Massive Abdominal Wall Hemorrhage from Injury to the Inferior Epigastric Artery: A Retrospective Review
| Autor: | Jeanne M. LaBerge, Paul R. Sobkin, Roy L. Gordon, Geoff S. Hastings, Lynn A. Brody, Allan I. Bloom, Robert K. Kerlan, Rajiv Sawhney, Mark W. Wilson |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Iatrogenic Disease Contrast Media Hemorrhage Wounds Nonpenetrating Sensitivity and Specificity Abdominal wall medicine.artery medicine Coagulopathy Paracentesis Humans Radiology Nuclear Medicine and imaging Embolization Inferior epigastric artery Retrospective Studies medicine.diagnostic_test business.industry Abdominal Wall Angiography Interventional radiology Blood Coagulation Disorders Middle Aged medicine.disease Embolization Therapeutic Epigastric Arteries Surgery medicine.anatomical_structure Blunt trauma Hemoperitoneum Drainage Female Radiology Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Vascular and Interventional Radiology. 19:327-332 |
| ISSN: | 1051-0443 |
| Popis: | Purpose To identify the etiology of inferior epigastric artery injury (IEAI) in patients referred to the interventional radiology service and determine the efficacy of diagnostic imaging and embolization in these patients. Materials and Methods A retrospective review of patients referred to the interventional radiology departments at three university-affiliated hospitals from 1995 through 2007 was performed. Patients were identified and data were extracted from case log books and the electronic medical record. Results Twenty IEAIs were identified in 19 patients. The etiology of arterial injury was paracentesis in eight (40%), surgical trauma in three (15%), percutaneous drain placement in three (15%), blunt trauma in two (10%), subcutaneous injection in one (5%), stabbing in one (5%), and unknown in two (10%). Fifteen of 19 patients (79%) had an underlying coagulopathy. The diagnosis was confirmed by contrast medium–enhanced computed tomography (CT) in 14 (70%), tagged red blood cell scan in two (10%), and noncontrast CT in one (5%). Three patients (15%) had no diagnostic imaging. Contrast medium–enhanced CT showed active extravasation in nine of 14 patients (64%) and 13 of 14 exhibited active extravasation on subsequent arteriography. The sensitivity and specificity of contrast medium–enhanced CT for demonstrating active arterial bleeding were 70% and 100%, respectively. All 20 IEAIs were treated with transcatheter embolization, with an overall success rate of 90% and no complications. Conclusions IEAI is most often an iatrogenic injury in a coagulopathic patient. Contrast medium–enhanced CT can be diagnostic for active bleeding, but in the setting of ongoing hemorrhage a negative study result should not preclude arteriography. Embolization is an effective means to control hemorrhage. |
| Databáze: | OpenAIRE |
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