complication of caesarean section resulting from damage to the superior or inferior epigastric arteries or their branches or from a direct tear of the muscle.
European Congress of Obstetrics and Gynaecology in conjunction with Congress of Turkish Society of Obstetrics and Gynaecology
17 - 21 May 2017 Titanic Deluxe Hotel, Antalya / Turkey
ABSTRACT BOOK
25th European Congress of Obstetrics and Gynaecology 15th Congress of Turkish Society of Obstetrics and Gynaecology May 17-21, 2017, Titanic Deluxe Hotel, Antalya / Turkey
P 441 RECTUS SHEATH HEMATOMA FOLLOWING CAESAREAN DELIVERY- A CASE REPORT 1
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Mahmut Arslan , Mehmet Fatih Yazar , Ömer Faruk Boran , Aykut Urfalıoğlu , Süleyman Murat 3 1 1 Bakacak , Gökçe Gişi , Şeyma Tekşen 1
Kahramanmaraş Sütçü Imam University, Department of Anesthesiology and Reanimation Kahramanmaraş Sütçü Imam University, Department of General Surgery 3 Kahramanmaraş Sütçü Imam University, Department of Obstetric and Gynecology 2
Introduction: Rectus sheath hematoma (RSH) is a very rare and potentially life-threatening complication of caesarean section resulting from damage to the superior or inferior epigastric arteries or their branches or from a direct tear of the muscle. These hematomas may contain high amounts of blood leading to hypovolemia and hemorrhagic shock (1). Case presentation: A 32-year-old female patient gestational age of 34 weeks was admitted after being referred as HELLP syndrome from government hospital. Baseline investigations showed hemoglobin 11.7 g/dL, platelets 90,000/ mm3, LDH 706 IU/L and serum alanine aminotransferase 362 units. On the day of admission, she underwent Caesarean section under general anesthesia and delivered a 2.5 kg male child. The surgical procedure was uneventful and blood loss was within normal range. At the end of the surgical procedure, the patient was extubated in the operating room and transferred to the intensive care unit (ICU). On admission to the ICU her hemodynamic variables were stable. After 12 hours, she complaint of palpitation and fatigue. Her heart rate was 128 b/min and her blood pressure was 90/50 mmHg. Her hemoglobin was detected as 7,4 g/dL. She did not have any vaginal bleeding and tone of the uterus was normal. 2 units of packed red blood cells was transfused and abdominal CT (computed tomography) was performed. CT revealed a 160X70 mm RSH that was located in the abdominal wall. Repetitive laboratory tests showed a further decrease in Hb levels therefore surgical exploration was planned by the general surgery clinic. Under general anesthesia, abdominal exploration was done. Approximately 750 mL of RSH was evacuated and epigastric artery was ligated. A total of 3 units of packed red blood cells was transfused. After the procedure Hb levels stayed stable and she was discharged on 7 days after surgery. Discussion: RSH is an uncommon condition. Although usually a benign self-limiting condition, it may be fatal with overall the mortality rate reported to be 4% (2). Common causes of RSH are trauma, abdominal operations, subcutaneous drug injections, anticoagulant therapy, hematologic diseases, hypertension, coughing, severe physical exercise, pregnancy but rarely it may occur spontaneously (3). Particularly in pregnancy, high mortality rates of up to 13 % for the mother and 50 % for the fetus have been reported (4). Therefore, early diagnosis is important and may be lifesaving. Differential obstetric diagnoses include acute abruptio placentae, infarcted myoma, preterm labor, uterine rupture, or HELLP syndrome and correct diagnose during pregnancy may be difficult. Ultrasound can be used as a first-line test but CT is the diagnostic gold standard test. Conservative treatment is appropriate for patients who are hemodynamically stable with smaller RSHs and it includes rest, analgesics, fluid resuscitation and treatment of predisposing conditions. Hemodynamically unstable patients like our case must undergo invasive treatment, including arterial embolization or surgical decompression. Conclusion: In conclusion, although RSH is not a common diagnose after Caesarean delivery but it should always be considered as a potential differential diagnosis of progressive decrease in Hb levels with abdominal pain. Keywords: Rectus sheath hematoma, Caesarean delivery, Postpartum hemorrhage
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