Spontaneous rectus sheath hematoma is a rare condition. It encompasses a wide spectrum of severity (self-limiting to fatal) depending of its size, etiology, and the development of complications. It enters into the differential diagnosis of abdominal pain but it's frequently difficult to diagnose and often radiologic imaging is required. Authors report a series of five patients admitted at emergency room within a 2-year period. Patient were between 63 to 78 years old. One of them was in therapy with warfarin, one was in therapy with acetilsalicililate and clopidogrel and in an another patient a coagulation disorder was detected. Diagnosis was suspected in all cases by clinical exam and ultrasonography, but CT-scan was necessary in three cases. All patients underwent conservative treatment, mainly pain relief and rest. In two cases blood transfusion was performed and in two cases clotting abnormalities were corrected with vitamin K and fresh frozen plasma. Average ospedalization was 10 days (range 5-17). One patient developed late seroma and was treated with ultrasound-guided aspiration. Rectus sheath hematoma is a rare but important entity in the differential diagnosis of abdominal pain. The difficulties in the correct diagnosis frequently lead to delay in treatment or unneeded surgery. CT-scan is the gold-standard investigation. Treatment options are variable and include conservative treatment, intravascular embolization and surgery Frequently an interdisciplinary team approach is needed.
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Plast Reconstr Surg Glob Open
January 2025
From the Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom.
The demand for aesthetic surgery continues to increase, and it is therefore essential to ensure that the next generation of plastic surgeons are adequately trained. We propose a safe method in aesthetic training in abdominoplasty and facelift, utilizing free deep inferior epigastric perforator (DIEP) flap and parotidectomy for training aesthetic procedures. The trainees' focus differed between the 2 procedures.
View Article and Find Full Text PDFJAMA Surg
January 2025
Section of Minimally Invasive Surgery, Department of Surgery, The University of Chicago, Chicago, Illinois.
J Pain Res
January 2025
Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China.
Objective: To evaluate the clinical efficacy and safety of ultrasound-guided rectus sheath block (RSB) in laparoscopic umbilical hernia repair with intraperitoneal onlay mesh (IPOM).
Methods: A total of 139 patients scheduled for laparoscopic umbilical hernia repair with IPOM were selected and randomly assigned to either the group receiving general anesthesia combined with bilateral rectus sheath block (Group GR, 71 patients) or the group receiving general anesthesia alone (Group G, 68 patients). We monitored the patients' heart rate (HR) and mean arterial pressure (MAP) at four time points: before anesthesia induction (T1), at the start of surgery (T2), during mesh fixation (T3), and upon removal of the laryngeal mask (T4).
Cureus
December 2024
Anesthesia and Intensive Care Unit, Giuseppe Mazzini Hospital, Teramo, ITA.
The management of postoperative pain in pediatric patients undergoing emergency surgical procedures, particularly in non-pediatric hospitals, presents significant challenges due to the unique physiological requirements of children. The utilization of opioid analgesia may result in severe complications, necessitating a transition toward multimodal analgesia, which integrates various pain management strategies to enhance effectiveness while mitigating adverse effects. Locoregional anesthesia techniques, such as fascial plane blocks, provide targeted pain alleviation, reducing dependence on opioids.
View Article and Find Full Text PDFMedicina (Kaunas)
December 2024
Department of Surgery, Riga East Clinical University Hospital, 1038 Riga, Latvia.
Multimodal analgesia has been shown to be effective in facilitating early postoperative gastrointestinal function and rehabilitation in patients undergoing open gastrectomy. We conducted a clinical trial to investigate the effectiveness of bilateral rectus sheath block (RSB) with continuous bupivacaine infusion in comparison with placebo following elective open gastrectomy. Patients indicated for elective open gastrectomy were screened, enrolled, and randomised between October 2021 and September 2023.
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