A Case Series Of Spontaneous Extraperitoneal Hemorrhage In COVID-19 Patients In Malaysia.

Authors

  • Adib Amir Department of Radiology, Hospital Sungai Buloh, Sungai Buloh, Malaysia
  • Arvin Rajadurai Department of Radiology, Hospital Sungai Buloh, Sungai Buloh, Malaysia
  • Zulkifli Zaki Abdul Ghani Department of Radiology, Hospital Sungai Buloh, Sungai Buloh, Malaysia

DOI:

https://doi.org/10.32896/cvns.v4n2.40-48

Keywords:

COVID-19, Extraperitoneal Hermorrhage, Embolization

Abstract

Background: COVID-19 infection is associated with thrombotic events causing micro thrombosis and venous thromboembolism. Anticoagulant treatment has been shown to reduce mortality in COVID-19 cases and is routinely used. Spontaneous extraperitoneal hemorrhage (SEH), which includes retroperitoneal, iliopsoas or rectus sheath hematomas, is a known complication of anticoagulant use. Trans arterial embolization (TAE) is a safe and minimally invasive management option to control bleeding in SEH. We report 7 cases of SEH in COVID-19 patients admitted to Hospital Sungai Buloh. This case series highlights the occurrence of SEH in COVID-19 patients, its clinical and radiological manifestations and management pathways.

Case presentation: All patients were on anticoagulants and presented with abdominal pain and/or swelling with sudden drop in hemoglobin. Computed tomography angiography (CTA) showed contrast extravasation indicative of active bleed. All patients proceeded with conventional transfemoral angiography with option of TAE. TAE was utilized in 6 out of 7 cases and was successful in achieving hemostasis with no procedure related complication.

Conclusion: SEH should be suspected in COVID-19 patients on anticoagulants presenting with abdominal pain or drop in hemoglobin. CTA is confirmatory and TAE offers a viable and safe treatment option.

References

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–7.

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094–9.

Al-Samkari H, Karp Leaf RS, Dzik WH, Carlson JCT, Fogerty AE, Waheed A, et al. COVID-19 and coagulation: Bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020;136(4):489–500.

British Thoracic Society. BTS Guidance on Venous Thromboembolic Disease in patients with COVID-19 Updated 8 February 2021 Summary. Bts. 2021;(February):1–10.

González C, Penado S, Llata L, Valero C, Riancho JA. The clinical spectrum of retroperitoneal hematoma in anticoagulated patients. Medicine (Baltimore). 2003;82(4):257–62.

Ohn MH, Ng JR, Ohn KM, Luen NP. Double-edged sword effect of anticoagulant in COVID-19 infection. BMJ Case Rep. 2021;14(3):1–4.

Patel I, Akoluk A, Douedi S, Upadhyaya V, Mazahir U, Costanzo E, et al. Life-Threatening Psoas Hematoma due to Retroperitoneal Hemorrhage in a COVID-19 Patient on Enoxaparin Treated With Arterial Embolization: A Case Report. J Clin Med Res. 2020;12(7):458–61.

Erdinc B, Raina JS. Spontaneous Retroperitoneal Bleed Coincided With Massive Acute Deep Vein Thrombosis as Initial Presentation of COVID-19. Cureus. 2020;12(8):8–13.

Conti CB, Henchi S, Coppeta GP, Testa S, Grassia R. Bleeding in COVID-19 severe pneumonia: The other side of abnormal coagulation pattern? Eur J Intern Med. 2020;77(May):147–9.

Singh B, Mechineni A, Kaur P, Reid RJ, Maroules M. COVID-19 and bleeding at unusual locations: Report of four cases. Hematol Transfus Cell Ther [Internet]. 2021;43(2):214–8. Available from: https://doi.org/10.1016/j.htct.2021.01.007

Dohan A, Sapoval M, Chousterman BG, Di Primio M, Guerot E, Pellerin O. Spontaneous soft-tissue hemorrhage in anticoagulated patients: Safety and efficacy of embolization. Am J Roentgenol. 2015;204(6):1303–10.

Maruhashi T, Kashimi F, Kurihara Y, Oi M, Tamura S, Osada M, et al. extraperitoneal hemorrhage. 2019;(June):119–24.

Touma L, Cohen S, Cassinotto C, Reinhold C, Barkun A, Tran VT, et al. Transcatheter Arterial Embolization of Spontaneous Soft Tissue Hematomas: A Systematic Review. Cardiovasc Intervent Radiol [Internet]. 2019;42(3):335–43. Available from: https://doi.org/10.1007/s00270-018-2086-x

Zissin R, Gayer G, Kots E, Ellis M, Bartal G, Griton I. Transcatheter arterial embolisation in anticoagulant-related haematoma - A current therapeutic option: A report of four patients and review of the literature. Int J Clin Pract. 2007;61(8):1321–7.

