Surgical Procedures for Buttock Hematomas
For large or symptomatic buttock hematomas, ultrasound-guided suction technique using a stab incision under local anesthesia is the recommended surgical approach, as it is minimally invasive while effectively evacuating the hematoma. 1
Assessment and Initial Management
- Evaluate hemodynamic stability and assess for significant blood loss, as large hematomas can cause substantial hemorrhage requiring fluid resuscitation 2
- Apply cold compresses to the affected area during the first 24-48 hours to reduce swelling and limit hematoma expansion 2
- Consider discontinuing or reversing anticoagulation therapy after weighing risks and benefits 2
Indications for Surgical Intervention
- Persistent, recurrent, or symptomatic hematomas that fail conservative management 3
- Large hematomas causing significant pain, functional limitation, or compression of surrounding structures 1
- Expanding hematomas that may indicate ongoing bleeding 2
- Chronic hematomas extending over multiple gluteal muscles that may cause complications such as piriformis syndrome 4
Surgical Approaches
Minimally Invasive Techniques (Preferred)
Ultrasound-guided suction technique:
- Performed under local anesthesia
- Requires only a stab incision
- Allows precise targeting of the hematoma
- Minimizes tissue trauma and risk of complications 1
Percutaneous mechanical thrombectomy:
- Effective for persistent post-surgical hematomas
- Can be performed in a single setting
- Particularly useful for consolidated hematomas that are difficult to evacuate through simple aspiration 3
Open Surgical Evacuation
- Consider for complex cases or when minimally invasive approaches fail 5
- May be necessary for:
- Chronic expanding hematomas
- Hematomas with organized clots resistant to aspiration
- Cases with suspected underlying pathology 4
Special Considerations
- Rule out underlying malignancy in patients with:
- No history of trauma
- Unusual clinical course
- Recurrent or expanding hematomas without clear cause 6
- Perform biopsy when clinical presentation is atypical, as soft-tissue sarcomas can mimic large hematomas 6
- For hematomas associated with pelvic fractures that spontaneously drain ("hematoma necessitans"), consider diverting colostomy and aggressive wound management to prevent infectious complications 7
Post-Procedure Management
- Monitor for recurrence and signs of infection (increasing pain, redness, swelling, or discharge) 8
- Follow up within 24 hours to ensure proper healing 8
- Address any underlying coagulation disorders to prevent recurrence 2
Pitfalls and Caveats
- Insufficient biopsy material may lead to missed diagnoses of underlying malignancies 6
- Repeated procedures without definitive diagnosis should raise suspicion for alternative pathologies 6
- Avoid attempting evacuation without imaging guidance, as this may result in incomplete removal or damage to surrounding structures 1