Hemodynamic Instability in Emergency Department: Giant Rectus Sheath Hematoma and Point-of-Care Ultrasonography

Iatrogenic vascular complications of non-vascular percutaneous abdominal procedures

PURPOSE

The purpose of this paper is to compile and present all of the reported vascular complications that resulted from common non-vascular abdominal procedures in the literature. Non-vascular procedures include, though are not limited to, percutaneous abscess/fluid collection drainage (PAD), percutaneous nephrostomy (PN), paracentesis, percutaneous transhepatic cholangiography (PTC)/percutaneous biliary drainage (PBD), percutaneous biliary stone removal, and percutaneous radiologic gastrostomy (PG)/percutaneous radiologic gastrojejunostomy (PG-J). By gathering this information, radiologists performing these procedures can be aware of the associated vascular injuries, as well as take steps to minimize risks.

METHODS

A literature review was conducted using the PubMed database to catalog relevant articles, published in the year 2000 onward, in which an iatrogenic vascular complication occurred from the following non-vascular abdominal procedures: PAD, PN, paracentesis, PTC/PBD, percutaneous biliary stone removal, and PG/PG-J. Biopsy and tumor ablation were deferred from this article.

RESULTS

214 studies met criteria for analysis. 28 patients died as a result of vascular complications from the analyzed non-vascular abdominal procedures. Vascular complications from paracentesis were responsible for 19 patient deaths, followed by four deaths from PTC/PBD, three from biliary stone removal, and two from PG.

CONCLUSION

Despite non-vascular percutaneous abdominal procedures being minimally invasive, vascular complications still can arise and be quite serious, even resulting in death. Through the presentation of vascular complications associated with these procedures, interventionalists can improve patient care by understanding the steps that can be taken to minimize these risks and to reduce complication rates.

A case of rectus sheath hematoma in the setting of paroxysmal coughing and platelet dysfunction

Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that may mimic other intra-abdominal pathologies. It is caused by the rupture of the superior or inferior epigastric artery or vein in the rectus abdominis muscle. Clinical features include sudden-onset abdominal pain and a palpable mass, and common risk factors include anti-coagulants, platelet dysfunction, and cough. Workup includes a physical exam, complete blood count, coagulation profile, ultrasound, and computed tomography. While most cases are treated conservatively, uncontrolled hemorrhage may be lethal and requires prompt recognition. We discuss a case of RSH which developed in the setting of paroxysmal coughing and platelet dysfunction. The purpose is to highlight the diagnosis and treatment of RSH and emphasize the importance of its inclusion in the differential for acute abdominal pain.