Is a scrotal hematoma dangerous

Trauma can hurt your scrotum and your testicles, even tearing the protective tissue or causing the testicles to split open. Your testicles make sperm and hormones. Testicular trauma can harm those functions and interfere with blood flow. Cleveland Clinic is a non-profit academic medical center.

Is a scrotal hematoma dangerous. For Dogs For Dogs Arthritis & Pain

A hematoma is basically a collection of blood oozing from under the dog's subcutaneous tissues (dog's skin). This condition is commonly seen in dogs who were allowed to be too active. For a good reason, vets' orders say to keep a recently neutered dog calm; too much activity is a trigger that may cause a blood vessel to ooze within the …

How dangerous are tanning beds? Visit HowStuffWorks to learn how dangerous tanning beds are. Advertisement For years, scientists have been trying to knock down the myth of the "hea...Scrotal hematoma and tenderness; Scrotal ultrasound is the investigation of choice; Management. Urology consult; Reduce a dislocated (luxed) testicle in the ED (i.e. replace it into the scrotal sac) Surgical repair for testicular rupture, hematocoele, non-reducible testicular dislocation and scrotal degloving.Indications. The management of an intrascrotal abscess, regardless of the cause, requires surgical drainage (see image below). The abscess cavities must be opened and drained, including the testis if it is involved. The cavity should be left open and packed. Fournier gangrene (necrotizing fasciitis) requires prompt resuscitation and surgical ... Spermatocele is a term used to describe a cyst which forms on the epididymis. The male anatomy is shown in the picture. The scrotum, or sac, contains a testicle on each side. The testicle has two functions. It makes testosterone, the male hormone, which is absorbed into the blood stream. It also makes sperm which travels from the testicle into ... Case presentation. Case report 1. An 80 years-old male presented with swelling in the left inguinoscrotal region for the past 12 years with occasional pain inside the swelling. The onset was insidious, progressive, and reached a size of 15 x 15 cm. The inguinoscrotal swelling increased in size and reached the left knee joint (Figure.

A subdural hematoma is a type of bleeding inside your head. It happens when blood collects under the dura mater, one of the layers of tissue that protect your brain. It most often happens from a head injury and can be fatal. The dura mater is one of the meninges — the three layers of membranes that cover and protect your brain and spinal …2. squirrelgirl18. • 8 yr. ago. When I was working at a shelter we had a couple dogs that got scrotal hematomas. One dog's was literally the size of a grapefruit but after a few weeks it went down. Just be sure he isn't irritating it too much and it should heal on it's own. If after a week you notice it has not shrunk at all give you vet a call.For many radiologists, requests for imaging evaluation of testicular or scrotal symptoms and physical exam findings may cause some degree of uneasiness, for two main reasons: first, the number of tumor entities and tumor-like lesions in the testes and scrotum is relatively large and their histopathologic classification is complex (Table 1) and second, case volume of scrotal studies for non ...Conclusion: Scrotal hematoma is a rare but potentially fatal puncture site complication that should be considered during neuro-endovascular treatment. Discover the world's research 25+ million membersUnless you’re a professional chef, you probably don’t know all there is about cooking and kitchen safety. As a result, there’s a lot you’re doing in the kitchen that isn’t too good...Objective: In order to expand the athletic trainer's awareness of acute scrotal injuries, the objective is to present a case of a collegiate football player sustaining a spermatic cord hematoma injury. Background: Hematomas tend to resolve with conservative management. However, untreated testicular injuries may have serious ramifications, including ischemic atrophy, necrosis, and secondary ...The scrotal hematoma was evacuated and right testis was reposed back to the scrotum without fixation. At 6-month follow up, both the testes were equal sized and in their normal intrascrotal position. ... a potential danger which necessitates post-reduction Doppler to exclude it. We do not find any need for additional testicular fixation after ...

Objective: We report a case of huge scrotal hematoma during emergency mechanical thrombectomy. Case Presentation:An 85-year-old man presented with sudden aphasia and right-sided hemiplegia. He was diagnosed with cerebral infarction due to left M1 occlusion and underwent an emergency mechanical thrombectomy. The treatment was completed with full ...Blunt trauma scrotum is a common mode of scrotal injury which may result in testicular rupture, haematocele, testicular dislocation and hematoma. Testicular injuries are managed both ...These blood vessels are tiny and sometimes not seen by the urologist and then after the vas deferens retract back into the scrotum-they ooze. Like a small oil leak, the blood continues to leak and accumulate until the surrounding tissues stop it. The result is a hematoma. Hematomas can vary in size depending on the size of the vessels and the ...A hydrocelectomy (removal of a hydrocele) is considered the treatment of choice when a hydrocele does not subside on its own, becomes too large, or causes pain. But surgery can result in several complications, including: . Hematoma (bleeding into the tissue) Infection. Persistent swelling. Chronic (long term) pain.Key Takeaways. Blood blisters on dogs are red lumps on the skin that develop from the blood vessels, hence the medical term vascular tumors. If a tumor is benign, it is called hemangioma; whereas tumors that spread on the body are called hemangiosarcomas. Blood blisters can occur due to several causes including trauma, scratches, excessive head ...Hematoma treatment often involves surgery. The type of surgery depends on the type of hematoma you have. Options include: Surgical drainage. If the blood is in one area and has changed from a solid clot to a liquid, your doctor might create a small hole in your skull and use suction to remove the liquid. Craniotomy.

