Rectus sheath hematoma with low molecular weight heparin administration: a case series.

BACKGROUND: Rectus sheath hematoma is an uncommon but potentially serious bleeding complication that can occur spontaneously or as a result of anticoagulation administration. CASE PRESENTATION: Case number one: A 62 year old chronically ill Caucasian female develops a rectus sheath hematoma seven days after hospital discharge. The previous hospitalization included low molecular weight heparin administration for deep vein thrombosis prophylaxis. The patient ultimately chooses comfort care and expires due to sepsis and respiratory failure. Case number two: A 79 year old Caucasian male develops a rectus sheath hematoma during hospital admission where LMWH is used for deep vein thrombosis prophylaxis. He is managed conservatively; however, his hematocrit drops from 46 to 25.8%. Case number three: A 44 year old chronically ill Caucasian female is treated with therapeutic low molecular weight heparin for recent deep vein thrombosis during a hospital admission. She develops a large rectus sheath hematoma requiring embolization as well as blood transfusion. CONCLUSION: We believe this reflects an underreported significant cause of morbidity and mortality with low molecular weight heparin administration. We review the pathophysiology of rectus sheath hematoma as well as its presentation, diagnosis, and treatment. We identify at-risk populations and proposed contributing factors. We also discuss factors leading to underreporting as well as preventive strategies implemented at our institution.

Hemophilic pseudotumor--is there a role of radiotherapy? Literature review and a case report.

We share the literature and management of an adult with moderate hemophilia a presented with a calcaneal pseudotumor and non healing ulcer by radiation therapy, factor VIII and cryoprecipitate supplement. Numerous literatures so far have quoted the satisfactory role of radiotherapy in hemophilic pseudotumor. We found it to be of great help as our case responded with radiotherapy, factor VIII and cryoprecipitate supplement and has a satisfactory 2 years follow up.

Role of radiotherapy in hemophilic pseudotumor of the orbit.

Hemophilic pseudotumor is an encapsulated, chronic, slowly expanding hematoma usually seen in 1-2% patients with severe coagulative disorder (James et al., 2003). It usually occurs in soft tissues, muscles, tendons, and subperiosteal part of the bones. It slowly enlarges, develops a fibrous capsule, and destroys underlying tissues by progressive necrosis (James et al., 2003). Hemophilia is an X chromosome-linked hereditary disorder caused by defective synthesis or synthesis of dysfunctional factor VIII molecules (Harold et al., 2006).

Successful treatment of hemophilic hand pseudotumors by only radiotherapy.

Hemophilic pseudotumor is a rare complication of hemophilia. We describe a 14-year-old young male with hemophilic pseudotumor in the second and fifth fingers of the left hand. We treated him only with radiotherapy. A total dose of 2000 cGy in 10 fractions was administered in 2 weeks. Factor VIII was not given. After 4 months, complete healing was seen. The patient was followed up at 24 months, and there was no evidence of recurrence and no bone growth disturbance. Based on our experience and a review of the literature, radiotherapy can be an effective alternative modality in treating hemophilic pseudotumor.

Could ionizing radiation forestall cauliflower ear?

Repeated trauma to the ear very often results in "cauliflower ear." Many methods have been suggested to prevent an injured ear from demonstrating a cauliflowerlike deformity. The principles of treatment are evacuation of the hematoma, control of the reaccumulation of fluid, and maintenance of the cartilage contour. The authors studied the effect of ionizing radiation on deformed rabbit ears induced by repeated trauma. Twenty ears (10 rabbits) were used in the experiment. The animals were divided into four groups (control, preradiation, low dose, and high dose). Hematoma was produced by pounding the lateral side of the auricle 10 times with a 50-g weight at a height of 15 cm. The thickness of the injured and uninjured sites was measured, and histological analysis was performed for each group. The thickness of the ears of the irradiated groups was significantly less than the control group. The authors think that radiation treatment of repeatedly injured ears could prevent ear deformity, and could possibly be an adjunctive form of management of cauliflower ear in addition to hematoma evacuation and compression therapy.

Haemophilic pseudotumour of the paranasal sinuses: management with radiotherapy and factor replacement therapy.

A case of pseudotumour of the paranasal sinuses occurring in a patient with haemophilia A is reported. There was a favourable response to combined treatment with radiation therapy and factor VIII replacement.

Treatment of hemophilic pseudotumor with low-dose radiotherapy.

Hemophilic pseudotumor is one of the most serious complications of hemophilia and is usually treated with extensive surgery. A new treatment approach is radiotherapy. Patients with long-bone pseudotumors are usually treated with high doses of radiotherapy greater than 1500 cGy. We treated a 13-year-old hemophilic boy who had a pseudotumor of the tibia with low-dose radiotherapy (600 cGy). There was no complication during the two-and-a-half-year follow-up. Improvement of both the clinical and radiological status of the patient was noteworthy. We would like to suggest the use of low-dose radiotherapy in patients with hemophilic pseudotumors.

Radiotherapy of pseudotumors of bone in hemophiliacs with circulating inhibitors to factor VIII.

Pseudotumors of bone in two hemophiliacs with severe factor VIII deficiency and a high level of circulating inhibitors are reported. Both had favorable response to radiation therapy after unsuccessful treatment with factor concentrates and remain free of recurrence at 18-62 months. A review of the literature of cases in which radiotherapy has been used is presented. Radiotherapy in the treatment of pseudotumors of bone in hemophiliacs should be strongly considered, particularly if coagulation factor inhibitors are present.

[The analgesic and resorptive laser therapy of wound infiltrates, seromas and hematomas in episiorrhaphy and perineorrhaphy]. / Analgetichna i rezorbtsionna lazer-terapiia na ranevi infiltrati, seromi i khematomi pri epiziorafii i perineorafii.

The therapeutic effects of helium-neon laser irradiation with density of power (DP) of 100, 90, 80, 70 and 50 mW/cm2 were studied on 126 parturients in respect to occurring analgetic and resorptive action on wound infiltrates, seromas and hematomas after episiorrhaphies and perineorrhaphies. The scanning was made by shifting the laser spot on wound edges and the located around them infiltrates, seromas and hematomas with exposition time of the field of 1.5 min. The most manifested analgetic and resorptive effect of the described early wound complications was achieved by DP of laser irradiation within the range of 100-70 mW/cm2. The density of power of helium-neon laser irradiation of 50 mW/cm2 was slightly effective.

[Laser therapy of wound infiltrates, seromas and hematomas following gynecologic operations. Clinical research]. / Lazerterapiia na ranevi infiltrati, seromi i khematomi sled ginekologichni operatsii. Klinichni prouchvaniia.

The therapeutic possibilities of helium-neon laser light with densities of power (DP)-100, 90, 80, 70 and mW/cm2 as well as exposition time of the field of 1.5 min were studied in 109 women with skin subcutaneously located wound infiltrates, seromas and hematomas after gynecological operations. Clinical observations were carried out on 32 women with more deeply located (epifascial) infiltrates, irradiated by DP of laser light (LL) of 100 mW/cm2. The initial resorption of inflammatory tissue changes and analgetic effect was established even after 1-3 irradiations with DP of 100,90 and 80 mW/cm2. The final resorption of postoperative wound complications and healing of complicated operative wounds was achieved after irradiation with LL of 100, 90, 80 and 70 mW/cm2 for the shortest intervals (1-3 and 4-6 days). The investigated DP of LL of 50 mW/cm2 was not sufficiently effective for resorption and healing of wound skin and subcutaneously located infiltrations, seromas and hematomas. Resorption of epifascial wound infiltrations by DP of 100 mW/cm2 was not achieved.