Bladder hematoma as an unusual cause or consequence of obstructed labour

Bladder hematoma is a rare complication but also an unusual mechanical cause of obstructed labour, whose incidence in India is 1-2%. The most common reason for intraluminal urinary bladder hematoma is trauma, but it can occur with cystitis, pelvic malignancy and irradiation. A large hematoma may mimic a neoplastic mass on imaging. We reported a first case of bladder hematoma as a cause or result of obstructed labour in a multipara where the diagnosis was made intraoperatively. This bladder complication also became the indication for classical caesarean section, the technique which is almost obsolete nowadays, where the indication for classical caesarean section was obligatory.

Endosurgical treatment of traumatic inferior gluteal artery pseudoaneurysm in adolescent

Inferior gluteal artery pseudoaneurysms are rare, and most of the cases are due to blunt (pelvic fractures, femur’s dislocations) or penetrating trauma. Herein, we present a case of traumatic blunt rupture of an inferior gluteal artery pseudoaneurysm in adolescent 15th years old. Patient went through the complex examination and endosurgical treatment: endovascular occlusion of inferior gluteal artery and endoscopic evacuation of the large hematoma. Patient in short time came back to his ordinary live and sport.

Adolf Gessner. - Zwei Fälle von Spontaner Uterusruptur. (Centralbl. F. Gynäk., 1895, No. 2). Two cases of arbitrary uterine rupture

1) In 35-year-olds, multiparous, with the correct pelvis, the transverse position of the fetus, the prolapse of the handle and umbilical cord were recognized. During anesthesia and disinfection of the genital parts, a left-sided rupture of the uterus and an upper cut of the vagina was detected, with the exit of the fetal head into the abdominal cavity. Turning and ejecting the child (2600 grm., 48 cm) in asphyxiation, soon revived. After removing it is easy. The gap is tamped. The phenomena of internal bleeding with all the manifestations of acute anemia were soon discovered. Charevosuchenie. There was a large hematoma in the left broad ligament; there is no continuing bleeding. The abdominal wound was sutured. The patient recovered.

Dual-chambered venous access port as alternative access for extracorporeal apheresis therapy

Purpose: To evaluate the use of a dual-chambered venous access port for extracorporeal apheresis therapy. Methods: This was a single-center retrospective analysis of all patients who received a dual-chambered venous access port for apheresis therapy over a 36-month period. Clinical success was defined as successful completion of at least one round of apheresis via the venous access port. Major complications were defined as any event requiring elevation of patient care and/or venous access port removal or repositioning. Minor complications were defined as venous access port issues resolved with clinical intervention. Results: Forty-four patients had a venous access port placed at the time of this study. Patients underwent red cell exchange (n = 33), therapeutic plasma exchange (n = 6) or extracorporeal photopheresis (n = 5). Forty (90%) patients had autoimmune diseases and four (10%) had neoplastic processes. Clinical success was achieved in 42 (95.5%) patients. Average venous access port dwell time was 632 days (range = 42–1191 days). All therapies through the venous access ports were well tolerated and no patients reported pain or discomfort. Major complications were seen in nine (20.5%) patients–the majority (n = 7) of which were due to venous access port malfunction–and resolved with catheter revision. One (2.27%) major complication involved an infected venous access port, and one involved a large hematoma at the venous access port site. Minor complications were seen in eight (18.2%) patients, where simple flushing of the catheter with saline or tissue plasminogen activator resolved the issue. Conclusion: The dual-chambered venous access port was successfully used for sustained blood flow in apheresis therapy with a moderate, yet correctable complication rate.

Endovascular treatment of acute tandem occlusion of the left internal carotid and middle cerebral arteries, which is a complication of carotid endarterectomy

