Hematoma

Hematomas are collections of blood in subcutaneous tissue or deeper tissues at site of surgery (in post-operative setting). They are named according to location (e.g. abdominal wall, parathyroid, retroperitoneal) and treatment employed may vary as a result.

Etiology

• Incomplete hemostasis
• Clotting disorders
  • Hemophilia A
  • Hemophilia B (Christmas disease)
  • Von Willebrand disease
  • Factor IX deficiency
  • Factor X deficiency
  • Antiphospholipid syndrome
  • Plus more…
• Medications

Risk factors

• Known medication use or clotting disorder
• HAS-BLED: used to calculate surgical bleeding risk
  • HAS-BLED score
    • 0-1 → low bleeding risk
    • 2 → intermediate bleeding risk
    • ≥3 → high bleeding risk
  • HAS-BLED surgery risk
    • Low bleeding risk: surgery <45 minutes, abdominal hernia, cholecystectomy
    • High bleeding risk: cardiovascular surgery, orthopedic surgery, head/neck cancer surgery, urologic surgery, surgery >45 minutes

Presentation

• Swelling and pain at area of hematoma
• Skin discoloration/ecchymosis, firm, tender → superficial hematoma
• Compartment syndrome → deeper hematoma
• Airway compromise → neck hematoma
• Ileus → abdominal hematoma
• Anemia, hypovolemia → clotting disorder
• Fever, leukocytosis, sepsis → infected hematoma

Labs

• BUN, Cr
• LFTs
• Coagulation tests
• CBC

Imaging

• Depends on location of hematoma
• Ultrasound and CT
• CT with arterial phase can show active extravasation

Treatment

• Small → resolve with time 
• Large → consider surgical evacuation
• Hemodynamically unstable or symptomatic
  • Surgical intervention
  • IR embolization
  • Transfusion
• Infected → drainage and washout