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O'Brien K, Fei F, Quint E, Dendrinos M. Non-Obstetric Traumatic Vulvar Hematomas in Premenarchal and Postmenarchal Girls. J Pediatr Adolesc Gynecol 2022; 35:546-551. [PMID: 35358706 DOI: 10.1016/j.jpag.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/27/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Traumatic non-obstetrical hematomas of the vulva are rare, and most reports only involve adult patients. There are no data on presentation, management, and outcomes from either conservative or surgical management in pediatric and adolescent patients. The objective of this project was to compare the etiology, treatment, and outcomes of traumatic vulvar hematomas occurring in premenarchal and postmenarchal young women. METHODS A retrospective chart review was performed on females aged 0-24 years seen at a tertiary care academic center using ICD 9 and 10 codes for traumatic vulvar hematoma from 2006-2019. Data describing their clinical presentation and course were collected. IRB approval was obtained. RESULTS Twenty patients, aged 3-23 years (median age of 13.5 years) were identified. All 8 premenarchal patients presented with a straddle injury, whereas only 50% of postmenarchal patients were found to have a straddle injury. Other etiologies among postmenarchal patients included consensual sexual intercourse and recent vulvar surgery. Hematoma diameter ranged from 1-3 cm in premenarchal patients and 0.4-7 cm in postmenarchal patients. Associated perineal lacerations were reported in 50% of the premenarchal girls and 8% of postmenarchal young women. Of the 8 premenarchal patients, 5 were managed conservatively, and 3 were taken to the operating room for repair of perineal lacerations; 1 patient also underwent evacuation of a 3-cm hematoma. Of the 12 postmenarchal patients, 5 had surgical intervention, 2 for pain secondary to large 7-cm hematomas and 3 for suspected vulvar abscesses, which were identified as hematomas after drainage. One patient in each group required a Foley catheter for comfort. Two postmenarchal patients required a second surgery for further wound management. One premenarchal patient with surgical treatment required a follow-up exam under anesthesia. Four patients were admitted for pain and postoperative observation, 1 of whom was premenarchal. Eleven patients were seen for follow-up, and 10 were doing well. One postmenarchal patient in the conservative management group returned to the Emergency Department with continued pain 10 days later. CONCLUSIONS In this study that examined traumatic vulvar hematomas in premenarchal and postmenarchal young women, the only mechanism of injury in premenarchal girls was straddle injury, and surgical intervention was usually needed only for repair of perineal lacerations, not a primary hematoma. In the postmenarchal patients, surgical intervention was undertaken for larger hematomas and suspected vulvar abscesses. Our study suggests that most hematomas up to 3 cm in premenarchal patients and up to 6 cm in postmenarchal patients can be managed conservatively.
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Affiliation(s)
- Kathleen O'Brien
- University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, Michigan
| | - Frances Fei
- Section of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
| | - Elisabeth Quint
- Division of Pediatric and Adolescent Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Melina Dendrinos
- Division of Pediatric and Adolescent Gynecology, University of Michigan, Ann Arbor, Michigan
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Cizek SM, Tyson N. Pediatric and Adolescent Gynecologic Emergencies. Obstet Gynecol Clin North Am 2022; 49:521-536. [PMID: 36122983 DOI: 10.1016/j.ogc.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diagnosis of gynecologic emergencies in the pediatric and adolescent population requires a high index of suspicion to avoid delayed or incorrect diagnoses. This article aims to dispel common misunderstandings and aid with diagnosis and management of 3 common pediatric and adolescent gynecologic emergencies: adnexal torsion, vulvovaginal lacerations, and nonsexually acquired genital ulcers.
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Affiliation(s)
- Stephanie M Cizek
- Pediatric and Adolescent Gynecology, Department of OB/GYN, Stanford University School of Medicine, Center for Academic Medicine, MC 5317, 453 Quarry Road, Palo Alto, CA 94304, USA.
| | - Nichole Tyson
- Pediatric and Adolescent Gynecology, Department of OB/GYN, Stanford University School of Medicine, Center for Academic Medicine, MC 5317, 453 Quarry Road, Palo Alto, CA 94304, USA
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Bono M, Woolum D, Jones A, Counselman F. Vaginal Swelling After Intercourse: A Case Report. Clin Pract Cases Emerg Med 2022. [DOI: 10.5811//cpcem.2022.2.55284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: A vulvar hematoma is a hemorrhagic fluid collection in the female external genitalia. The majority occur as an obstetrical complication, especially during labor. Non-obstetrical vulvar hematomas are usually the result of trauma, with coitus being the most common etiology.
