Severe Postoperative Bleeding Following Minor-to-Moderate Abdominal and Flank Liposuction Performed at a Day Surgery Center: A Case Report

Patient: Male, 51-year-old Final Diagnosis: Hemorrhage Symptoms: Abdominal pain • dizziness • edema • palpitations • scrotal pain • weakness Medication: — Clinical Procedure: Liposuction and lipoflling Specialty: Plastic Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Liposuction is a one of the most common aesthetic procedures. The super-wet and tumescent techniques are used most frequently. Both serve to reduce collateral blood loss, facilitate the suctioning procedure, and providing local anesthesia. Overall, liposuction is considered safe and effective, with minor adverse effects such as swelling, minute bleeding, contour irregularities, and seroma. Serious complication such as life-threatening bleeding are rare. In this case report, we present a patient with significant postoperative bleeding following minor-to-moderate liposuction performed at a day surgery center. CASE REPORT: A 51-year-old healthy man, 4 days after 1600-cc aspirate tumescent liposuction performed in a day surgery center, was admitted to our ward with tachycardia, weakness, abdominal pain and disseminated hematoma. On admission, laboratory testing showed hematocrit of 20.9% and hemoglobin of 6.9 gr/dl. Immediate abdominal CT angiography was performed to exclude active bleeding, showing diffused hematoma in the subcutaneous fat all over the abdomen and scrotum, with some edema without active bleeding. The patient was treated with blood transfusion to facilitate fast home discharge during the peak of the COVID-19 epidemic that time. CONCLUSIONS: We discuss the common work-up and treatment of postoperative hemorrhage. Blood transfusion following minor-to-moderate liposuction is unusual but during the COVID-19 pandemic it can facilitate quick discharge of a patient with postoperative hemorrhage with no active bleeding. Improper patient selection, an inexperienced surgeon, and inadequate operating locale can all result in postoperative complications. We call for the formulation of more detailed guidelines for liposuction setting.