ПРИКАЗ НА СЛУЧАЈ: ТРЕТМАН СО ЕМБОЛИЗАЦИЈА НА ХЕМАТОМ ВО ПРАВИОТ СТОМАЧЕН МУСКУЛ КАЈ ПАЦИЕНТ СО КОВИД-19 A CASE REPORT: EMBOLIZATION TREATMENT OF RECTUS SHEATH HEMATOMA IN A COVID-19 PATIENT
Journal
Македонски медицински преглед = Macedonian Medical Review
Date Issued
2022-10
Author(s)
Sopova, Zaklina
Osmani L., Arlinda
Bogoeva-Tasevska, Suncica
Abstract
Introduction. In this case report we present a patient
with COVID-19 pneumonia and rectus sheath
hematoma (RSH) treated with embolization.
Methods. A 63-year-old man positive for SARS-CoV-
2 presented with cough, fever and dyspnea to our
Clinic. The patient was admitted and treated with
oxygen, antibiotics, corticosteroid, anticoagulant and
oral antiplatelet therapy. Thirteen days after admission
the patient had severe abdominal pain, the CT scan
confirmed left rectus sheath hematoma and he
underwent a CT angiography with embolization of the
left inferior epigastric artery. Ten days after
embolization the patient recovered completely and was
discharged.
Result. SARS-CoV-2 infection is associated with coagulopathy,
hence the anticoagulant therapy. The main
side effect of anticoagulant therapy is an increased risk
of bleeding. A rare complication of anticoagulant therapy
is rectus sheath hematoma. The treatment is usually
conservative with intravenous fluids, pain medication,
discontinuation of anticoagulant therapy, and blood
transfusion in cases of severe anemia. The computed
tomography is the most common method to establish
or confirm the diagnosis. Еmbolization of bleeding vessels
can be performed in large RSH with hemodynamic
instability and/or with evidence of active bleeding.
Conclusion. Inpatient treatment of COVID-19 pneumonia
includes anticoagulant agents, but clinicians must
carefully monitor their possible side effects and suspect a
rectus sheath hematoma in patients with abdominal pain
and palpable mass. Those with clinically relevant rectus
sheath hematoma that do not respond to supportive care
can be successfully treated using embolization, thus
avoiding invasive surgical approach.
with COVID-19 pneumonia and rectus sheath
hematoma (RSH) treated with embolization.
Methods. A 63-year-old man positive for SARS-CoV-
2 presented with cough, fever and dyspnea to our
Clinic. The patient was admitted and treated with
oxygen, antibiotics, corticosteroid, anticoagulant and
oral antiplatelet therapy. Thirteen days after admission
the patient had severe abdominal pain, the CT scan
confirmed left rectus sheath hematoma and he
underwent a CT angiography with embolization of the
left inferior epigastric artery. Ten days after
embolization the patient recovered completely and was
discharged.
Result. SARS-CoV-2 infection is associated with coagulopathy,
hence the anticoagulant therapy. The main
side effect of anticoagulant therapy is an increased risk
of bleeding. A rare complication of anticoagulant therapy
is rectus sheath hematoma. The treatment is usually
conservative with intravenous fluids, pain medication,
discontinuation of anticoagulant therapy, and blood
transfusion in cases of severe anemia. The computed
tomography is the most common method to establish
or confirm the diagnosis. Еmbolization of bleeding vessels
can be performed in large RSH with hemodynamic
instability and/or with evidence of active bleeding.
Conclusion. Inpatient treatment of COVID-19 pneumonia
includes anticoagulant agents, but clinicians must
carefully monitor their possible side effects and suspect a
rectus sheath hematoma in patients with abdominal pain
and palpable mass. Those with clinically relevant rectus
sheath hematoma that do not respond to supportive care
can be successfully treated using embolization, thus
avoiding invasive surgical approach.
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