Case Report: We present the case of a 25-year-old woman with significant vaginal pain and swelling after vigorous sexual intercourse. She exhibited tenderness and swelling of the left labia majora and minora. The differential diagnosis included bleeding, abscess, and deep venous thrombosis.
Laboratory studies were normal and computed tomography of the pelvis indicated the swelling was most likely due to blood. The patient was taken to the operating room, and approximately 150 cubic centimeters of clot was evacuated. The patient had an uneventful recovery and was discharged home the next day.
Conclusion: This case illustrates the unique presentation and challenges in making the diagnosis of vulvar hematoma.
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Affiliation(s)
- Michael Bono
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia; Emergency Physicians of Tidewater, Norfolk, Virginia
| | - Dylan Woolum
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia
| | - A. Jones
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia
| | - Francis Counselman
- Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia; Emergency Physicians of Tidewater, Norfolk, Virginia
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Kim MS, Lee HJ, Joo E, Kang S, Lee MH, Kim HC. Management of non-obstetric traumatic vulvar haematoma: a retrospective review of 33 cases. J OBSTET GYNAECOL 2021; 42:1301-1304. [PMID: 34726110 DOI: 10.1080/01443615.2021.1960289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The cases of non-obstetric traumatic vulvar haematomas are rare, and there is a lack of consensus statements for the necessity of surgical intervention. We retrospectively analysed the data of 33 cases (mean age: 25.7 years) of non-obstetric traumatic vulvar haematoma (mean haematoma size: 8.4 cm). Women who underwent surgery (surgery group) were compared to those who received conservative management (conservative group). Twenty-four patients underwent surgery; most cases were of haematoma removal and primary closure. Nine patients received conservative management, such as ice bag application, antibiotics, or analgesia. The rate of deviation of the contralateral vulva because of haematoma was higher (54.2% versus 11.1%, p = .047) and the mean haematoma size was larger (9.5 versus 5.2 cm, p = .004) in the surgical than in the conservative group. While conservative management affects cases of minor vulvar haematoma, surgical evacuation of haematoma can be performed in cases of large haematoma (mean size: 9.5 cm), severe pain, distorted vulvar anatomy, and invisible urethral opening for indwelling urinary catheter.IMPACT STATEMENTWhat is already known on this subject? Cases of non-obstetric traumatic vulvar haematomas are rare. There are no consensus statements for the necessity of surgical intervention.What do the results of this study add? The study showed that surgical evacuation of haematoma can be performed in cases of large haematoma (mean size: 9.5 cm), severe pain, distorted vulvar anatomy, and invisible urethral opening for indwelling urinary catheter. Moreover, surgical management could hasten recovery.What are the implications of these findings for clinical practice and/or further research? The results of this study can be used in counselling non-obstetric traumatic vulvar haematomas. Further research is needed to confirm these findings.
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Affiliation(s)
- Mi Sun Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Centre, Seongnam-si, Republic of Korea
| | - Hyun Jung Lee
- Department of Obstetrics and Gynecology, CHA Bundang Medical Centre, Seongnam-si, Republic of Korea
| | - Eunhui Joo
- Department of Obstetrics and Gynecology, CHA Bundang Medical Centre, Seongnam-si, Republic of Korea
| | - Sukho Kang
- Department of Obstetrics and Gynecology, CHA Bundang Medical Centre, Seongnam-si, Republic of Korea
| | - Mee-Hwa Lee
- Department of Obstetrics and Gynecology, CHA Bundang Medical Centre, Seongnam-si, Republic of Korea
| | - Hyeon Chul Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Centre, Seongnam-si, Republic of Korea
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Mangwi AA, Ebasone PV, Aroke D, Ngek LT, Nji AS. Non-obstetric vulva haematomas in a low resource setting: two case reports. Pan Afr Med J 2019; 33:314. [PMID: 31692848 PMCID: PMC6815487 DOI: 10.11604/pamj.2019.33.314.19488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/18/2019] [Indexed: 12/02/2022] Open
Abstract
Vulva haematomas are uncommon outside the obstetric population, with an incidence of 3.7% and represent only 0.8% of all gynaecological emergencies. The first case is a 24-year-old G2P1011 referred after the failure of conservative management of a progressively increasing right labia majora swelling. Vulva incision, exploration and relieve of hematoma were done under local anaesthesia. The second case is a 17-year-old G1P1001, a student who presented with spontaneous pain and swelling of the left labia majora. The swelling was rapidly increasing, tense and tender. It spontaneously ruptured, clots were drained and the wound was packed. Vulva hematomas are not very common hence necessitating careful assessment, right diagnosis and management. Management could be conservative (analgesics, local compression) as well as surgical in cases of hemodynamic instability, rapidly increasing size of hematoma and pain intensity. Prompt surgical management reduces the risk of infection and longer hospital stays, which is important in low resource settings like ours.
