1/42. Multiple postoperative intracerebral haematomas remote from the site of craniotomy.A postoperative haemorrhage is a common and serious complication of a neurosurgical procedure. It usually occurs at the site of the surgery, but on occasion a postoperative haematoma is found at a distance from the previous craniotomy. Multiple postoperative haemorrhages are extremely rare. We report the case of a 63-year-old woman, operated on for the removal of a supratentorial astrocytoma, who developed in the early post-operative period multiple bilateral intracerebral haematomas without involvement of the surgical bed.- - - - - - - - - - ranking = 1keywords = haemorrhage, haematoma (Clic here for more details about this article) |
2/42. Cerebellar haemorrhage after evacuation of an acute supratentorial subdural haematoma.Recent reports have highlighted the unusual complication of distant cerebellar haemorrhage after supratentorial craniotomy, with only 25 previous cases reported in the literature. Nearly all reported cases occurred after craniotomy for temporal lobectomy or for deep seated intracerebral pathology requiring brain retraction and removal of CSF at surgery. Only one previous case of a cerebellar haemorrhage after evacuation of an extracerebral fluid collection has been reported. We describe the case of a cerebellar haemorrhage complicating the evacuation of an acute/subacute supratentorial subdural haematoma in a 83-year-old woman. The literature is reviewed and possible mechanisms of haemorrhage discussed.- - - - - - - - - - ranking = 3.2797315189174keywords = haemorrhage, haematoma, subdural haematoma, subdural (Clic here for more details about this article) |
3/42. life-threatening haemorrhage after elevation of a fractured zygoma.A 21-year-old man presented with a fractured left zygoma after an alleged assault. The fracture was elevated four days later, at which time he had a brisk left-sided epistaxis. Recovery was uneventful except for a haematoma that was drained a month later. Two weeks after this, he was admitted after having collapsed. He was shocked and bleeding profusely from his nose. He had a further major bleed in hospital and this was treated by tying off the left external carotid artery. He has made an uneventful recovery and investigations have shown no bleeding diathesis.- - - - - - - - - - ranking = 1.5586410692302keywords = haemorrhage, haematoma (Clic here for more details about this article) |
4/42. Massive postoperative swelling of the tongue: manual decompression and tactile intubation as a life-saving measure.Massive swelling of the tongue due to haemorrhage is a rare but potentially fatal complication secondary to trauma, surgery, tumour invasion or uncontrolled anticoagulant therapy. This article presents a report of bleeding from the left lingual artery secondary to elective excision of a lipoma of the floor of the mouth and subsequent life-threatening upper airway obstruction. In this case, the upper airway obstruction was managed by manual decompression of the tongue and tactile nasal intubation. To our knowledge this case provides the first description of using this method in life-threatening upper airway obstruction caused by massive haemorrhagic swelling of the tongue.- - - - - - - - - - ranking = 0.37962938251732keywords = haemorrhage (Clic here for more details about this article) |
5/42. Management of acute surgical orbital haemorrhage: an otorhinolaryngological and ophthalmological perspective.This retrospective report describes the management and outcome of seven patients who suffered an acute surgical orbital haemorrhage (ASOH), secondary to a surgical procedure performed on either the sinuses, orbits or eyelids. All patients but one recovered their pre-operative vision. A management plan is outlined on how to assess and tackle this complication, so that the ENT surgeon may be better prepared to meet such an acute surgical emergency, should it arise.- - - - - - - - - - ranking = 1.8981469125866keywords = haemorrhage (Clic here for more details about this article) |
6/42. Postoperative retroperitoneal hemorrhage due to a bleeding ureteric artery: treatment by transcatheter embolization.We report a case of a postoperative retroperitoneal haemorrhage due to an iatrogenic perioperative injury of an ureteric artery. Transcatheter embolization using microparticles stopped the bleeding and the patient stabilized immediately. Ureteric artery injury is a very rare condition but can be managed successfully by percutaneous interventional techniques.- - - - - - - - - - ranking = 0.37962938251732keywords = haemorrhage (Clic here for more details about this article) |
