Hematoma retroperitoneal espontáneo en pacientes con neumonía grave por SARS-CoV-2 / Spontaneous retroperitoneal hematoma in patients with severe SARS-CoV-2 pneumonia

Recientemente se han publicado varios casos de hematomas retroperitoneales espontáneos (Hre) en el contextode infección por SarS-CoV-2. este estudio presenta una revisión sistemática de la literatura con el objetivo deprofundizar en esta infrecuente asociación. Se identificaron 32 casos de Hre, el 28,1 % con enfermedad COVID-19 crítica. el 68,7 % recibió anticoagulacióncon HBpM y el 15,6 % con heparina sódica. La mediana de días hasta el diagnóstico fue de 10,5 (rango de 0-38).en el 31,2 % de los casos se optó por manejo conservador, mientras que otro 31,2 % requirió angioembolización. Se comunicaron 10 exitus (31,2 %), 6 probablemente relacionados con el Hre.existen hipótesis acerca de la relación entre la infección por SarS-CoV-2 y los fenómenos hemorrágicos. Se handescrito dos mecanismos que explicarían la coagulopatía: la unión al receptor aCe2 y la acción directa del virussobre el endotelio vascular. Por otra parte, la disfunción plaquetaria, la trombocitopenia inmune y la respuesta alSIrS, así como los microtraumas secundarios al esfuerzo tusígeno, la ventilación mecánica invasiva o los cambiosposturales, sugieren un origen multicausal del Hre.La literatura sobre esta asociación es escasa. Dado el exceso de morbimortalidad que supone, se considera nece-sario profundizar en su investigación.(AU)

Recently, cases of spontaneous retroperitoneal haematomas (SrH) in the context of SarS-CoV-2 infection havebeen published. this study presents a systematic review with the aim of further investigating this rare association. Thirty-two cases were identified, with a 28,1 % of critical patients. a total of 68,7 % received anticoagulation withLMWH, and a 15,6 % with UFH. the median number of days to diagnosis was 10,5 (0-38). Conservative manage-ment was chosen in 31,2 %, while another 31,2 % required angio-embolisation. ten exitus (31,2 %) were reported,6 related to SrH. There are hypotheses on the link between SarS-CoV-2 infection and haemorrhagic phenomena. two mechanismshave been described that would explain coagulopathy: the binding of SarS-CoV-2 to the aCe2 receptor and itsdirect action on the vascular endothelium. Furthermore, the platelet dysfunction, immune thrombocytopenia andSIrS, added to the endothelial disruption in retroperitoneal vessels, as well as microtrauma secondary to coughstress, invasive mechanical ventilation and/or postural changes, suggest a multicausal origin of SrH. The literature concerning this association is scarce. Given the excess morbidity and mortality involved, it is consid-ered necessary to investigate it further.(AU)

Transplantation-mediated alloimmune thrombocytopenia successfully treated by retransplantation.

INTRODUCTION: Transplantation-mediated alloimmune thrombocytopenia (TMAT) is a rare complication affecting the recipient of an organ from a donor with immune thrombocytopenia (ITP). METHODS: We present a case of TMAT following liver transplantation successfully treated by retransplantation, along with a review of previously published cases.Clinical presentation: The liver donor had lupus and ITP and died from an intracranial hemorrhage. The recipient's platelet count fell to 2x109/L on postoperative day 2. Due to the lack of response to medical treatment, emergency retransplantation was undertaken with a steady recovery of the platelet count within a few days. DISCUSSION: Six additional cases of transplantation-mediated alloimmune thrombocytopenia after liver transplantation have been reported. In all cases, severe thrombocytopenia ensued within 3 days after liver transplantation. Four patients suffered hemorrhagic complications. Three patients died. Early retransplantation was needed in three out of four patients receiving a graft from a donor with ITP and splenectomy. All recovered shortly after the new graft was in place. CONCLUSION: Severe refractory transplantation-mediated alloimmune thrombocytopenia can develop in liver recipients from donors with ITP, especially those with previous splenectomy. Early retransplantation should be considered if there is no rapid response to medical therapy.

Isquemia aguda de extremidad inferior tras lesión arterial secundaria a hernioplastia crural / Acute lower limb ischemia after arterial injury secondary to femoral hernia repair

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Síndrome de la pinza aorto-mesentérica (Sind. de Wilkie). Análisis de una serie de 7 casos / Superior mesenteric artery syndrome (Wilkie syndrome): Analysis of a series of 7 cases

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Esófago negro tras doble trasplante hepatorrenal / Black esophagus after combined liver-kidney transplantation

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Hidronefrosis derecha por fecaloma / Right hydronephrosis secondary to fecal impaction

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