Abdominal wall haematoma in the obese: a dangerous phenomenon
A 59-year-old obese female was admitted to the hospital with fever on the background of poorly controlled Type 2 diabetes (Hba1c 9.5%). The patient's background included ischaemic heart disease, chronic kidney disease, peripheral vascular disease and a right-side, below-knee amputation. On examination, the patient's weight was 125 kg, height 154 cm and body mass index was 53. A diabetic foot ulcer was identified at the base of the left heel.\nTwo weeks later, the patient remained hospitalized for the management of an infected diabetic foot ulcer and awoke one morning with acute abdominal pain and shortness of breath. The patient was haemodynamically compromised with a pulse rate of 120 and blood pressure 90/60 lying. The haemoglobin fell overnight from 126 to 90 g/l and a few hours later there was a further fall to 79 g/l. The medical emergency team were called. Platelet count was 242, international normalized ratio (INR) 1.0, activated partial thromboplastin time (APTT) 33 and anti-factor Xa level 0.41 in keeping with prophylactic clexane administration. A CT scan was performed, which demonstrated a large abdominal wall haematoma (see Fig. ).