7/42. Therapeutic embolisation for postoperative haemorrhage after total arthroplasty of the hip and knee.We describe three cases of postoperative haemorrhage, two after total hip and one after total knee replacement, treated by percutaneous embolisation. After diagnostic angiography, this is the preferred method for the treatment of postoperative haemorrhage due to the formation of a false aneurysm, after hip or knee arthroplasty. This procedure, carried out under local anaesthesia, has a low rate of complications and avoids the uncertainty of further surgical exploration.- - - - - - - - - - ranking = 2.2777762951039keywords = haemorrhage (Clic here for more details about this article) |
8/42. Surreptitious bleeding in surgery: a major challenge in coagulation.Apart from inadequate surgical haemostasis, postoperative bleeding can be related to acquired disorders of platelet number, platelet function or coagulation proteins (e.g. vitamin k deficiency, DIC or liver injury). We highlight our experience with three patients who suffered life-threatening bleeding in the postoperative setting. The three patients - a 47-year-old man and 70- and 74-year-old women -- all had negative histories for excessive bleeding with prior surgeries, and all had normal preoperative PT and aPTT tests. Surgeries were resection of ischaemic bowel, cholecystectomy and coronary artery bypass grafting. All patients experienced unexpected bleeding within the first few postoperative days requiring multiple red cell transfusions and surgical re-explorations. Evaluations within the first 4--7 days after surgery revealed that these three patients had developed prolonged aPTT due to demonstrable factor viii antibodies initially at low titre. One patient was treated with high doses human factor viii, corticosteroids, intravenous gammaglobulin and plasma exchanges. The inhibitor was no longer demonstrable after 6 weeks of such therapy, and he has remained in remission without therapy. The second patient was initially treated with high-dose human factor viii infusions. Five months later, prednisone and 6-mercaptopurine were begun for worsening inhibitor titre and diffuse purpura and subcutaneous haematomas. The factor inhibitor remitted, but the patient died from liver failure related to post-transfusion hepatitis. The third patient was initially managed with high-dose human factor viii. Two months later, worsening inhibitor titre and tongue haematoma was treated with activated prothrombin complex, corticosteroids and cyclophosphamide. Eight years later, she is on no therapy, demonstrates a mild bleeding tendency and has a stable low-titre inhibitor. There have been a few case reports of inhibitors to coagulation factors including factor viii becoming manifest in the postoperative setting but surgery has not been widely recognized as an underlying cause for acquired haemophilia. This paper speculates on pathogenesis and reviews treatment options. This syndrome is remarkable for its abrupt onset in the first few postoperative days and for its substantial morbidity. The problem is potentially reversible with immunosuppressive therapy. Clinicians should be aware of this syndrome, considering acquired haemophilia in patients with unexpected postoperative bleeding.- - - - - - - - - - ranking = 0.080247078321788keywords = haematoma (Clic here for more details about this article) |
9/42. The use of the laryngeal mask airway in post-tonsillectomy haemorrhage--a case report.INTRODUCTION: The use of the laryngeal mask airway in elective adenotonsillectomy has been well described. However, there is no literature to support its use in post-tonsillectomy haemorrhage. CLINICAL PICTURE: We report a case of a patient who presented with primary post-tonsillectomy haemorrhage, which required general anaesthesia for haemostasis after undergoing bilateral functional endoscopic sinus surgery, uvulopalatopharyngoplasty and tonsillectomy. TREATMENT AND OUTCOME: The laryngeal mask airway was used successfully after an initial attempt at endotracheal intubation had failed. There were no complications. CONCLUSIONS: The laryngeal mask airway can be used to secure the airway for haemostasis for post-tonsillectomy haemorrhage if intubation is not possible.- - - - - - - - - - ranking = 2.6574056776212keywords = haemorrhage (Clic here for more details about this article) |
10/42. Concealed post-tonsillectomy haemorrhage associated with the use of the antiemetic tropisetron.A two-year-old child experienced concealed haemorrhage after adenotonsillectomy. In our patient, the absence of vomited or significant gastric blood and the presence of melaena stools may partly be attributed to prophylactic antiemetic treatment with tropisetron. This group of patients has a high incidence of postoperative nausea and vomiting, and antiemetic treatment is important and valuable. Rather than advocating the withholding of prophylactic antiemetic treatment, we suggest that whatever medication and techniques are used, good clinical care is dependent on careful postoperative observation and assessment for an appropriate period of time.- - - - - - - - - - ranking = 1.8981469125866keywords = haemorrhage (Clic here for more details about this article) |
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