Image-Guided Thrombin Injection for Post-procedural Hematomas in Various Surgical Settings: A Case Series

Post-procedural hematomas are uncommon but clinically significant complications that can lead to morbidity and mortality. Conventional management often requires surgical re-exploration or embolization, which may be technically unfeasible or high risk in patients with multiple comorbidities. Thrombin injection, although well established for pseudoaneurysm treatment, has been less frequently reported in the management of postsurgical hematomas. We describe five patients who developed post-procedural hematomas following different interventions: robotic hernia repair, ovarian cystectomy, percutaneous nephrostomy, endoscopy, and percutaneous endoscopic gastrostomy tube insertion. Each patient was treated with image-guided thrombin injection under computed tomography or ultrasound guidance. Hemostasis was successfully achieved in all cases without thrombin-related complications, and patients recovered without the need for surgical or major endovascular intervention. Image-guided thrombin injection is a safe, effective, and minimally invasive technique for managing selected post-procedural hematomas. This case series highlights its potential as an alternative when conventional surgical or embolization options are not feasible. Further studies are needed to standardize protocols and evaluate long-term outcomes.