ABSTRACT
Extensive drug treatment for coronavirus disease 2019 (COVID-19) includes low molecular weight heparin (LMWH). At therapeutic doses of LMWH, there is an increased risk of bleeding complications. Spontaneous, non-traumatic bleeding into the retroperitoneum is a life-threatening condition that can progress very rapidly. We describe a complication of COVID-19 bronchopneumonia treatment in which a patient developed a shock condition caused by non-traumatic bleeding into the retroperitoneum and abdominal wall due to LMWH overdose. The patient was operated on under difficult conditions - in biosafety level 3 (BSL-3). This case is exceptionally fascinating and informative. Nowadays, it is essential to point out possible complications associated with the treatment of COVID-19. Based on this report, we emphasize the need for careful LMWH dosing and quick and accurate diagnosis. Surgeons should maintain a higher index of suspicion for spontaneous bleeding in non-specific abdominal pain patients with COVID-19 or patients receiving therapeutic doses of LMWH.
ABSTRACT
Aortodecubital fistula is a pathologic communication between aorta and a decubitus ulcer. It is very rarely encountered vascular condition in abdominal aortic aneurysms (AAA), with difficult diagnostics and high mortality. Patients often present with systemic and local infection and are at risk for hemorrhage. We present a paraplegic patient with fistulous communication between an inflamed abdominal aortic aneurysm and a sacral decubitus ulcer, leading to intermittent bleeding episodes and finally to exsanguination. While extremely rare, this case emphasizes the need for early, accurate diagnosis and salvage intervention when possible.
Subject(s)
Aortic Aneurysm/complications , Aortic Rupture/etiology , Pressure Ulcer/complications , Vascular Fistula/complications , Aortic Aneurysm/diagnostic imaging , Aortic Rupture/diagnostic imaging , Fatal Outcome , Humans , Male , Middle Aged , Pressure Ulcer/diagnostic imaging , Vascular Fistula/diagnostic imagingABSTRACT
Mediastinal pancreatic pseudocysts are rarely encountered complications of pancreatic diseases. Pseudocysts most often expand into surrounding structures, just rarely into the mediastinum. Usually, they present with abdominal pain, and the symptoms correlate with the location of the pseudocysts. We describe a case of a pancreatic pseudocyst that penetrated the thoracic cavity through the diaphragm and set up a communication with the bronchial tree developing an episode of massive hemoptysis. This case is of particular interest because just a few similar cases were published before. Based on this report, we emphasize the need for early accurate diagnosis; surgeons should maintain a higher index of suspicion for mediastinal pancreatic pseudocyst in patients with chronic pancreatitis.
