Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center

Özdemir, Ali Ulvi; Demir, Ali Aslan; DEMİRAL, Gökhan; Colakoglu, Muhammet Kadri; Pergel, Ahmet; KALCAN, Süleyman

doi:10.14744/tjtes.2019.32485

Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center

Muhammet Kadri ÇOLAKOĞLU, (Girilmemişş)

Ali Ulvi ÖZDEMİR, (Girilmemişş)

Süleyman KALCAN, (Girilmemişş)

Ali Aslan DEMİR, (Girilmemişş)

Gökhan DEMİRAL, (Girilmemişş)

Ahmet PERGEL (Girilmemişş)

Ulusal Travma ve Acil Cerrahi Dergisi

1 1

Yıl: 2020 Cilt: 26 Sayı: 1 Sayfa Aralığı: 50 - 54 Metin Dili: İngilizce DOI: 10.14744/tjtes.2019.32485 İndeks Tarihi: 10-11-2020

Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center

Öz:

BACKGROUND: The incidence of abdominal wall hematomas increased after the introduction of anticoagulant and antiplateletdrugs in clinical practice. These patients are usually old, and they have more than one comorbidity. Most spontaneous hematomas tendto limit itself and conservative treatment with close follow up is usually enough, but surgery is an option that should be decided critically. Unnecessary surgical interventions could worsen the situation. The present study aims to analyze the results of patients underanticoagulant/antiplatelet treatment and with spontaneous abdominal wall hematomas from surgeons’ perspective.METHODS: This is a retrospective study that the medical records of 43 patients who were under anticoagulant/antiplatelet therapyand consulted our general surgery clinic because of the spontaneous abdomen and abdominal wall hematoma between January-2016and September-2018 were reviewed.RESULTS: The findings showed that most of the cases were presented with abdominal pain. Thirty of these patients were female(69.7%). The mean age was 69.32 years. More than half of the patients (58.1%) were referred from the emergency department. Allof the cases were under anticoagulant and antiplatelet treatment for several reasons. With presenting signs and symptoms and afterevaluation of laboratory tests, computed tomography was performed to 30 patients (69.7%) as an initial test. USG and MRI were theother methods used. The most common diagnosis was rectus sheath hematoma (n=16; 37.2%) and followed by intestinal and colonwall, lumbar, psoas, pelvic and retroperitoneal hematoma in decreasing order. Among 43 patients, 39 patients (90.6%) followed withconservative treatment and two patients were treated with transcatheter arterial embolization. Two patients (4.6%) were died on day1 and 11 after diagnosis. No surgery needed for all patients.CONCLUSION: Early recognition, hospitalization of risky patients, close follow-up of hemodynamic parameters, patients’ responseto conservative treatment and minimal invasive methods are key points. Conservative care is the choice of treatment, but surgery mustalways keep in mind in hemodynamic unstable patients

Anahtar Kelime:

Antikoagülan/antiplatelet kullanımına bağlı spontan abdomen ve abdominal duvar hematomları: Tek merkez, cerrah perspektifi

Öz:

