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Percutaneous artery embolization of bleeding rectus sheath hematomas in hemodynamically unstable patients: Outcomes of 43 patients in a tertiary referral hospital

Alberto Cereda, Paolo Aseni, Lucio De Capitani, Marco Cereda, Ruggero Vercelli, Cristina Giannattasio, Antonio Gaetano Rampoldi
  • Alberto Cereda
    Cardiology IV, Cardiotoracovascular A. De Gasperis Department, Niguarda Cà Granda Hospital, Milan; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy | tskcer@hotmail.it
  • Paolo Aseni
    Emergency Department, Niguarda Cà granda Hospital, Milan, Italy
  • Lucio De Capitani
    Department of Statistics and Quantitative Methods, Bicocca University, Milan, Italy
  • Marco Cereda
    Emergency Department, Niguarda Cà granda Hospital, Milan, Italy
  • Ruggero Vercelli
    Interventional Radiology, Niguarda Cà Granda Hospital, Milan, Italy
  • Cristina Giannattasio
    Cardiology IV, Cardiotoracovascular A. De Gasperis Department, Niguarda Cà Granda Hospital, Milan; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
  • Antonio Gaetano Rampoldi
    Interventional Radiology, Niguarda Cà Granda Hospital, Milan, Italy

Abstract

Rectus sheath hematoma (RSH) is an uncommon cause of abdominal pain that can lead to life-threatening bleeding, particularly in elderly patients receiving anticoagulation therapy. Type III RSHs, based on computer tomography (CT) evaluation, is characterized by active bleeding with intramuscular or intraperitoneal extension and hemodynamic instability. Medical contemporary knowledge of this condition is contentious and overall 20% of acute mortality has been reported. The purpose of this study was to retrospectively review our experience and outcomes in the management of RSHs treated with percutaneous arterial embolization of the epigastric vessels. We retrospectively analyzed 43 patients with RSH type III, submitted to percutaneous epigastric artery embolization from 2007 to 2015. Percutaneous arterial embolization was feasible and successful in patients with a high burden of comorbidities and receiving anticoagulation therapy. There was no acute mortality and a late mortality at 3 months of 9.1% (4/43) was not directly related to RSHs or arterial embolization. Patients with late mortality had lower ejection fraction, prolonged PTT, greater RDW and warfarin in overlapping with low-molecular-weight heparins. Transcatheter arterial embolization of the epigastric vessels was safe, feasible and effective in stopping the bleeding. Despite anti-platelets/anti-coagulation therapy and a high burden of comorbidities, there was no acute mortality related to RSH.

Keywords

rectus sheath hematoma; percuteanous arterial embolization; epigastric artery; life threatening abdominal bleeding; anticoagulation

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Submitted: 2017-04-15 17:46:00
Published: 2017-11-07 11:18:26
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Copyright (c) 2017 Alberto Cereda, Paolo Aseni, Lucio De Capitani, Marco Cereda, Ruggero Vercelli, Cristina Giannattasio, Antonio Gaetano Rampoldi

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