Case of endovascular treatment of a patient with tandem left internal carotid artery (ICA) and middle cerebral artery (MCA), which was a complication of carotid endarterectomy, are presented. The rupture at the location of the suture in the bulb of the ICA during endovascular intervention required implantation of a graft-stent and subsequent removal of the hematoma in the neck soft tissues.A 51 year old man in the residual period of ischemic stroke in the left carotid basin with elements of sensory speech disorders, with subtotal stenosis in the bulb of the left ICA, stenosis 35 % in the bulb of the right ICA and severe hypoplasia of the A1-segment of the left anterior cerebral artery underwent left-side carotid endarterectomy. The next morning after surgery, 1 hour after awakening, a right-sided hemiparesis progressing to hemiplegia, total aphasia. The level of consciousness deteriorated to the sopor. A computer tomography was performed immediately. New ischemic lesions were not identified. Cerebral angiography revealed the occlusion from the mouth of the left ICA, occlusion in the M1-segment of the left MCA. Thrombospiration from MCA and ICA was performed with Sofia Plus distal approach catheter. The MCA was recanalized in one pass (mTICI 3), but the patency of the left ICA was not recovered. The anti-embolic device SpiderFX was introduced and opened in the C2-segment of the left ICA. Then, a slow inflation of the Submarine 5 × 20 mm balloon catheter was performed in the left ICA bulb. At a pressure of 4.0 atm, the balloon opened like an hourglass, indicating a rough rigid stenosis in the ICA bulb. At a pressure of 4.5 atm, the balloon fully opened. Immediately after balloon deflation, intense contrast extravasation is determined at the level of the ICA bulb. Inflation of the balloon at a pressure of 4 atm was performed again. Intubation of the trachea of ​​the patient was performed. Intravenous administration of 300 mg acetylsalicylic acid was initiated. The balloon catheter is deflated and withdrawn from vessels, the carotid stent Protégé 8–6×40 mm was implanted into the left ICA bulb and the left common carotid bifurcation segment. The bloodstream above the stent is not determined, but extravasation through the stent cells at the level of the former defect is determined. Stent graft Graftmaster 4×15 mm was implanted into the carotid stent at the level of the defect in the ICA. Stent graft was additionally opened in its lower part by a 5×20 mm balloon-catheter. Thrombaspiration from the left ICA was performed again. Patency of the ICA and intracranial arteries was totally restored – mTICI3, stenosis in the left ICA bulb was completely eliminated. The patient’s neurological status was restored to baseline. A large hematoma in the soft tissues of the neck to the left was determined. Only “old” ischemic foci in the left temporal lobe were determined on brain CT, a large hematoma laterally and anteriorly to the carotid artery was determined in the soft tissues of the left side of the neck on computer tomography. Ticagrelor was added to aspirin therapy. Hematoma was removed surgically. The postoperative period was unremarkable. The patient was discharged from the clinic in good condition with an level modified Rankin scale 1.In the presented case, the friendly work of different profiles specialists avoided the devastating consequences of such a relatively rare complication of carotid endarterectomy as cerebral arteries tandem thrombosis. The availability of graft-stents in access to interventional neuroradiologists is extremely important in such cases.

Comparison of endoscopic evacuation, stereotactic aspiration, and craniotomy for treatment of basal ganglia hemorrhage

BackgroundThe main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques.ObjectiveTo explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage.MethodsFive hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes.ResultsFor the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40–<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551).ConclusionEndoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.

Infected delayed puerperal hematoma complicated by retention of urine: a case report and literature review

The puerperal hematoma corresponds to a tissue cleavage, most often paravaginal or vulvar, in which the vascular wounds, linked to the detachment, have no spontaneous tendency to haemostasis. The aggravation of this pathology is progressive. Diagnosis and management must be an obstetric emergency. Author report a case of infected puerperal hematoma complicated by rectal compression and acute retention of urine. This is a 26-year-old patient with a history of chronic hypertension. Labor was induced by misoprostol. The delivery was uneventful at 37 weeks vaginally. Ten days after delivery, she returned to the obstetrical emergency service for acute urine retention. The examination with the vaginal speculum showed a tumefaction of six centimeters on the left lateral side of the vagina. Surgical treatment has been performed. The suite was without particularity. The diagnosis of puerperal hematoma must be early. Even for the delayed form, the complications are identical. Blood loss, compression of proximity organs and infection are the most common complications. The care must be multidisciplinary. Resuscitation of the patient associated with haemostasis of the vessel is the main treatment in cases of large hematoma with hemodynamic instability.

A large bladder hematoma resulting from infectious hemorrhagic cystitis after pelvic reconstruction with transvaginal mesh: An unusual complication

A large hematoma resulting from hemorrhagic cystitis after uncomplicated pelvic reconstruction surgery with a transvaginal mesh is rare. A 66-year-old female who underwent pelvic reconstruction with transvaginal mesh presented with acute urinary retention and hematuria on postoperative day 10. Leukocytosis, pyuria, and hematuria were noted in the emergency room. After using cystoscopy to irrigate the coagulum, there was no mesh erosion or bladder perforation on inspection. A large bladder hematoma resulting from infectious hemorrhagic cystitis was confirmed, and uropathogenic Escherichia coli was isolated. The clinical condition improved after a 1-week treatment with an indwelling Foley catheter and oral antibiotics. Careful aseptic techniques and antibiotic prophylaxis reduce bacterial contamination only for brief periods of time, and patients may still be at risk for delayed infections. The possible modalities to prevent postoperative urinary tract infection after pelvic reconstruction surgery with transvaginal mesh include shortening the indwelling Foley catheter period and administration of an additional antibiotic during catheter removal. However, the antibiotic policies for pelvic reconstruction with transvaginal mesh demand further cost analyses.