AMAÇ: Abdominal duvar hematomlarının insidansı, klinik uygulamada antikoagülan ve antiplatelet ilaçların kullanılmasından sonra artmıştır. Bu hastalar genellikle yaşlıdır ve birden fazla komorbiditeye sahiptirler. Çoğu spontan hematom kendini kısıtlama eğilimindedir ve yakın takip ile konservatif tedavi genellikle yeterlidir ancak cerrahi, kritik olarak karar verilmesi gereken bir seçenektir. Gereksiz cerrahi müdahaleler durumu daha da kötüleştirebilir. Bu çalışmanın amacı, antikoagülan/antiplatelet tedavi altındaki ve spontan abdominal duvar hematomları olan hastaların sonuçlarını cerrahi perspektiften incelemektir. GEREÇ VE YÖNTEM: Bu çalışma, Ocak 2016 ve Eylül 2018 yılları arasında antikoagülan/antiplatelet tedavi gören ve spontan abdomen ve abdominal duvar hematomu nedeniyle genel cerrahi kliniğimize başvuran 43 hastanın tıbbi kayıtlarının gözden geçirildiği geriye dönük bir çalışmadır. BULGULAR: Olguların birçoğu karın ağrısı ile başvurdu. Bu hastaların 30’u kadındı (%69.7). Yaş ortalaması 69.32 idi. Hastaların yarısından fazlası (%58.1) acil servisten refere edildi. Olguların tamamı çeşitli nedenlerle antikoagülan ve antiplatelet tedavi altındaydı. Belirti ve semptomların izlenmesi ve laboratuvar testlerinin değerlendirilmesinden sonra 30 hastaya (%69.7) başlangıç testi olarak bilgisayarlı tomografik görüntüleme uygulandı. USG ve MRI kullanılan diğer yöntemlerdi. En sık rastlanan tanı rektus kılıf hematomuydu (n=16; %37.2) ve bunu sırasıyla bağırsak ve kolon duvarı, lombar, psoas, pelvik ve retroperitoneal hematom izledi. Kırk üç hastadan 39’una (%90.6) konservatif tedavi uygulandı ve iki hastaya transkateter arteriyel embolizasyon uygulandı. Tanıdan sonraki birinci ve 11. günde iki hasta (%4.6) hayatını kaybetti. Tedavi için cerrahi uygulama gerekmedi. TARTIŞMA: Erken tanı, riskli hastaların hastaneye yatırılması, hemodinamik parametrelerin yakın takibi, konservatif tedaviye yanıt verme ve minimal invaziv yöntemler tedavide önemli noktalardır. Konservatif bakım ilk tedavi seçeneğidir ancak hemodinamik stabil olmayan hastalarda her zaman cerrahi akılda tutulmalıdır.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Scott WW Jr., Fishman EK, Siegelman SS. Anticoagulants and abdominal pain. The role of computed tomography. JAMA 1984;252:2053−6.
2. Fitzgerald JE, Fitzgerald LA, Anderson FE, Acheson AG. The changing nature of rectus sheath haematoma: case series and literature review. Int J Surg 2009;7:150−4.
3. Alla VM, Karnam SM, Kaushik M, Porter J. Spontaneous rectus sheath hematoma. West J Emerg Med 2010;11:76−9.
4. Donaldson J, Knowles CH, Clark SK, Renfrew I, Lobo MD. Rectus sheath haematoma associated with low molecular weight heparin: a case series. Ann R Coll Surg Engl 2007;89:309−12.
5. Cherry WB, Mueller PS. Rectus sheath hematoma: review of 126 cases at a single instution. Medicine (Baltimore) 2006;85:105−10.
6. Risch O, Alfidja A, Mulliez A, Amani AH, Boyer L, Camilleri L, et al. Severe non-traumatic bleeding events detected by computed tomography: do anticoagulants and antiplatelet agents have a role? J Cardiothorac Surg 2014;9:166.
7. Aktürk OM, Kayılıoğlu SI, Aydoğan I, Dinc T, Yıldız B, Cete M, et al. Spontaneous rectus sheath hematoma: an overview of 4-year single center experience. Indian J Surg 2015;77:1219−21.
8. Siu WT, Tang CN, Law BK, Chau CH, Li MK. Spontaneous rectus sheath hematoma. Can J Surg 2003;46:390
9. Maharaj D, Ramdass M, Teelucksingh S, Perry A, Naraynsingh V. Rectus sheath haematoma: a new set of diagnostic features. Postgrad Med J 2002;78:755−6.
10. Pei MW, Hu MR, Chen WB, Qin C. Surgical Treatment of a Giant Spontaneous Abdominal Wall Hematoma. Chin Med J 2017; 130:1621−2.
11. Carkman S, Ozben V, Zengin K, Somuncu E, Karatas A. Spontaneous rectus sheath hematoma: an analysis of 15 cases. Ulus Travma Acil Cerrahi Derg 2010;16:532−6.
12. Dag A, Ozcan T, Turkmenoglu O, Colak T, Karaca K, Canbaz H, et al. Spontaneous rectus sheath hematoma in patients on anticoagulation therapy. Ulus Travma Acil Cerrahi Derg 2011;17:210−4.
13. Gundes E, Cetin DA, Aday U, Ciyiltepe H, Deger KC, Uzun O, et al. Spontaneus rectus sheath hematoma in cardiac patients: a single-center experience Ulus Travma Acil Cerrahi Der 2017;23:483−8.
14. Virmani V, Sethi V, Fasih N, Ryan J, Kielar A. The abdominal wall lumps and bumps: cross-sectional imaging spectrum. Can Assoc Radiol J 2014;65:9−18.
15. Leonardou P, Kierans AS, Elazazzi M, Shaikh F, Semelka RC. MR imaging findings of small bowel hemorrhage: two cases of mural involvement an done of perimural J Magn Reson Imaging 2009;29:1185−9.
16. Nakayama T, Ishibashi T, Eguchi D, Yamada K, Tsurumaru D, Sakamoto K, et al. Spontaneous internal oblique hematoma successfully treated by transcatheter arterial embolization. Radiat Med 2008;26:446−9.

