Glue Embolization in the Management of Rectus Sheath Hematomas

Abstract Objective: This study aims to describe the results achieved in the management of rectus sheath hematoma (RSH) using glue embolization. Method: Data about all consecutive patients presenting with RSH, between January 2005 and December 2020 were retrospectively reviewed. RSHs were classified according to the Berna CT scan Classification. Clinical and technical outcomes were evaluated during in-hospital period and 1-month follow-up. Results: Among 74 patients presenting with RSH, CTA revealed an active bleeding in 61 (n = 42, 69% women; median age = 68.8 y range: 47-91). 19 cases of type 1 RSH (25.7%), under anticoagulation therapy and hemodynamically stable, were successfully managed conservatively. Conversely, endovascular embolization with cyanoacrylate glue diluted with ethiodized oil (Lipiodol Ultrafluid, Guerbet, France) was needed in n = 42 (56.8%) patients, in 16 cases after failure of conservative management; a single session of percutaneous glue embolization was adequate to achieve technical and clinical success in all patients with stabilization or progressive improvement of hemoglobin values after procedure (7.1 + 1.8 g/dL pre-procedure vs 11.1 + 1.6 g/dL post-procedure). No major complications occurred. Two minor complications were reported: 1 case (2.4%) of puncture site-related complication (local self-limiting hematoma) and 1 case (2.4%) of post-embolization syndrome (abdominal pain) spontaneously regressive. The median hospital stay was 7 d. At 30-day follow-up, 2 patients (2.7%) died of multiorgan failure. Conclusions: In the management of RSH, glue embolization was shown to be safe and efficacious. Glue allowed the immediate occlusion of both the "front and back doors" of bleeding without the need to reach the bleeding point, preventing potentially life-threatening recurrence.