Venu Vinayak, Bakhshi Girish, Sabale Chandrakant, Raichur Apoorva M, Hussain Khadeija
General Surgery, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND.
General Surgery, Sir JJ Group of Hospitals, Mumbai, IND.
Cureus. 2024 Mar 29;16(3):e57194. doi: 10.7759/cureus.57194. eCollection 2024 Mar.
This case report highlights an unusual manifestation of a giant subgaleal hematoma in a 15-year-old child, which progressed to a potentially life-threatening condition requiring surgical drainage. Subgaleal hematomas occur when the emissary veins between the periosteal and aponeurotic layers of the scalp rupture. In many cases, subgaleal hematomas undergo spontaneous absorption without intervention. However, in this particular case, the hematoma measured approximately 1300 ml, making it the largest documented in medical literature and necessitating surgical intervention. In cases where hematoma absorption is problematic, clinicians should consider the possibility of underlying coagulopathy or persistent trauma, such as head banging, child maltreatment, or repeated falls due to seizure attacks, as observed in this patient. While there is no universally agreed-upon treatment protocol for subgaleal hematomas, incision and drainage offer immediate relief by evacuating the collection. Employing a negative-pressure suction drain can help alleviate the loss of tamponade effect. In addition, subsequent behavioral therapy and rehabilitation efforts may enhance the overall recovery and well-being of affected individuals.
本病例报告重点介绍了一名15岁儿童巨大帽状腱膜下血肿的罕见表现,该血肿进展为需要手术引流的潜在危及生命的状况。当头皮骨膜层和腱膜层之间的导静脉破裂时,就会发生帽状腱膜下血肿。在许多情况下,帽状腱膜下血肿无需干预即可自行吸收。然而,在这个特殊病例中,血肿量约为1300毫升,是医学文献中记录的最大血肿,因此需要手术干预。在血肿吸收存在问题的情况下,临床医生应考虑潜在凝血病或持续性创伤的可能性,如该患者所观察到的头部撞击、虐待儿童或因癫痫发作反复跌倒。虽然对于帽状腱膜下血肿尚无普遍认可的治疗方案,但切开引流通过排出积血可立即缓解症状。采用负压吸引引流有助于减轻填塞效果的丧失。此外,后续的行为治疗和康复努力可能会促进受影响个体的全面康复和福祉。