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Scrotal emergencies are rare but potentially life and fertility threatening. This article explains how to diagnose and manage scrotal emergencies such as testicular torsion, Fournier gangrene, and testicular trauma. These diagnoses are often difficult to discern from less-concerning causes. This article helps to elucidate the differences between the dangerous and the less-harmful pathologic ...Diagnosis. To diagnose a lipoma, your doctor may perform: A physical exam. A tissue sample removal (biopsy) for lab examination. An X-ray or other imaging test, such as an MRI or CT scan, if the lipoma is large, has unusual features or appears to be deeper than the fatty. There's a very small chance that a lump resembling a lipoma may actually ...Kidney injury. A blow or other injury to the kidneys from an accident or contact sports can cause blood to show up in urine. Medicines. The anti-cancer drug cyclophosphamide (Cytoxan) and the antibiotic penicillin are linked to blood in urine. Medicines that prevent blood clots also are tied to blood in urine.While some varicoceles may be asymptomatic, others can cause chronic scrotal pain, scrotal heaviness, and infertility. The incidence of pain among patients with varicocele is estimated to be between 2 and 10% [ 16 ]. Different types of pain have been reported, including dull, dragging, throbbing, and sharp pain.Ultrasound. Ultrasound is usually the sole imaging modality used, typically being first line for those with a scrotal swelling or pain following trauma to the scrotum. Unlike a hydrocele, which is anechoic, a haematocele is of increased echogenicity and often has septa within. If the ultrasonographic investigation is performed right after the ...Treatments for testicular and scrotal conditions usually fall into the following categories: Medications. Antibiotics to treat infections. Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. Other pain relieving medications to reduce pain. Hormone replacement therapy to replace testosterone for hypogonadism.

Introduction. Scrotal and testicular trauma are uncommon injuries, accounting for less than 1% of overall trauma in the United States [1-3].Scarcity of these injuries is attributed to the location and mobility of the scrotum [].A recent study using the National Trauma Data Bank found over an eight-year period that testicular and scrotal trauma had a prevalence of only 0.23% [].Access site bleeding for femoral access occurs in 0.82% of cases after percutaneous coronary intervention. 1 Retroperitoneal bleeding is the most catastrophic …A hematoma is basically a blood-filled sac under the skin. The most common skin hematomas affect the ears and scrotal area. Head shaking, scratching, or surgery can cause hematomas. Hematoma surgery is often necessary for treatment. Awareness, good hygiene, and regular veterinary visits can help prevent hematomas.For many patients with urethral injury, extravasation of blood contained within different fascial planes is present. On examination, patients with injury to the urethra distal to the urogenital diaphragm and not contained by the Buck fascia typically have a butterfly hematoma, which forms as blood collects in the superficial perineum. [] Scrotal enlargement is common with this injury, as ...View Scrotal hematoma & more Canis resources at Vetlexicon. Over 28,000 peer-reviewed resources: Bovis, Equis, Felis, Lapis & Exotis.Objective: We report a case of huge scrotal hematoma during emergency mechanical thrombectomy. Case Presentation:An 85-year-old man presented with sudden aphasia and right-sided hemiplegia. He was diagnosed with cerebral infarction due to left M1 occlusion and underwent an emergency mechanical thrombectomy. The treatment was completed with full ...A hematoma is a collection of blood. A bruise is a type of hematoma. A hematoma may form in a muscle or in the tissues just under the skin. A hematoma that forms under the skin will feel like a bump or hard mass. Hematomas can happen anywhere in your body, including in your brain. Your body may break down and absorb a mild hematoma on its own.Scrotal trauma is a rare surgical emergency. Blunt trauma scrotum is a common mode of scrotal injury which may result in testicular rupture, haematocele, testicular dislocation and hematoma ...

Dangerous Drugs & Medical Devices. News & Commentary on Prescription Drug & Medical Device Lawsuits. Home > Devices > Penile Implants > 2009 - Scrotal Hematoma, Infection, Material Migration, and Surgical Revision Associated with Penile Prostheses 2009 - Scrotal Hematoma, Infection, Material Migration, and Surgical Revision Associated with ...

