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Abdominal Wall Hematoma

Abdominal Wall Haematoma


Presentation

  • An 87-year-old male patient known to have polycythemia vera presented at the hospital as an acute abdominal emergency.[ncbi.nlm.nih.gov]
Collapse
  • CASE REPORT An 80-year-old female had collapsed and had been found on the floor, before being diagnosed with cerebral infarction at another hospital, 2 weeks before being seen at our hospital.[kjccm.org]
Soft Tissue Mass
  • […] bhau Infectious Diseases Liver abscess Apes Radiology And Nuclear Medicine Soft tissue mass meri Radiology And Nuclear Medicine Infiltrative anterior abdominal wall mass. Differentials include soft tissue sarcoma, fibrosarcoma and Desmond tumor.[app.figure1.com]
Intermittent Fever
  • Antibiotic therapy was changed to piperacillin sodium with tazobactam sodium combined with quinolone therapy, because she had developed intermittent fever. A serial follow-up chest X-ray showed slight worsening of the chest consolidation.[kjccm.org]
High Fever
  • On day 4 of hospitalization, she complained of severe coughing and developed a high fever of 38 C with dyspnea. She was treated immediately with 2-g of ceftriaxone once/day.[kjccm.org]
Abdominal Pain
  • Although it is a very rare entity, rectus sheath hematoma should be included in the differential diagnosis of every pregnant patient who presents with abdominal pain.[degruyter.com]
  • A fifty-seven-year-old male patient on warfarin therapy presented to the emergency department with severe abdominal pain that had started after a cough episode and persisted for four days.[ncbi.nlm.nih.gov]
  • In severely coughing patients, sudden abdominal pain together with an abdominal painful mass, must alert physicians about the diagnosis of abdominal wall hematoma, especially in patients who are under anticoagulant and antiaggregant therapy.[link.springer.com]
  • Case report: We report a 52 year old female who presented with fever, myalgia and abdominal pain. Dengue IgM was positive. On the 6th day she developed a tender lump over left abdominal wall which increased in size rapidly.[journals.sjp.ac.lk]
  • Conclusion Keeping a high suspicion of abdominal haemorrhage is important if a patient on long term warfarin therapy presented with abdominal pain.[omicsonline.org]
Abdominal Mass
  • mass is found which does not move with respiration.[howmed.net]
  • mass in hypovolemic shock.[kjccm.org]
  • The ability to appreciate an intra-abdominal mass is ordinarily degraded with contraction of the rectus muscles.[physiotherapy-treatment.com]
  • Rectus sheath hematomas most often present as acute onset of abdominal pain with a palpable abdominal mass. Additional findings may include: fevers, chills, nausea, vomiting, abdominal tenderness, and abdominal guarding.[radiopaedia.org]
  • mass would be less tender Cullen sign: Periumbilical ecchymosis with retroperitoneal / abdominal wall injury Diagnostic testing Laboratory evaluation General trauma labs Diagnostic imaging Plain films: AP pelvis, CXR, lateral C spine U/S Hemodynamically[fprmed.com]
Abdominal Tenderness
  • Additional findings may include: fevers, chills, nausea, vomiting, abdominal tenderness, and abdominal guarding.[radiopaedia.org]
  • Physical examination revealed lower right quadrant pain with involuntary guarding and rebound abdominal tenderness at Mcburney s point. He had 30 IMC. The rest were normal. Laboratory tests showed leukocytosis and neutrophilia.[ispub.com]
  • Once again, physical examination found nothing unusual except right upper abdominal tenderness. Her blood tests, including coagulation parameters, returned normal.[panafrican-med-journal.com]
  • DISCUSSION In 1926, Carnett described a test to differentiate pain originating from the abdominal wall versus pain arising from intra-abdominal pathology. 13 The test involves placing the patient supine and the site of maximal abdominal tenderness is[pmj.bmj.com]
  • ., lying, sitting, standing) Pain not related to meals or bowel function No findings of an intra-abdominal process (see Table 1 ) Abdominal tenderness unchanged or increased when abdominal wall is tensed (positive Carnett's sign) Discrete, tender pain[aafp.org]
Abdominal Wall Pain
  • Furthermore, abdominal wall pain is often chronic, nagging and nonprogressive.[aafp.org]
  • While there are many causes of abdominal wall pain, 2 this patient’s presentation was more consistent with abdominal muscle pathology.[ultrasoundoftheweek.com]
Heart Disease
  • […] non-pulsatile abdominal mass, local peritoneal irritation signs, and abdominal compartment syndrome.[ 5, 10 ] LMWH is increasingly being used in both community and hospital settings to initiate anticoagulation for many clinical conditions, ischemic heart[kjccm.org]
Systolic Murmur
  • There was no significant finding on physical examination other than a mild systolic murmur at the apical region.[link.springer.com]
Hepatomegaly
  • I have to wonder if this is secondary to some underlying process. aven Emergency Medicine I'd say hematoma ADDa Other Nurse Hepatoma or pancreatic abscess asku Lab Scientist Its abdominal abcess rud_ Medical Student #Hepatomegaly from HF memi Emergency[app.figure1.com]
Myalgia
  • Case report: We report a 52 year old female who presented with fever, myalgia and abdominal pain. Dengue IgM was positive. On the 6th day she developed a tender lump over left abdominal wall which increased in size rapidly.[journals.sjp.ac.lk]
Dysarthria
  • She had complained of left-sided paralysis with dysarthria and the symptoms gradually worsened.[kjccm.org]
Excitement
  • Road Less Traveled » Abdominal Wall nerve entrapment 6 Replies, The Road Less Traveled Advertisement Hysterectomy News May 13,2019 CURRENT NEWS HysterSisters Takes On Partner To Manage Continued Growth And Longevity I have news that is wonderful and exciting[hystersisters.com]

