1/9. Multiple postoperative intracerebral haematomas remote from the site of craniotomy.A postoperative haemorrhage is a common and serious complication of a neurosurgical procedure. It usually occurs at the site of the surgery, but on occasion a postoperative haematoma is found at a distance from the previous craniotomy. Multiple postoperative haemorrhages are extremely rare. We report the case of a 63-year-old woman, operated on for the removal of a supratentorial astrocytoma, who developed in the early post-operative period multiple bilateral intracerebral haematomas without involvement of the surgical bed.- - - - - - - - - - ranking = 1keywords = haematoma (Clic here for more details about this article) |
2/9. Cerebellar haemorrhage after evacuation of an acute supratentorial subdural haematoma.Recent reports have highlighted the unusual complication of distant cerebellar haemorrhage after supratentorial craniotomy, with only 25 previous cases reported in the literature. Nearly all reported cases occurred after craniotomy for temporal lobectomy or for deep seated intracerebral pathology requiring brain retraction and removal of CSF at surgery. Only one previous case of a cerebellar haemorrhage after evacuation of an extracerebral fluid collection has been reported. We describe the case of a cerebellar haemorrhage complicating the evacuation of an acute/subacute supratentorial subdural haematoma in a 83-year-old woman. The literature is reviewed and possible mechanisms of haemorrhage discussed.- - - - - - - - - - ranking = 0.83333333333333keywords = haematoma (Clic here for more details about this article) |
3/9. life-threatening haemorrhage after elevation of a fractured zygoma.A 21-year-old man presented with a fractured left zygoma after an alleged assault. The fracture was elevated four days later, at which time he had a brisk left-sided epistaxis. Recovery was uneventful except for a haematoma that was drained a month later. Two weeks after this, he was admitted after having collapsed. He was shocked and bleeding profusely from his nose. He had a further major bleed in hospital and this was treated by tying off the left external carotid artery. He has made an uneventful recovery and investigations have shown no bleeding diathesis.- - - - - - - - - - ranking = 0.16666666666667keywords = haematoma (Clic here for more details about this article) |
4/9. Surreptitious bleeding in surgery: a major challenge in coagulation.Apart from inadequate surgical haemostasis, postoperative bleeding can be related to acquired disorders of platelet number, platelet function or coagulation proteins (e.g. vitamin k deficiency, DIC or liver injury). We highlight our experience with three patients who suffered life-threatening bleeding in the postoperative setting. The three patients - a 47-year-old man and 70- and 74-year-old women -- all had negative histories for excessive bleeding with prior surgeries, and all had normal preoperative PT and aPTT tests. Surgeries were resection of ischaemic bowel, cholecystectomy and coronary artery bypass grafting. All patients experienced unexpected bleeding within the first few postoperative days requiring multiple red cell transfusions and surgical re-explorations. Evaluations within the first 4--7 days after surgery revealed that these three patients had developed prolonged aPTT due to demonstrable factor viii antibodies initially at low titre. One patient was treated with high doses human factor viii, corticosteroids, intravenous gammaglobulin and plasma exchanges. The inhibitor was no longer demonstrable after 6 weeks of such therapy, and he has remained in remission without therapy. The second patient was initially treated with high-dose human factor viii infusions. Five months later, prednisone and 6-mercaptopurine were begun for worsening inhibitor titre and diffuse purpura and subcutaneous haematomas. The factor inhibitor remitted, but the patient died from liver failure related to post-transfusion hepatitis. The third patient was initially managed with high-dose human factor viii. Two months later, worsening inhibitor titre and tongue haematoma was treated with activated prothrombin complex, corticosteroids and cyclophosphamide. Eight years later, she is on no therapy, demonstrates a mild bleeding tendency and has a stable low-titre inhibitor. There have been a few case reports of inhibitors to coagulation factors including factor viii becoming manifest in the postoperative setting but surgery has not been widely recognized as an underlying cause for acquired haemophilia. This paper speculates on pathogenesis and reviews treatment options. This syndrome is remarkable for its abrupt onset in the first few postoperative days and for its substantial morbidity. The problem is potentially reversible with immunosuppressive therapy. Clinicians should be aware of this syndrome, considering acquired haemophilia in patients with unexpected postoperative bleeding.- - - - - - - - - - ranking = 0.33333333333333keywords = haematoma (Clic here for more details about this article) |
