Post-Hysterectomy: Managing Persistent Hematoma and Symptoms

Q: Post-Hysterectomy: Managing Persistent Hematoma and Symptoms

Hello： There is a possibility of hematoma formation after surgery, which usually resolves on its own over time, although the rate of absorption can vary. <br>It is recommended to continue monitoring the situation. <br>You can discuss your concerns with your attending physician, a

Fascial hematoma after hysterectomy

Hello Doctor: I underwent an open abdominal surgery for adenomyosis and fibroids at the beginning of August, resulting in a total hysterectomy with ovarian preservation.
The surgeon mentioned that there was significant adhesion.
After the surgery, I noticed a long, vertical hard lump just below my navel, which occasionally causes sharp pain and a tingling sensation.
The doctor performed an ultrasound and indicated that it is a hematoma measuring approximately 3 cm (presumably in width, as the length was not specified; the screen showed a linear shadow).
The doctor mentioned that it would absorb on its own, but it has been eight weeks, and the lump is still present.
There is no fever, and pressing on it firmly causes a sharp sensation, but otherwise, I do not have any symptoms.
What should I do now? Thank you, Doctor.

emma, 40~49 year old female. Ask Date: 2010/10/04

Dr. Dong Yuhong reply Obstetrics and Gynecology

Hello: There is a possibility of hematoma formation after surgery, which usually resolves on its own over time, although the rate of absorption can vary.
It is recommended to continue monitoring the situation.
You can discuss your concerns with your attending physician, allowing them to assess whether additional examinations or treatments are necessary based on your condition.
Thank you.

Reply Date: 2010/10/04

More Info

Post-hysterectomy complications, such as persistent hematomas, can be a source of concern for many patients. In your case, it appears that you have developed a hematoma, which is essentially a localized collection of blood outside of blood vessels, often resulting from surgical trauma. Given that you underwent a total abdominal hysterectomy with severe adhesions, the formation of a hematoma is not uncommon.

Understanding Hematomas
Hematomas can occur post-operatively due to various reasons, including bleeding from the surgical site, injury to blood vessels, or inadequate hemostasis during surgery. They can present as palpable masses, and in your case, the hematoma is located just below the umbilicus, measuring approximately 3 cm. The symptoms you describe—occasional sharp pain and a tingling sensation—are not unusual and may be related to the pressure of the hematoma on surrounding tissues or nerves.

Management of Persistent Hematomas
1. Observation: In many cases, small hematomas can be managed conservatively. Your doctor has indicated that the hematoma is likely to resolve on its own, which is often the case. The body can reabsorb the blood over time, and many hematomas will decrease in size and symptoms will improve.

2. Follow-Up Imaging: Since it has been eight weeks since your surgery and the hematoma has not resolved, it may be prudent to have follow-up imaging, such as an ultrasound or CT scan, to assess the size and characteristics of the hematoma. This can help determine if it is indeed resolving or if there are other complications, such as infection or the formation of a seroma (a collection of serous fluid).

3. Pain Management: For the discomfort you are experiencing, over-the-counter pain relievers such as acetaminophen or ibuprofen may help alleviate symptoms. However, it's essential to consult your healthcare provider before taking any medication, especially if you have other underlying conditions or are taking other medications.

4. Surgical Intervention: If the hematoma does not resolve on its own or if it becomes symptomatic (increasing pain, signs of infection such as fever or redness), surgical intervention may be necessary. This could involve drainage of the hematoma, especially if it is causing significant discomfort or complications.

5. Monitoring for Complications: Keep an eye out for any signs of complications, such as fever, increased swelling, or changes in the characteristics of the mass. If you experience any of these symptoms, it is crucial to contact your healthcare provider promptly.

Conclusion
In summary, while it is common for hematomas to take time to resolve, your ongoing symptoms warrant close monitoring. It is advisable to maintain regular follow-up appointments with your healthcare provider to ensure that the hematoma is being appropriately managed. If you have concerns or if your symptoms worsen, do not hesitate to seek further evaluation. Your health and comfort are paramount, and your medical team is there to support you through your recovery.

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