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Affiliation(s)
- Ako Annabel Mangwi
- Anako Mother and Child Medical Centre, Yaoundé, Cameroon.,Clinical Research Education Networking and Consultancy, Yaoundé, Cameroon
| | | | - Desmond Aroke
- Health and Human Development Research Network, Douala, Cameroon
| | | | - Ako Simon Nji
- Anako Mother and Child Medical Centre, Yaoundé, Cameroon
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Yadav GS, Marashi A. Evacuation of a large traumatic vulvar haematoma with an intravaginal cosmetic approach. BMJ Case Rep 2019; 12:12/5/e228535. [PMID: 31079041 DOI: 10.1136/bcr-2018-228535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A healthy youngwoman presented 3 days after a jet ski accident with a large left vulvar haematoma measuring 12 cm. Immediately postinjury, she was managed conservatively in the emergency room of another hospital. However, the haematoma continued to slowly expand. She presented to our clinic with difficulty walking and severe discomfort. Decision was made to drain the haematoma surgically. The patient was sceptical to have scarring on her vulva. Thus, the haematoma was evacuated by a vertical incision on the left vaginal sidewall. After evacuation and achieving haemostasis, the was closed with two interrupted sutures. Edges of the incision were secured similar to marsupialisation with five interrupted sutures to allow continual drainage. Her discomfort resolved immediately postsurgery and she had an uncomplicated postoperative course. The intravaginal approach yielded superior aesthetic result with no scarring on the external vulva.
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Affiliation(s)
- Ghanshyam S Yadav
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Amir Marashi
- Department of Obstetrics and Gynecology, New York Presbyterian Brooklyn Methodist Hospital, New York City, New York, USA.,Obstetrics & Gynaecology, Professional Brooklyn Gynecological Services, New York City, New York, USA
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Lapresa Alcalde MV, Hernández Hernández E, Bustillo Alfonso S, Doyague Sánchez MJ. Non-obstetric traumatic vulvar hematoma: Conservative or surgical approach? A case report. Case Rep Womens Health 2019; 22:e00109. [PMID: 30976525 PMCID: PMC6441764 DOI: 10.1016/j.crwh.2019.e00109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/14/2019] [Accepted: 03/24/2019] [Indexed: 11/17/2022] Open
Abstract
Non-obstetric vulvar hematomas are rare and few cases have been reported in the literature. There are no clinical guidelines for their management. In most cases they can be treated conservatively but in some cases surgical intervention will be necessary. We present the case of a patient with a traumatic vulvar hematoma who required surgical treatment; we also review the literature on this gynecological pathology. Our case highlights the importance of early surgical intervention to reduce associated morbidity and to minimize hospital stay. Most traumatic vulvar hematomas are small and can be managed conservatively. Non-obstetric genital hematomas can reach a volume that may cause hemodynamic instability. Vulvar hematomas more than 4 cm across may cause necrosis and require surgical assessment. If surgical intervention is necessary, all the blood clots must be removed without excessive manipulation. Surgical intervention is necessary if the hematoma is expanding, of if there is hemodynamic instability or persistent pain.
