Spontaneous abdomen and abdominal wall hematomas due to anticoagulant/antiplatelet use: Surgeons’ perspective in a single center

BACKGROUND: The incidence of abdominal wall hematomas increased after the introduction of anticoagulant and antiplatelet drugs in clinical practice. These patients are usually old, and they have more than one comorbidity. Most spontaneous hematomas tend to limit itself and conservative treatment with close follow up is usually enough, but surgery is an option that should be decided critically. Unnecessary surgical interventions could worsen the situation. The present study aims to analyze the results of patients under anticoagulant/antiplatelet treatment and with spontaneous abdominal wall hematomas from surgeons’ perspective.
METHODS: This is a retrospective study that the medical records of 43 patients who were under anticoagulant/antiplatelet therapy and consulted our general surgery clinic because of the spontaneous abdomen and abdominal wall hematoma between January-2016 and September-2018 were reviewed.
RESULTS: The findings showed that most of the cases were presented with abdominal pain. Thirty of these patients were female (69.7%). The mean age was 69.32 years. More than half of the patients (58.1%) were referred from the emergency department. All of the cases were under anticoagulant and antiplatelet treatment for several reasons. With presenting signs and symptoms and after evaluation of laboratory tests, computed tomography was performed to 30 patients (69.7%) as an initial test. USG and MRI were the other methods used. The most common diagnosis was rectus sheath hematoma (n=16; 37.2%) and followed by intestinal and colon wall, lumbar, psoas, pelvic and retroperitoneal hematoma in decreasing order. Among 43 patients, 39 patients (90.6%) followed with conservative treatment and two patients were treated with transcatheter arterial embolization. Two patients (4.6%) were died on day 1 and 11 after diagnosis. No surgery needed for all patients.
CONCLUSION: Early recognition, hospitalization of risky patients, close follow-up of hemodynamic parameters, patients’ response to conservative treatment and minimal invasive methods are key points. Conservative care is the choice of treatment, but surgery must always keep in mind in hemodynamic unstable patients.

Antikoagülan/antiplatelet kullanýmýna baðlý spontan abdomen ve abdominal duvar hematomlarý: Tek merkez, cerrah perspektifi

AMAÇ: Abdominal duvar hematomlarýnýn insidansý, klinik uygulamada antikoagülan ve antiplatelet ilaçlarýn kullanýlmasýndan sonra artmýþtýr. Bu hastalar genellikle yaþlýdýr ve birden fazla komorbiditeye sahiptirler. Çoðu spontan hematom kendini kýsýtlama eðilimindedir ve yakýn takip ile konservatif tedavi genellikle yeterlidir ancak cerrahi, kritik olarak karar verilmesi gereken bir seçenektir. Gereksiz cerrahi müdahaleler durumu daha da kötüleþtirebilir. Bu çalýþmanýn amacý, antikoagülan/antiplatelet tedavi altýndaki ve spontan abdominal duvar hematomlarý olan hastalarýn sonuçlarýný cerrahi perspektiften incelemektir.
GEREÇ VE YÖNTEM: Bu çalýþma, Ocak 2016 ve Eylül 2018 yýllarý arasýnda antikoagülan/antiplatelet tedavi gören ve spontan abdomen ve abdominal duvar hematomu nedeniyle genel cerrahi kliniðimize baþvuran 43 hastanýn týbbi kayýtlarýnýn gözden geçirildiði geriye dönük bir çalýþmadýr.
BULGULAR: Olgularýn birçoðu karýn aðrýsý ile baþvurdu. Bu hastalarýn 30’u kadýndý (%69.7). Yaþ ortalamasý 69.32 idi. Hastalarýn yarýsýndan fazlasý (%58.1) acil servisten refere edildi. Olgularýn tamamý çeþitli nedenlerle antikoagülan ve antiplatelet tedavi altýndaydý. Belirti ve semptomlarýn izlenmesi ve laboratuvar testlerinin deðerlendirilmesinden sonra 30 hastaya (%69.7) baþlangýç testi olarak bilgisayarlý tomografik görüntüleme uygulandý. USG ve MRI kullanýlan diðer yöntemlerdi. En sýk rastlanan taný rektus kýlýf hematomuydu (n=16; %37.2) ve bunu sýrasýyla baðýrsak ve kolon duvarý, lombar, psoas, pelvik ve retroperitoneal hematom izledi. Kýrk üç hastadan 39’una (%90.6) konservatif tedavi uygulandý ve iki hastaya transkateter arteriyel embolizasyon uygulandý. Tanýdan sonraki birinci ve 11. günde iki hasta (%4.6) hayatýný kaybetti. Tedavi için cerrahi uygulama gerekmedi.
TARTIÞMA: Erken taný, riskli hastalarýn hastaneye yatýrýlmasý, hemodinamik parametrelerin yakýn takibi, konservatif tedaviye yanýt verme ve minimal invaziv yöntemler tedavide önemli noktalardýr. Konservatif bakým ilk tedavi seçeneðidir ancak hemodinamik stabil olmayan hastalarda her zaman cerrahi akýlda tutulmalýdýr.