APA	Colakoglu M, Özdemir A, KALCAN S, Demir A, DEMİRAL G, Pergel A (2020). Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center. , 50 - 54. 10.14744/tjtes.2019.32485
Chicago	Colakoglu Muhammet Kadri,Özdemir Ali Ulvi,KALCAN Süleyman,Demir Ali Aslan,DEMİRAL Gökhan,Pergel Ahmet Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center. (2020): 50 - 54. 10.14744/tjtes.2019.32485
MLA	Colakoglu Muhammet Kadri,Özdemir Ali Ulvi,KALCAN Süleyman,Demir Ali Aslan,DEMİRAL Gökhan,Pergel Ahmet Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center. , 2020, ss.50 - 54. 10.14744/tjtes.2019.32485
AMA	Colakoglu M,Özdemir A,KALCAN S,Demir A,DEMİRAL G,Pergel A Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center. . 2020; 50 - 54. 10.14744/tjtes.2019.32485
Vancouver	Colakoglu M,Özdemir A,KALCAN S,Demir A,DEMİRAL G,Pergel A Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center. . 2020; 50 - 54. 10.14744/tjtes.2019.32485
IEEE	Colakoglu M,Özdemir A,KALCAN S,Demir A,DEMİRAL G,Pergel A "Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center." , ss.50 - 54, 2020. 10.14744/tjtes.2019.32485
ISNAD	Colakoglu, Muhammet Kadri vd. "Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center". (2020), 50-54. https://doi.org/10.14744/tjtes.2019.32485

APA	Colakoglu M, Özdemir A, KALCAN S, Demir A, DEMİRAL G, Pergel A (2020). Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center. Ulusal Travma ve Acil Cerrahi Dergisi, 26(1), 50 - 54. 10.14744/tjtes.2019.32485
Chicago	Colakoglu Muhammet Kadri,Özdemir Ali Ulvi,KALCAN Süleyman,Demir Ali Aslan,DEMİRAL Gökhan,Pergel Ahmet Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center. Ulusal Travma ve Acil Cerrahi Dergisi 26, no.1 (2020): 50 - 54. 10.14744/tjtes.2019.32485
MLA	Colakoglu Muhammet Kadri,Özdemir Ali Ulvi,KALCAN Süleyman,Demir Ali Aslan,DEMİRAL Gökhan,Pergel Ahmet Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center. Ulusal Travma ve Acil Cerrahi Dergisi, vol.26, no.1, 2020, ss.50 - 54. 10.14744/tjtes.2019.32485
AMA	Colakoglu M,Özdemir A,KALCAN S,Demir A,DEMİRAL G,Pergel A Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(1): 50 - 54. 10.14744/tjtes.2019.32485
Vancouver	Colakoglu M,Özdemir A,KALCAN S,Demir A,DEMİRAL G,Pergel A Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(1): 50 - 54. 10.14744/tjtes.2019.32485
IEEE	Colakoglu M,Özdemir A,KALCAN S,Demir A,DEMİRAL G,Pergel A "Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center." Ulusal Travma ve Acil Cerrahi Dergisi, 26, ss.50 - 54, 2020. 10.14744/tjtes.2019.32485
ISNAD	Colakoglu, Muhammet Kadri vd. "Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center". Ulusal Travma ve Acil Cerrahi Dergisi 26/1 (2020), 50-54. https://doi.org/10.14744/tjtes.2019.32485