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Unusual cause of haemorrhage from surgical wound in a child.

Singh R, Magu S, Kadian VK, Siwach R, Rohilla RK, Dhir V - Strategies Trauma Limb Reconstr (2009)

Bottom Line: Haemorrhage from a surgical wound can be from many potential sources such as injury to vessel, muscle and bone; bleeding disorders; incomplete haemostasis; pseudoaneurysm; and neovascularisation.We report an unusual cause of haemorrhage from the surgical incision in a 9-year-old child.We emphasize that a high index of suspicion is required for early diagnosis, and pseudoaneurysm and neoangiogenesis should be considered in the differential diagnosis of soft tissue masses resulting from direct, blunt trauma even in children.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, 9-J/52, Medical Enclave, Rohtak, 124001, Haryana, India, drroopsingh@rediffmail.com.

ABSTRACT
Haemorrhage from a surgical wound can be from many potential sources such as injury to vessel, muscle and bone; bleeding disorders; incomplete haemostasis; pseudoaneurysm; and neovascularisation. We report an unusual cause of haemorrhage from the surgical incision in a 9-year-old child. We emphasize that a high index of suspicion is required for early diagnosis, and pseudoaneurysm and neoangiogenesis should be considered in the differential diagnosis of soft tissue masses resulting from direct, blunt trauma even in children.

No MeSH data available.


Related in: MedlinePlus

Stitched surgical incision with no active bleed at the time of presentation
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Fig1: Stitched surgical incision with no active bleed at the time of presentation

Mentions: A 9-year-old male child was referred to our institute with haemorrhage, when a surgeon in periphery incised a posttraumatic swelling left thigh assuming it to be abscess. On admission, he had a blood pressure of 96/60 mmHg, pulse rate of 115 bpm and oxygen saturation of 98%. Peripheral pulses were palpable. No active bleed was present from the stitched incision site at that time (Fig. 1). He was anaemic (Hb 4 g), with normal coagulation profile (PTI/PTTK). X-ray of left thigh showed soft tissue swelling and no bony pathology (Fig. 2). Ultrasonography revealed haematoma in subcutaneous tissues and in muscles planes. The patient was managed conservatively with blood transfusion and dressings of the surgical wound. The haemoglobin level rose to 8.4 g/dl by fifth postoperative day and a repeat ultrasonography showed slight decrease in the haematoma. On tenth postoperative day, the patient had an episode of active bleed from incision site with dressing fully soaked with fresh blood. Patient was resuscitated with blood transfusion, as he was hypotensive and anaemic (5.2 g/dl). Urgent MRI and CT angiography were done. CT angiography showed hypodense area in vasti and vessels coursing in between the hypodense area. A dilated tortuous vessel was seen beneath the incision site and fresh bleed (Fig. 3a, b). MRI showed large haematoma in vasti and subcutaneous plane (Fig. 4a, b). Patient was shifted to operation theatre, adequate cross-matched blood was arranged and the wound was explored. Common femoral and profunda femoris arteries were isolated and tagged to deal with any eventuality of exsanguinations during wound exploration. Wound exploration showed large haematoma in subcutaneous tissue and in plane between rectus femoris and vasti muscles. A tortuous, dilated vessel was found to be the source of bleeding and forming pseudoaneurysm (Fig. 5a). Profunda femoris and this abnormal vessel were ligated (Fig. 5b). Postoperatively distal vessels were palpable and thigh swelling subsided in 3 weeks time. There was no bleeding or swelling until last follow-up of 2 years.Fig. 1


Unusual cause of haemorrhage from surgical wound in a child.

Singh R, Magu S, Kadian VK, Siwach R, Rohilla RK, Dhir V - Strategies Trauma Limb Reconstr (2009)

Stitched surgical incision with no active bleed at the time of presentation
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2666824&req=5

Fig1: Stitched surgical incision with no active bleed at the time of presentation
Mentions: A 9-year-old male child was referred to our institute with haemorrhage, when a surgeon in periphery incised a posttraumatic swelling left thigh assuming it to be abscess. On admission, he had a blood pressure of 96/60 mmHg, pulse rate of 115 bpm and oxygen saturation of 98%. Peripheral pulses were palpable. No active bleed was present from the stitched incision site at that time (Fig. 1). He was anaemic (Hb 4 g), with normal coagulation profile (PTI/PTTK). X-ray of left thigh showed soft tissue swelling and no bony pathology (Fig. 2). Ultrasonography revealed haematoma in subcutaneous tissues and in muscles planes. The patient was managed conservatively with blood transfusion and dressings of the surgical wound. The haemoglobin level rose to 8.4 g/dl by fifth postoperative day and a repeat ultrasonography showed slight decrease in the haematoma. On tenth postoperative day, the patient had an episode of active bleed from incision site with dressing fully soaked with fresh blood. Patient was resuscitated with blood transfusion, as he was hypotensive and anaemic (5.2 g/dl). Urgent MRI and CT angiography were done. CT angiography showed hypodense area in vasti and vessels coursing in between the hypodense area. A dilated tortuous vessel was seen beneath the incision site and fresh bleed (Fig. 3a, b). MRI showed large haematoma in vasti and subcutaneous plane (Fig. 4a, b). Patient was shifted to operation theatre, adequate cross-matched blood was arranged and the wound was explored. Common femoral and profunda femoris arteries were isolated and tagged to deal with any eventuality of exsanguinations during wound exploration. Wound exploration showed large haematoma in subcutaneous tissue and in plane between rectus femoris and vasti muscles. A tortuous, dilated vessel was found to be the source of bleeding and forming pseudoaneurysm (Fig. 5a). Profunda femoris and this abnormal vessel were ligated (Fig. 5b). Postoperatively distal vessels were palpable and thigh swelling subsided in 3 weeks time. There was no bleeding or swelling until last follow-up of 2 years.Fig. 1

Bottom Line: Haemorrhage from a surgical wound can be from many potential sources such as injury to vessel, muscle and bone; bleeding disorders; incomplete haemostasis; pseudoaneurysm; and neovascularisation.We report an unusual cause of haemorrhage from the surgical incision in a 9-year-old child.We emphasize that a high index of suspicion is required for early diagnosis, and pseudoaneurysm and neoangiogenesis should be considered in the differential diagnosis of soft tissue masses resulting from direct, blunt trauma even in children.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, 9-J/52, Medical Enclave, Rohtak, 124001, Haryana, India, drroopsingh@rediffmail.com.

ABSTRACT
Haemorrhage from a surgical wound can be from many potential sources such as injury to vessel, muscle and bone; bleeding disorders; incomplete haemostasis; pseudoaneurysm; and neovascularisation. We report an unusual cause of haemorrhage from the surgical incision in a 9-year-old child. We emphasize that a high index of suspicion is required for early diagnosis, and pseudoaneurysm and neoangiogenesis should be considered in the differential diagnosis of soft tissue masses resulting from direct, blunt trauma even in children.

No MeSH data available.


Related in: MedlinePlus