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Tsumagari A, Ohara R, Mayumi M, Yagi H, Nagai Y, Obata-Yasuoka M, Hamada H, Satoh T. Clinical characteristics, treatment indications and treatment algorithm for post-partum hematomas. J Obstet Gynaecol Res 2019; 45:1127-1133. [PMID: 30788889 DOI: 10.1111/jog.13943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/01/2019] [Indexed: 11/27/2022]
Abstract
AIM Post-partum hematomas are a serious obstetrical complication. Choosing treatments for post-partum hematomas is difficult, and the application of transcatheter arterial embolization remains unclear. We aimed to clarify the clinical characteristics, identify the treatment indications and create a treatment algorithm for post-partum hematomas. METHODS Fifty-four patients with post-partum hematomas were enrolled. Hematomas were categorized according to location: upper vaginal, lower vaginal and vulvar. Blood loss, treatment methods and other clinical data were collected from the patients' medical records and analyzed retrospectively. RESULTS Five, 19 and 30 patients had upper vaginal wall, lower vaginal wall and vulvar hematomas, respectively. All upper vaginal wall hematomas required transcatheter arterial embolization to control bleeding, and the average blood loss was 2473 ± 1689 mL. Most lower vaginal wall hematomas were treated surgically; however, two patients required transcatheter arterial embolization, and the average blood loss in these patients was much higher (2010 ± 1145 mL) than that in patients with lower vaginal wall hematomas (395 ± 316 mL). No patient with vulvar hematomas was treated with transcatheter arterial embolization. Two and four patients with vulvar and lower vaginal wall hematomas, respectively, were managed with observation. CONCLUSION We created an algorithm for post-partum hematoma management. Post-partum hematoma location should guide treatment selection. Transcatheter arterial embolization should be selected for upper vaginal wall hematomas. Most lower vaginal wall hematomas are treatable with surgery, but transcatheter arterial embolization should be considered for hemostasis in difficult cases. Management with observation may also be possible for lower vaginal wall and vulvar hematomas.
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Affiliation(s)
- Ayako Tsumagari
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Rena Ohara
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Miyuki Mayumi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiroya Yagi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuko Nagai
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Mana Obata-Yasuoka
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Hiromi Hamada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Papoutsis D, Haefner HK. Large Vulvar Haematoma of Traumatic Origin. J Clin Diagn Res 2017; 11:QJ01-QJ02. [PMID: 29207790 DOI: 10.7860/jcdr/2017/30104.10542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/09/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Dimitrios Papoutsis
- Research Fellow, Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, United Kingdom
| | - Hope K Haefner
- Professor, Department of Obstetrics and Gynaecology, University of Michigan Center for Vulvar Diseases, Michigan Medicine, Ann Arbor, Michigan, United States of America
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A case of vulvar hematoma with rupture of pseudoaneurysm of pudendal artery. Obstet Gynecol Sci 2014; 57:168-71. [PMID: 24678493 PMCID: PMC3965703 DOI: 10.5468/ogs.2014.57.2.168] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/07/2013] [Accepted: 09/09/2013] [Indexed: 11/24/2022] Open
Abstract
Vulvar hematomas are uncommon outside of the obstetric population and may be the result of trauma to the perineum. Vulvar hematomas most often present with low abdominal pain and urologic and neurologic symptoms. The vulva has rich vascularization that is supplied by the pudendal artery, a branch of the anterior division of the internal iliac artery. We describe a rare case of a 15-cm-sized vulvar hematoma with the suggested rupture of a pseudoaneurysm of the left pudendal artery without trauma injury. A 14-year-old girl presented with sudden pain and swelling in her left labium and was successfully treated with selective arterial embolization and surgical evacuation. We provide a literature review and discuss patient treatment and management strategies.
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Abstract
OBJECTIVE To describe the mechanism, injury pattern and management of women who present to the ED with non-obstetric vulval trauma. METHODS A retrospective, single-institution case series was carried out. Data were sourced from medical records of women who presented to the ED and Royal Brisbane and Women's Hospital between 2007 and 2011. Records of possible injuries to the vulva were assessed to determine incidence, age, site, type of injury, mechanism of injury and whether urinary retention required treatment. This information was analysed using the computer software Statistical Package for the Social Sciences 11.0. RESULTS Vulval non-obstetric trauma was found in 19 of 519 cases, resulting in haematoma formation, lacerations, tears or a combination of the three in 16 of the 19 cases. Injuries were due to falling astride a firm object, consensual coitus, sexual assault, cold waxing and tight clothing. Urinary retention occurred in three cases. Site of injury, whether anterior or posterior, was evenly distributed irrespective of the mechanism of injury. Haematomas were treated conservatively and bleeding lacerations sutured. None required resuscitation. CONCLUSIONS Non-obstetric vulval injuries are uncommon (incidence 3.7%). All cases require assessment for vaginal, urethral, anal and bony pelvis injuries. This might require examination under anaesthesia. Conservative management of haematomas in the absence of acute haematoma expansion is favoured. The need to screen for sexually transmissible infections and pregnancy is important. Social worker and psychological support is important to reduce the incidence of long-term psychological problems.
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Affiliation(s)
- Ian S C Jones
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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