Life-threatening spontaneous hematoma of the chest wall treated with packing and delayed chest closure

Introduction

Bleeding of the thoracic and abdominal wall most commonly occur in anticoagulated patients [1]. The management is based on anticoagulant therapy reversal which is mostly effective [2]. If conservative treatment is insufficient, good results are provided by endovascular embolization techniques [2,3]. The need of surgical intervention is extremely rare and limited to cases in which minimally invasive techniques are unsuccessful or somehow contraindicated [4].

Case Report

We present the case of a 58-year-old male, affected by hepatic cirrhosis (CHILD C) admitted in Intensive Care Unit with a spontaneous bacterial peritonitis and signs of shock. The patient had severe coagulopathy (spontaneous INR 2.4) and was haemodynamically unstable (arterial pressure 66/48 mmHg), requiring maximal supportive therapy with fluid restoration and vaso-active agents. Abdominal ultrasound and chest x-ray performed at admission resulted as normal. Hemoglobin was 96 g/L and a gastroscopy was performed in order to rule out any gastrointestinal bleeding.