# Life-threatening bleeding after mastectomy and deliverance by a single suture: A case-report

## TL;DR

An 84-year-old woman with atrial fibrillation experienced life-threatening bleeding after mastectomy and was successfully treated with an unconventional single suture.

## Contribution

A novel emergency treatment approach using a figure-of-eight suture to control postoperative bleeding in a high-risk patient.

## Key findings

- Severe postoperative bleeding occurred on the fifth day after mastectomy in a patient on apixaban.
- Doppler ultrasound identified the bleeding source, and a figure-of-eight suture successfully controlled the hemorrhage.
- The unconventional treatment averted the need for emergency surgery in a delayed care scenario.

## Abstract

Postoperative bleeding after mastectomy is rarely a life-threatening complication. However, it can be fatal without treatment, particularly in patients taking antithrombotic medications. We present a case of 84-year-old woman with atrial fibrillation and apixaban medication, who developed breast cancer requiring mastectomy. The patient experienced severe post-operative bleeding on the fifth postoperative day, with first symptoms being disorientation, stomachache, and unstable hemodynamics. A contrast-enhanced computed tomography revealed an active bleeding site superficially in the skin flap. Unfortunately, the patient had to face a two-hour delay before emergency surgery could be performed and the on-call surgeon decided to attempt an unconventional treatment. The source of the bleeding was pinpointed using Doppler ultrasound in the emergency room, and the artery was occluded with a large needle and a figure-of-eight suture.