Workup

  • We present a patient with chronic renal insufficiency who developed a massive posttraumatic abdominal wall hematoma after a single therapeutic dose of enoxaparin administered during workup of chest pain.[ncbi.nlm.nih.gov]
Kingella
  • Medical Illustrations Musculoskeletal Infection Journal Club Jan 2019 Imaging of Kingella kingae musculoskeletal infecti... Dec 2018 CT evaluation of musculoskeletal trauma: initial e... Nov 2018 Thoracic Diseases With Musculoskeletal Manifestati...[ctisus.com]

Treatment

  • In the latter case, although conservative treatment is possible, hospital stay is prolonged and large amounts of blood-bank resources are consumed.[ncbi.nlm.nih.gov]
  • Effect of Sex: 2-3 times more common in females due to decreased muscle mass and also during pregnancy. [5]Treatment: Treatment depends on the extent of injury and haematoma formation. 1.[howmed.net]
  • Warfarin treatment was reinitiated as small dose with adjustment of the dose during hospital stay.[omicsonline.org]

Prognosis

  • […] dissect along the transversalis fascial plane or cross the midline 6 type III: large, usually below the arcuate line, and often presents with evidence of hemoperitoneum and/or blood within the prevesical space of Retzius (retropubic space) 6 Treatment and prognosis[radiopaedia.org]
  • What Is the Prognosis for Hematoma? Blood vessels are routinely injured and may leak blood causing hematomas or blood clots. Depending upon their size and location, hematomas may be insignificant or may cause life-threatening damage.[emedicinehealth.com]
  • The location of a hematoma plays a role in its prognosis. From Reviewed by: Tova Alladice, M.D. American Board of Physical Medicine & Rehabilitation[rxlist.com]

Etiology

  • The etiologies, presenting findings, diagnostic studies, and modes of therapy reported for abdominal wall hematomas are reviewed.[ncbi.nlm.nih.gov]
  • Etiology The majority of hematomas result from the rupture of epigastric vessels or by tearing of the fibers of the rectus abdominis muscle.[radiopaedia.org]
  • Abdominal wall muscle hematomas are rarely fatal, and encompass a wide spectrum of severity depending on size, etiology, and associated complications; but because of their rarity may be misdiagnosed clinically.[kjccm.org]
  • View/Print Table TABLE 3 Etiology of Abdominal Wall Pain Etiology Comments Diagnosis Hernia Protuberance in abdominal wall that usually decreases in size when patient is supine Abdominal CT scanning, abdominal ultrasonography, herniography Rectus nerve[aafp.org]
  • Patients present with varying symptoms, but the most common features are abdominal pain and a mass in the lower abdomen, most frequently on the right side. [1], [2] An abdominal wall hematoma has multiple possible etiologies, including antithrombotic[onlinejets.org]

Epidemiology

  • Landefeld CS, Beyth RJ (1993) Anticoagulant-related bleeding: clinical epidemiology, prediction and prevention. Am J Med 95: 315-328. Coon WW, Willis PW 3rd (1974) Hemorrhagic complications of anticoagulant therapy. Arch Intern Med 133: 386-392.[omicsonline.org]
  • Anticoagulant-related bleeding: clinical epidemiology, prediction, and prevention. Am J Med. 1993 ; 95 : 315–328. Crossref Medline Google Scholar 3 Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single institution.[circ.ahajournals.org]
  • Epidemiology Frequency International Rectus sheath hematoma is an uncommon, but not rare, cause of abdominal pain.[reference.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology, evaluation, and treatment are then discussed in detail.[ncbi.nlm.nih.gov]
  • Abdominal Wall Trauma Background Injury to abdominal wall Contusions Strong abdominal muscle contractions Strenuous activity Coughing / valsalva (repeated) Commonly missed diagnosis Pathophysiology Injury mechanism: Seatbelt injuries Can cause avulsion[fprmed.com]
  • Pathophysiology Rectus sheath hematomas (RSHs) are generally caused either by rupture of one of the epigastric arteries or by a muscular tear with shearing of a small vessel.[reference.medscape.com]

Prevention

  • We conclude that trocar injury is a potentially preventable complication in laparoscopic surgery if certain precautions are taken.[ncbi.nlm.nih.gov]
  • It is indicated for the prevention of systemic embolism in patients with prosthetic heart valves or atrial fibrillation and for the primary and secondary prevention of venous thromboembolism [ 2, 9 ].[omicsonline.org]
  • Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 1998; 339: 80–85. 3). Weitz JI. Low-molecular-weight heparins.[kjccm.org]

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