Limits...
21st century twist on Cullen's sign: new generation anticoagulants and splenic traum.

Bilkhu A, Mosley F, Gokhale JA - J Surg Case Rep (2016)

Bottom Line: New anticoagulants such as Rivaroxaban have become a popular choice for patients needing anticoagulation for atrial fibrillation or venous thromboembolism, chiefly because anticoagulation is maintained without the need for monitoring.This can be problematic in cases of trauma, and in this article, we discuss the management and outcome of managing an elderly patient with a shattered spleen while on Rivaroxaban.

View Article: PubMed Central - HTML - PubMed

Affiliation: Bradford Teaching Hospitals NHS Trust, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK.

No MeSH data available.


Related in: MedlinePlus

Axial image from CT with IV contrast.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4979530&req=5

rjw114F4: Axial image from CT with IV contrast.

Mentions: On Day 4, her haemoglobin had decreased to 64 g/dL. Her blood pressure and heart rate remained within normal parameters but a repeat clinical examination revealed a large peri-umbilical ecchymosis (Cullen's sign) (Figs 1 and 2). At this point, she was referred to the surgical team and a computed tomography (CT) scan confirmed a grade V splenic injury with overlying rib fractures, free fluid within the pelvis, but no active bleeding (Figs 3 and 4). The patient's Rivaroxaban was discontinued and Haematology advice was sought. The patient was transfused with packed red blood cells and managed non-operatively. The patient responded well to fluid and blood-product resuscitation, and since discussion with the Radiology team excluded active haemorrhage on the CT non-operative treatment was opted. Concurrent treatment was given for pneumonia and the patient was discharged on the 14th day. Rivaroxaban was re-commenced in the community on discharge following advice from the hospital Haematology team. A 24-h ECG and cardiology follow-up was arranged as an outpatient. Up to the current time of publication, her recovery has been unremarkable.Figure 1:


21st century twist on Cullen's sign: new generation anticoagulants and splenic traum.

Bilkhu A, Mosley F, Gokhale JA - J Surg Case Rep (2016)

Axial image from CT with IV contrast.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4979530&req=5

rjw114F4: Axial image from CT with IV contrast.
Mentions: On Day 4, her haemoglobin had decreased to 64 g/dL. Her blood pressure and heart rate remained within normal parameters but a repeat clinical examination revealed a large peri-umbilical ecchymosis (Cullen's sign) (Figs 1 and 2). At this point, she was referred to the surgical team and a computed tomography (CT) scan confirmed a grade V splenic injury with overlying rib fractures, free fluid within the pelvis, but no active bleeding (Figs 3 and 4). The patient's Rivaroxaban was discontinued and Haematology advice was sought. The patient was transfused with packed red blood cells and managed non-operatively. The patient responded well to fluid and blood-product resuscitation, and since discussion with the Radiology team excluded active haemorrhage on the CT non-operative treatment was opted. Concurrent treatment was given for pneumonia and the patient was discharged on the 14th day. Rivaroxaban was re-commenced in the community on discharge following advice from the hospital Haematology team. A 24-h ECG and cardiology follow-up was arranged as an outpatient. Up to the current time of publication, her recovery has been unremarkable.Figure 1:

Bottom Line: New anticoagulants such as Rivaroxaban have become a popular choice for patients needing anticoagulation for atrial fibrillation or venous thromboembolism, chiefly because anticoagulation is maintained without the need for monitoring.This can be problematic in cases of trauma, and in this article, we discuss the management and outcome of managing an elderly patient with a shattered spleen while on Rivaroxaban.

View Article: PubMed Central - HTML - PubMed

Affiliation: Bradford Teaching Hospitals NHS Trust, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK.

No MeSH data available.


Related in: MedlinePlus