Endovascular management of the rectus muscle hematoma View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2015-02-20

AUTHORS

Stefano Pieri, Paolo Agresti, Grazia Loretta Buquicchio, Ilenia Di Giampietro, Margherita Trinci, Vittorio Miele

ABSTRACT

PurposeNon-traumatic spontaneous hematoma of the rectus abdominal muscle is not considered a critical condition. Nevertheless, it can be a serious complication in some patients due to continuous and/or consistent bleeding. The most frequent cause of spontaneous rectus muscle hematoma is the anticoagulation therapy. The natural history of rectus muscle hematoma usually leads to a positive outcome and can be spontaneously self-limited only by conservative therapy. Nevertheless, in some patients, despite a correct and early medical therapy, the continuous bleeding requests a more radical handling. Up to now, the surgical hematoma evacuation and the bonding of blood vessels were considered the most appropriate treatment, while at present, the percutaneous management by means of selective catheters and embolization of the bleeding vessel is considered to be the most used option. Our purpose is to report our experience in the endovascular spontaneous rectus muscle bleeding treatment in the elderly patients.Materials and methodsFrom the data base and medical reports of the hospital, we selected 144 medical reports. We focused on those cases that showed the following criteria: patients with rectus muscle hematoma undergoing anticoagulation therapy and/or non-traumatic spontaneous hematoma and with persistent bleeding revealed on CT examination despite a pharmacological treatment aimed to timely reverse coagulopathy. These criteria were found in 18 patients: 15 females and 3 males, with a median age of 73 (range 64–81). In all patients, the diagnosis had been confirmed by an abdominal CT in emergency setting, performed before and after contrast medium intravenous administration. Because of clinical conditions, all patients had been moved on the angiographic room for diagnostic arteriography and embolization. The criteria for this treatment were hemodynamic instability and the continuous bleeding despite the correct medical therapy.ResultsCT imaging detected rectus muscle hematoma in 18/18 patients and active bleeding in 7/18 patients. Selective catheterization was applied to all 18 patients; arteriographic study confirmed the information of the CT study in all of the seven patients. The inferior epigastric artery was the main cause of the bleeding in all 18 patients. In 14 patients, one single vessel was responsible for the bleeding, while in the other four patients, more than one vessel were involved: In two patients, we also found the involvement of the superior epigastric artery; while the other two patients showed also the involvement of the deep iliac circumflex artery. The material for embolization was compatible coils with micro-catheters in 17/18 patients, and glue for 1/18 patient.Conclusions Patients with large rectus muscle hematoma, which have not yet recovered with conservative therapy, should then consider undergoing endovascular treatment. This procedure is highly recommended in patients with other coexisting pathologies that could eventually lead to a fatal outcome. It is difficult to determine when surgery is necessary when there is very poor data provided by scientific literature review, so the decision to use surgery can be suggested when embolization is unsuccessful or when it is necessary to evacuate a complex huge fluid mass in peritoneal cavity. More... »

PAGES

951-958

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s11547-015-0516-2

DOI

http://dx.doi.org/10.1007/s11547-015-0516-2

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1030613802

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25698300


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82 embolization
83 emergency setting
84 endovascular management
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86 endovascular treatment
87 epigastric artery
88 evacuation
89 examination
90 experience
91 fatal outcome
92 females
93 fluid mass
94 frequent cause
95 glue
96 handling
97 hematoma
98 hematoma evacuation
99 hemodynamic instability
100 history
101 hospital
102 huge fluid mass
103 iliac circumflex artery
104 inferior epigastric artery
105 information
106 instability
107 intravenous administration
108 involvement
109 large rectus muscle hematoma
110 literature review
111 main cause
112 males
113 management
114 mass
115 materials
116 means
117 median age
118 medical reports
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120 medium intravenous administration
121 muscle
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123 muscle hematoma
124 natural history
125 non-traumatic spontaneous hematoma
126 options
127 outcomes
128 pathology
129 patients
130 percutaneous management
131 peritoneal cavity
132 persistent bleeding
133 pharmacological treatment
134 poor data
135 positive outcomes
136 present
137 procedure
138 purpose
139 radical handling
140 rectus abdominal muscle
141 rectus muscle bleeding treatment
142 rectus muscle hematoma
143 report
144 review
145 room
146 scientific literature review
147 selective catheter
148 selective catheterization
149 serious complications
150 setting
151 single vessel
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153 spontaneous rectus muscle bleeding treatment
154 spontaneous rectus muscle hematoma
155 study
156 superior epigastric artery
157 surgery
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159 therapy
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162 vessels
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