Minimally invasive therapy for the resolution of a subcapsular hepatic hematoma in a newborn.
| Autor: | Santos C M; Clínica Alemana de Santiago, Santiago, Chile., Zamboni T GP; Clínica Alemana Santiago, Santiago, Chile., Hasson D; Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile., Poblete S M; Clínica Alemana Santiago, Santiago, Chile., Vargas H P; Clínica Alemana Santiago, Santiago, Chile. |
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| Jazyk: | English; Spanish; Castilian |
| Zdroj: | Andes pediatrica : revista Chilena de pediatria [Andes Pediatr] 2021 Feb; Vol. 92 (1), pp. 99-103. Date of Electronic Publication: 2021 Feb 22. |
| DOI: | 10.32641/andespediatr.v92i1.2375 |
| Abstrakt: | Objective: To describe an innovative alternative to exploratory laparotomy in a newborn with a sub capsular hepatic hematoma secondary to umbilical vein catheterization. Clinical Case: A preterm baby with a history of hyaline membrane disease, pulmonary hypertension, and large patent ductus arteriosus, requiring mechanical ventilation and the use of vasoactive drugs. Umbilical catheters were inserted and through an abdomen X-ray, we observed their proper position. The patient evolved with greater requirements of vasoactive drugs, abdominal wall pallor, and abdominal distention. Abdominal ultrasound showed a subcapsular hepatic hematoma, with no signs of active bleeding, so expectant management was decided. The patient required increased vasoactive drugs and presented a decrease in hematocrit. New ultrasound showed a larger subcapsular hematoma, abundant perihe patic fluid, and the intraparenchymal position of the umbilical catheter was confirmed. Endovascular embolization was performed through the umbilical catheter with Gelita®, achieving occlusion of the capsular path. Posterior ultrasound showed a reduction of the hematoma. Conclusions: The use of embolization through angiography is not commonly used in pediatric emergencies. It is a procedure with fewer comorbidities and complications than exploratory laparotomy, therefore it should be considered as first-line therapy in patients like the one presented above. The limitation for its routine performance is the lack of available angiography operating room and trained interventional radio logy team. |
| Databáze: | MEDLINE |
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