Mumbai: Doctors saved a 37-year-old woman suffering from intra-abdominal bleeding by removing two litres of blood from her abdomen. The patient had suffered a hemorrhagic ovarian cyst along with a haemorrhage in the anterior abdominal wall, which had caused accumulation of blood in the abdomen.
The 37-year-old housewife, who had arrived in casualty with difficulty in breathing and dizziness along with abdominal pain, was examined with a massive bruising of the anterior abdominal wall suggesting haemorrhage in the wall. While all signs of free fluid in the abdomen were positive it was revealed that more than 2 litres of free fluid was present in her abdomen and a right-sided ovarian mass.
The patient had undergone an aortic valve replacement surgery four years ago and was recommended an anticoagulant medication regimen. Patient however failed to monitor her international normalised ratio (INR) regularly. A team of doctors led by Dr Rekha Agrawal, senior honorary consultant In Obstetrics And Gynaecology at Bandra’s Lilavati Hospital, diagnosed that the patient was in early disseminated intravascular coagulation, a rare and nearly fatal blood clotting disorder where the body consumes all clotting factors.
Dr Agrawal said, “Because of this consumption of coagulopathy, blood does not clot if not treated in time and the patient can bleed from all mucous membranes. When one gets hurt, the clotting factors play a crucial role in stopping the bleeding. These clotting factors are consumed rapidly if there is bleeding inside the body. All the clotting factors in the patient were fully utilised and her blood had become so thin that any test or procedure could result in bleeding from the puncture site of her body.”
The doctors tried to normalise her INR to carry out a laparoscopic surgery and stem the bleeding. However, the patient's haemoglobin plunged to 4.5she was administered 8-10 fresh frozen plasma, packed blood cells. platelet infusions and Nova 7 for over six hours. This brought her blood levels to a safe range for surgery, and under expert anaesthetic team laparoscopic surgery was conducted,which minimises time of surgery and the morbidity accompanied by open surgery.
During the laparoscopic surgery, it was discovered that she was bleeding from a hemorrhagic ovarian cyst, a sac that forms on the ovary and swells up with fluid which can release blood and fluid into the lower belly and pelvis if it breaks open. This cyst had caused an accumulation of 2 litres of blood in her abdomen. The bleeding ovary and tube were excised and the abdomen was cleared of 2.2 litres of blood. By stemming the bleeding, her clotting profile returned to normal and recovered in 48 hours.
“Their quick thinking and mastery of surgical techniques played a pivotal role in ensuring the patient's survival. The complex nature of intra-abdominal bleeding requires prompt action and exceptional skill and abundant resources all of which were present at the hospital. With each successful outcome, the hospital aims to set new standards for patient care and treatment outcomes,” said Dr Niraj Uttamani, chief operating officer at Lilavati Hospital and Research Centre.