5/9. Haematoma of the floor of the mouth following implant placement.Placement of implants in the anterior mandibular region is generally regarded as a routine, safe procedure. This case report describes an extensive haematoma in the floor of the mouth, following such a procedure, which rapidly became life-threatening, requiring an emergency tracheostomy to establish a surgical airway. The anatomic, radiographic and surgical aspects to the problem are discussed. Finally, when undertaking such procedures it is advisable to perform them reasonably close to a hospital where such a complication can be effectively and promptly handled by suitably trained persons.- - - - - - - - - - ranking = 0.16666666666667keywords = haematoma (Clic here for more details about this article) |
6/9. Spinal subdural haematoma mimicking tethered cord after posterior fossa open surgery.We report the MRI findings in a girl aged 3 years and 10 months who developed a spinal subdural haematoma after posterior fossa open surgery for cerebellar malignant rhabdoid tumour. Emergency surgery was performed immediately because of increased intracranial pressure. Control MRI 48 h after surgery showed a spinal subdural haematoma without clinical signs of paresis or bladder dysfunction. Spinal subdural haematoma is rare, and only few cases have been reported, especially in children. This report suggests that "silent" (without clinical symptoms) postoperative spinal acute subdural haemorrhage can occur after posterior fossa surgery.- - - - - - - - - - ranking = 1.1666666666667keywords = haematoma (Clic here for more details about this article) |
7/9. Foreign body reaction to calcium alginate fibre mimicking recurrent tumour of the submandibular salivary gland.A 50-year-old woman was referred after the discovery of adenoid cystic carcinoma in an excised left submandibular gland. Treatment involved clearance of the left submandibular fossa, and bilateral levels II and III selective neck dissections. A left-sided submandibular haematoma developed during the immediate postoperative period. After removal of the clot, there was a persistent, low volume capillary ooze from the left submandibular fossa and a calcium alginate fibre pack (Kaltostat) was left in place to control the bleeding. After an extended period of time the pack excited a foreign body reaction which, on a computed tomogram, mimicked a recurrence of the tumour. We review the role of Kaltostat in this setting and its potential for foreign body reaction, which may mimic serious disease.- - - - - - - - - - ranking = 0.16666666666667keywords = haematoma (Clic here for more details about this article) |
8/9. Preoperative monitoring of warfarin in cutaneous surgery.BACKGROUND: We report a patient who developed postoperative bleeding as a result of inadvertent excessive warfarin intake. We subsequently introduced a policy of checking the international normalization ratio (INR) 24 h before cutaneous surgery for all patients on warfarin. OBJECTIVES: To review the perioperative INR and outcome of all patients on warfarin who had cutaneous surgery from January 1999 to June 2002 at the Department of dermatology, Sunderland Royal Hospital. methods: A retrospective review was undertaken from patients' medical records. RESULTS: Sixty-eight patients (1.84% of total) underwent 85 skin procedures comprising 33 excisions, 16 punch biopsies, 15 curettages, 13 diagnostic biopsies, five shave biopsies, two Mohs micrographic surgical excisions and one delayed reconstruction. Repairs included 50 direct closures, five secondary intention healing, seven local flaps, two full-thickness skin grafts and 20 by electrocautery. Forty-five surgical procedures were undertaken with the INR checked on the day of surgery, 37 procedures within 24 h, and three within 2 days. The preoperative INR ranged from 1.1 to 3.4, median 2.5. There was no excess intraoperative or postoperative bleeding or haematoma for all patients. CONCLUSIONS: Our experience supports the continued and safe use of warfarin for a wide variety of cutaneous surgical procedures with a preoperative INR of < 3.5. We recommend a routine INR before the procedure, preferably within 24 h.- - - - - - - - - - ranking = 0.16666666666667keywords = haematoma (Clic here for more details about this article) |
9/9. Rectus sheath haematoma (RSH) mimicking acute intra-abdominal pathology.AIM: Rectus sheath haematoma (RSH) is a rare cause of acute abdomen. We present a case series of patients seen at Wanganui Hospital, North Island, new zealand. methods: A retrospective survey of patients developing RSH over a 2-year period (from 2002 to 2004) in our hospital was carried out. RESULTS: Seven patients were identified with RSH (male:female ratio=6:1, age range=16-80 years). Six of the RSH were spontaneous and four out of these six were on anticoagulant therapy post-acute coronary event. Each presented with acute abdomen and all were missed on initial evaluation. Two were diagnosed initially as bowel obstruction, one as acute diverticulitis, one as incarcerated hernia, one as an ovarian mass, and another as non-specific abdominal pain. One patient had traumatic RSH with peritonitis secondary to accompanying jejunal perforation. The ultrasound pick-up rate was 50% of but computed tomography (CT) abdomen was 100% diagnostic. Five (70%) had a significant fall in haematocrit, requiring blood transfusion. All settled on conservative management, with one requiring admission to intensive care. CONCLUSION: Clinical diagnosis of RSH is unreliable. CT imaging is the procedure of choice and should be promptly carried out especially in those on anticoagulant therapy for early diagnosis and proper management.- - - - - - - - - - ranking = 0.83333333333333keywords = haematoma (Clic here for more details about this article) |