Limits...
Fatal retroperitoneal bleeding caused by neurofibromatosis: a case report and review of the literature.

Moerbeek PR, van Buijtenen JM, van den Heuvel B, Hoksbergen AW - Case Rep Med (2015)

Bottom Line: After successful resuscitation a total body CT-scan was performed to rule out potential bleeding sources.No thoracic abnormalities were found.Postoperative angiography showed active bleeding from a branch of the left internal iliac artery, which could be successfully coiled.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands.

ABSTRACT
A young female was brought into the emergency department with pulseless electrical activity (PEA) after local resection of neurofibromateous lesions. Chest ultrasonography was normal. Abdominal ultrasonography was not performed. After successful resuscitation a total body CT-scan was performed to rule out potential bleeding sources. However, haemodynamic instability reoccurred and the scan had to be aborted at the thoracoabdominal level. No thoracic abnormalities were found. Resuscitation was reinitiated and abdominal ultrasonography was performed, showing a large amount of abdominal fluid. A progressive fall in haemoglobin was noted. Emergency laparotomy was performed, revealing a large retroperitoneal haematoma. Despite ligation and packing, bleeding continued. Postoperative angiography showed active bleeding from a branch of the left internal iliac artery, which could be successfully coiled. Unfortunately, the patient died five days later due to irreversible brain damage. Revision of an MRI scan made one year earlier showed a 10 cm large retroperitoneal neurofibromatous lesion exactly at the location of the current bleeding. This case shows that patients with neurofibromatosis might develop spontaneous life-threatening bleeding from retroperitoneal located lesions. Furthermore, it points out the necessity of focused assessment with ultrasonography of the abdomen in all patients with PEA of unknown origin.

No MeSH data available.


Related in: MedlinePlus

Angiography showing a blush from a dorsal branch from the left internal iliac artery (arrow).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4321078&req=5

fig1: Angiography showing a blush from a dorsal branch from the left internal iliac artery (arrow).

Mentions: Despite these efforts, the bleeding persisted postoperatively and angiography was performed. Contrast extravasation from a dorsal branch of the left internal iliac artery was identified and was successfully coiled (Figures 1 and 2). After this procedure the patient stabilized and was transferred to the ICU.


Fatal retroperitoneal bleeding caused by neurofibromatosis: a case report and review of the literature.

Moerbeek PR, van Buijtenen JM, van den Heuvel B, Hoksbergen AW - Case Rep Med (2015)

Angiography showing a blush from a dorsal branch from the left internal iliac artery (arrow).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4321078&req=5

fig1: Angiography showing a blush from a dorsal branch from the left internal iliac artery (arrow).
Mentions: Despite these efforts, the bleeding persisted postoperatively and angiography was performed. Contrast extravasation from a dorsal branch of the left internal iliac artery was identified and was successfully coiled (Figures 1 and 2). After this procedure the patient stabilized and was transferred to the ICU.

Bottom Line: After successful resuscitation a total body CT-scan was performed to rule out potential bleeding sources.No thoracic abnormalities were found.Postoperative angiography showed active bleeding from a branch of the left internal iliac artery, which could be successfully coiled.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands.

ABSTRACT
A young female was brought into the emergency department with pulseless electrical activity (PEA) after local resection of neurofibromateous lesions. Chest ultrasonography was normal. Abdominal ultrasonography was not performed. After successful resuscitation a total body CT-scan was performed to rule out potential bleeding sources. However, haemodynamic instability reoccurred and the scan had to be aborted at the thoracoabdominal level. No thoracic abnormalities were found. Resuscitation was reinitiated and abdominal ultrasonography was performed, showing a large amount of abdominal fluid. A progressive fall in haemoglobin was noted. Emergency laparotomy was performed, revealing a large retroperitoneal haematoma. Despite ligation and packing, bleeding continued. Postoperative angiography showed active bleeding from a branch of the left internal iliac artery, which could be successfully coiled. Unfortunately, the patient died five days later due to irreversible brain damage. Revision of an MRI scan made one year earlier showed a 10 cm large retroperitoneal neurofibromatous lesion exactly at the location of the current bleeding. This case shows that patients with neurofibromatosis might develop spontaneous life-threatening bleeding from retroperitoneal located lesions. Furthermore, it points out the necessity of focused assessment with ultrasonography of the abdomen in all patients with PEA of unknown origin.

No MeSH data available.


Related in: MedlinePlus