Page 18 - Demo

Lewis and Ankita: Spontaneous pelvic, sigmoid hematoma with CVS thrombosis in a atraumatic vaginal deliveryMOGS Chronicles | Volume 1 | Issue 1 | September 2024 11episiotomy wound present over the left vulva was intact.Based on CT scan findings, the decision of exploratory laparotomy taken. Intraoperatively, a hematoma of 3 %u00d7 2 cm had encompassed the lateral and posterior aspects of the sigmoid-rectal junction with no hemoperitoneum [Figure 3]. Bowel tracing revealed no abnormality, hence decision was taken to manage the bowel hematoma conservatively.Post operatively patient received a blood transfusion and was started on Injection LMWH 0.6 cc subcutaneously twice a day for CVST with INR and activated partial thromboplastin time monitoring. She was discharged after 14 days on Tablet Dabigatran 150 mg twice a day with advise for follow up after 2 weeks.ConclusionPregnancy itself is a hypercoagulable state which is aggravated by haemoconcentration state seen in eclampsia.[1] This leads to multiple critical haemorrhages at various sites including atraumatic pelvic hematoma, sigmoid hematoma as well as cerebral venous sinus thrombosis.[2,3]Pelvic hematoma when coupled with sigmoid bowel hematoma as well as cerebral venous sinus thrombosis can become life threatening unless prompt diagnosis and appropriate management is done.[4,5] A combination of physical examination, imaging tests and tailored treatment can prevent significant morbidity as well as mortality associated with such hematomas.DeclarationConflict of interestNone.DisclosureNone.Informed consentInformed consent Informed consent was taken from the patient.References1. Zeeman GG, Cipolla MJ, Cunningham GF. Cerebrovascular (patho) physiology in preeclampsia/eclampsia. In: Lindhiemer M, Roberts J, Cunningham G, editors. Chesley%u2019s Hypertensive Disorders in Pregnancy. San Diego, CA: Elsevier; 2009. p.%u00a0227-48.2. Dag ZO, Is%u0327ik Y, Simsek Y, Tulmac OB, Demiray D. HELLP syndrome and cerebral venous sinus thrombosis associated with factor V Leiden mutation during pregnancy. Case Rep Obstet Gynecol 2014;2014:582890.3. Singh A, Singh S, Vardhan S. A rare case of post-partum cerebral venous sinus thrombosis. Int J Reprod Contracept Obstet Gynecol 2018;7:762-5.4. Bacalbas%u0326a N, Bohi%u0302lt%u0326ea RE, Dumitru M, Turcan N, Ci%u0302rstoiu MM. Subserosal hematoma of the sigmoid colon after vaginal delivery.J Med Life 2017;10:76-9.5. Tseng JY, Lin IC, Lin JH, Chang CM, Chao WT, Wang PH. The optimal approach for management of postpartum vulva hematoma: Report of three cases. Taiwan J Obstet Gynecol 2020;59:780-3.Figure 1: Post partum spontaneous atraumatic vulval hematomaFigure 2: Computed tomography scan imaging of brain showing partial contrast filling defect in frontal Portion of Superior sagittal sinusFigure 3: Intra operative finding of sigmoid bowel hematomaHow to cite this article: Lewis PF, Ankita K. Bleeding Trinity: Spontaneous Pelvic and Sigmoid Bowel Hematoma with Cerebral Venous Sinus Thrombosis in a Case of Atraumatic Vaginal Delivery %u2013 A Rare Case Report. MOGS Chronicles 2024;1(1):10-12.