Fig. 11

Active post-surgical bleeding in an elderly 84-year-old female with acute abdominal pain, hard-consistency swelling, and severe blood loss (8 g/dl nadir haemoglobin) 24 hours after Rives-Stoppa repair of a midline incisional hernia. Emergency CT depicted a 15x6x13 cm hyperattenuating (median 55 HU) fresh haematoma (*), extending ventrally from the surgical site through the rectus muscles and subcutaneous fat. Note PM (thin arrows) and drainage tubes (arrows). Sagittal (c) and coronal (d) MIP reconstructions showed serpiginous contrast extravasation (arrowheads) isoattenuating with the enhanced aortic lumen within the haematoma, consistent with active arterial bleeding. Relaparotomy confirmed bleeding suprafascial haematoma, which required haemostasis and surgical drainage [Partly reproduced with permission from Ref. no. [18]]