication has been documented in some case reports, but it is not explored further in trials or thoracic surgery texts [2-3]. One cohort study involving CT-angiography after lobectomy surgeries found that left upper lobectomy was unique as a risk factor for PV stump thrombosis1. It may be related to the relatively longer LSPV stump and stasis of blood in the stump [4].

scholarly journals Spontaneous haemorrhage of an adrenal angiomyolipoma: case report

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
Danielle Whiting ◽  
Ian Rudd ◽  
Amit Goel ◽  
Seshadri Sriprasad ◽  
Sanjeev Madaan
Keyword(s):  
Case Reports ◽  
Case Presentation ◽  
Open Adrenalectomy ◽  
Large Size ◽  
History Of ◽  
Loin Pain ◽  
Benign Tumours ◽  
Spontaneous Haemorrhage ◽  
Mesenchymal Tumours

Abstract Background Angiomyolipomas are rare mesenchymal tumours arising from the perivascular epithelioid cells consisting of variable amounts of adipose, thick-walled blood vessels and smooth muscle cells. These benign tumours commonly occur in the kidney with only a few case reports of adrenal angiomyolipomas which have the potential to reach a large size and haemorrhage. Case presentation A 45-year-old lady presented with a 3-week history of right loin pain, nausea and vomiting. A CT scan revealed a right adrenal angiomyolipoma measuring 6.3 × 6.8 cm with associated haemorrhage. The lesion was successfully treated with right open adrenalectomy, and histology confirmed the diagnosis of adrenal angiomyolipoma. The patient remained well with no evidence of recurrence at the 36-month follow-up. Conclusion Adrenal angiomyolipomas are rare benign tumours that have the ability to reach a large size and potential to bleed. Here, we report the second case of spontaneous haemorrhage in an adrenal angiomyolipoma, which was successfully treated with open adrenalectomy.

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