Albuquerque TVC, Monsignore LM, de Castro-Afonso LH, Elias-Junior J, Muglia VF, Abud DG. Transarterial embolization with n-butyl cyanoacrylate for the treatment of abdominal wall hemorrhage. Diagnostic Interv Radiol. 2020;26(3):216–22.

Palumbo D, Guazzarotti G, De Cobelli F. Spontaneous Major Hemorrhage in COVID-19 Patients: Another Brick in the Wall of SARS-CoV-2–Associated Coagulation Disorders? J Vasc Interv Radiol [Internet]. 2020;31(9):1494–6. Available from: https://doi.org/10.1016/j.jvir.2020.06.010

Lloyd NS, Douketis JD, Moinuddin I, Lim W, Crowther MA. Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: A systematic review and meta-analysis. J Thromb Haemost. 2008;6(3):405–14.

Zuo Y, Warnock M, Harbaugh A, Yalavarthi S, Gockman K, Zuo M, et al. Plasma tissue plasminogen activator and plasminogen activator inhibitor-1 in hospitalized COVID-19 patients. Sci Rep [Internet]. 2021;11(1):1–9. Available from: https://doi.org/10.1038/s41598-020-80010-z

Wang Z wei, Xue H dan, Li X guang, Pan J, Zhang X bo, Jin Z yu. Life-threatening Spontaneous Retroperitoneal Haemorrhage: Role of Multidetector CT-angiography for the Emergency Management. Chinese Med Sci J [Internet]. 2016;31(1):43–8. Available from: http://dx.doi.org/10.1016/S1001-9294(16)30021-9

Caleo O, Bocchini G, Paoletta S, Ierardi AM, Scionti A, Tonerini M, et al. Spontaneous non-aortic retroperitoneal hemorrhage: etiology, imaging characterization and impact of MDCT on management. A multicentric study. Radiol Medica. 2015;120(1):133–48.

Tani R, Sofue K, Sugimoto K, Katayama N, Hamada MAS, Maruyama K, et al. The utility of transarterial embolization and computed tomography for life-threatening spontaneous retroperitoneal hemorrhage. Jpn J Radiol [Internet]. 2019;37(4):328–35. Available from: https://doi.org/10.1007/s11604-019-00815-5

Chan YC, Morales JP, Reidy JF, Taylor PR. Management of spontaneous and iatrogenic retroperitoneal haemorrhage: Conservative management, endovascular intervention or open surgery? Int J Clin Pract. 2008;62(10):1604–13.

Riu P, Albarello F, Stefano F, Di Vergori A, Abramo AD, Cerini C, et al. Management of S[pntaneous Bleeding in COVID-19 Inpatients: Is Embolization Always Needed? 2021;2019:1–12.

Lucatelli P, Rocco B, Nardis PG, Cannavale A, Bezzi M, Catalano C, et al. Bleeding in COVID Patients: What We Have Understood So Far. Cardiovasc Intervent Radiol [Internet]. 2021;44(4):666–8. Available from: https://doi.org/10.1007/s00270-021-02775-8

Dobritz M, Engels HP, Schneider A, Bauer J, Rummeny EJ. Detection of intestinal bleeding with multi-detector row CT in an experimental setup. How many acquisitions are necessary? Eur Radiol. 2009;19(12):2862–9.

Kuhle WG, Sheiman RG. Detection of active colonic hemorrhage with use of helical CT: Findings in a swine model. Radiology. 2003;228(3):743–52.

Palumbo D, Guazzarotti G, De Cobelli F. Spontaneous Major Haemorrhage in COVID-19 Patients: a Proposal for a Pathophysiology-Based Angiographic Treatment. Cardiovasc Intervent Radiol [Internet]. 2021;44(8):1289–90. Available from: https://doi.org/10.1007/s00270-021-02842-0

Kish JW, Katz MD, Marx MV, Harrell DS, Hanks SE. N-butyl cyanoacrylate embolization for control of acute arterial hemorrhage. J Vasc Interv Radiol. 2004;15(7):689–95.

Abada HT, Golzarian J. Gelatine Sponge Particles: Handling Characteristics for Endovascular Use. Tech Vasc Interv Radiol. 2007;10(4):257–60.

Hill H, Chick JFB, Hage A, Srinivasa RN. N-butyl cyanoacrylate embolotherapy: Techniques, complications, and management. Diagnostic Interv Radiol. 2018;24(2):98–103.

Downloads

Published

2022-06-30

How to Cite

Amir, A., Rajadurai, A., & Abdul Ghani, Z. Z. (2022). A Case Series Of Spontaneous Extraperitoneal Hemorrhage In COVID-19 Patients In Malaysia. Journal Of Cardiovascular, Neurovascular &Amp; Stroke, 4(2), 40–48. https://doi.org/10.32896/cvns.v4n2.40-48