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Subserosal hematoma of the sigmoid colon after vaginal delivery

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ABSTRACT

Postpartum hemorrhage is an obstetrical emergency that represents the leading cause of maternal mortality. Severe hemorrhagic complications that could appear postpartum are the abdomino-pelvic hematomas, which result from the rupture of the pelvic vessels. We reported a very rare case of puerperal retroperitoneal subserosal hematoma of sigmoid colon following vaginal delivery, which was successfully managed by conservative methods. As far as we know, there are only a few case reports of intramural hematoma of sigmoid colon in literature, having other etiologies than vaginal delivery trauma. The particularities of the case consisted in the association of hemangiomas and the low risk thrombophilia. Diagnosis was based on the clinical exam and the paraclinical founding. Laparotomy is generally considered the last choice, in life threatening cases with hemodynamic instability, compression signs, and presence of contrast leakage on noninvasive imaging methods, but avoiding colonic resection after dissection represented the true challenge of the case.

No MeSH data available.


Repeated intramural lidocaine hydrochloride 1% injections of sigmoid
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Figure 4: Repeated intramural lidocaine hydrochloride 1% injections of sigmoid

Mentions: Ten hours post intervention, the laboratory’s findings included a decreasing value of hemoglobin, of 6.4 g/ dl, white blood cells count of 21.0*103/ µl, platelets count of 79*103/ µl, creatine kinase isoenzymes (CKI) of 687 U/ L superimposed on the patient’s general state of illness; blood pressure was of 140/ 80 and her pulse was of 110 bpm. An emergency diagnostic and therapeutic laparotomy was decided and applied. Intraoperatively, a retroperitoneal retro rectal hematoma was noted, extended through the mesosigmoid under the sigmoid colon serosa. After the dissection of sigmoid and rectum nearby pelvis floor without finding any active source of bleeding, despite the general necrotic aspect of these segments (Fig. 3), an expectant attitude was decided considering the positive response of the intestinal wall on the instillation of lidocaine hydrochloride 1% and repeated cold peritoneal lavage (Fig. 4).


Subserosal hematoma of the sigmoid colon after vaginal delivery
Repeated intramural lidocaine hydrochloride 1% injections of sigmoid
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5304379&req=5

Figure 4: Repeated intramural lidocaine hydrochloride 1% injections of sigmoid
Mentions: Ten hours post intervention, the laboratory’s findings included a decreasing value of hemoglobin, of 6.4 g/ dl, white blood cells count of 21.0*103/ µl, platelets count of 79*103/ µl, creatine kinase isoenzymes (CKI) of 687 U/ L superimposed on the patient’s general state of illness; blood pressure was of 140/ 80 and her pulse was of 110 bpm. An emergency diagnostic and therapeutic laparotomy was decided and applied. Intraoperatively, a retroperitoneal retro rectal hematoma was noted, extended through the mesosigmoid under the sigmoid colon serosa. After the dissection of sigmoid and rectum nearby pelvis floor without finding any active source of bleeding, despite the general necrotic aspect of these segments (Fig. 3), an expectant attitude was decided considering the positive response of the intestinal wall on the instillation of lidocaine hydrochloride 1% and repeated cold peritoneal lavage (Fig. 4).

View Article: PubMed Central - PubMed

ABSTRACT

Postpartum hemorrhage is an obstetrical emergency that represents the leading cause of maternal mortality. Severe hemorrhagic complications that could appear postpartum are the abdomino-pelvic hematomas, which result from the rupture of the pelvic vessels. We reported a very rare case of puerperal retroperitoneal subserosal hematoma of sigmoid colon following vaginal delivery, which was successfully managed by conservative methods. As far as we know, there are only a few case reports of intramural hematoma of sigmoid colon in literature, having other etiologies than vaginal delivery trauma. The particularities of the case consisted in the association of hemangiomas and the low risk thrombophilia. Diagnosis was based on the clinical exam and the paraclinical founding. Laparotomy is generally considered the last choice, in life threatening cases with hemodynamic instability, compression signs, and presence of contrast leakage on noninvasive imaging methods, but avoiding colonic resection after dissection represented the true challenge of the case.

No MeSH data available.