In a world where safety is a top priority, there are some jobs that stand out as incredibly dangerous. These jobs require individuals to put their lives on the line every day, faci...He got scrotal hematoma and I don't know what to do. Can somebody tell me is scrotal hematoma dangerous? Thanks! Loading... fairlie167071484 over a year ago. First you should know that these things happened all the time. I need to tell you that it may be dangerous but it's usually not. It was clear I had a scrotal hematoma. On (Day 3), which is today, a lot bruising has traveled up into my pubic area. Penis is still fully engorged with blood-blister, but the top of my scrotum is returning to a normal pink color and not sensitive to touch. This area is where my testicles are hanging out. An idiopathic scrotal hematoma is a very rare condition that can simulate it. Case Report A 3-day-old full-term baby, otherwise in good health, showed swelling and pain of the left inguinal-scrotal region. A testicular torsion was suspected, so the baby underwent an ultrasound examination of the testis and spermatic cord that showed a left ...Increased swelling: One of the first signs that a scrotal hematoma may be becoming dangerous is increased swelling. If the scrotum continues to swell even after …Diagnosis of scrotal hematoma as a result of SLH was considered. On follow up, the clinical condition of the baby improved gradually. At age 14 days, the swelling and bluish discoloration of the scrotum and groin were resolved. Follow-up abdominal sonography showed liquefaction of the hematoma. The patient was healthy and eventually discharged ...Intratesticular hematoma is one of the most frequent presentations of scrotal trauma. Ultrasound is the first-line imaging modality in the evaluation of scrotal trauma, and its findings are crucial for the choice of treatment. An intratesticular hematoma may represent a diagnostic pitfall for the investigating physician since its appearance may mimic other conditions, such as testicular ...Collection of blood around the testicle (hematoma) The balance between the benefits and risks of surgery shifts if the treatment is only for pain management. While varicoceles may cause pain, most do not. A person with a varicocele may have testicular pain, but the pain may be caused by something else — an unknown or not yet identified …For optimal results, a 7-14-MHz high-frequen-cy linear-array transducer is used, and the gel should be warm. If the patient has an open wound, sterile technique is recommended. Im-mediately after trauma injury, the scrotum is often tender to palpation, which makes scan-ning exceptionally challenging.

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Scrotal wall hematoma; Evaluation. Scrotal ultrasonography of a hematocele, a couple of weeks after appearance, as a fluid volume with multiple thick septations. The hematocele displays no blood flow on Doppler ultrasonography. A pyocele has a similar appearance, but was excluded by lack of inflammation. It is more likely that this is a scrotal hematoma. These typically do resolve in their own, but it can take weeks. Keep his activity level as low as possible to discourage more swelling, continue the anti inflammatory medication, make sure he cannot bite or lick it by using a “cone” if needed. The absence of scrotal swelling and hematoma may indicate a relatively benign injury. Additional imaging tests or scrotal exploration is required if testicular rupture is suggested because of clinical findings or when a patient experiences pain out of proportion to the physical examination findings. Blunt trauma to the testes may manifest as a ...Key Takeaways. Blood blisters on dogs are red lumps on the skin that develop from the blood vessels, hence the medical term vascular tumors. If a tumor is benign, it is called hemangioma; whereas tumors that spread on the body are called hemangiosarcomas. Blood blisters can occur due to several causes including trauma, …Scrotal pain is a frequent presenting complaint in the primary care setting. It accounts for up to 5% of outpatient urology visits. Despite this, chronic scrotal content pain (CSCP) remains a poorly understood condition. ... While rare, there are potential complications associated with surgery, including hematoma, hydrocele and testicular ...What causes a seroma? A seroma may form after a surgical procedure. In some cases, a seroma may form after a very minor surgery. Most seromas, though, will appear after a rather extensive ...Scrotal ultrasound required for all blunt testicular injuries Reliable in diagnosing ruptured testes; Management. Most testicular injuries are managed conservatively Analgesia, ice, elevation, scrotal support, urology follow up; Consult Urology for urgent operative care Testicular rupture; Testicular dislocation (absence) Disposition. See above.1. Introduction. Scrotal hematoma in the neonate, though a rare condition, warrants prompt diagnosis and urgent intervention. It commonly results from testicular torsion, adrenal hemorrhage, and birth trauma. However, in some cases no cause may be discernable. Since Putnam recorded his first experience in 1989 [ 1 ], few other cases of … ….

Case Report. A 3-day-old full-term baby, otherwise in good health, showed swelling and pain of the left inguinal-scrotal region. A testicular torsion was suspected, so the baby underwent an ultrasound examination of the testis and spermatic cord that showed a left scrotal hematoma with superior displacement of the didymus; the right testicle …A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries.A hematoma is benign and is initially in liquid form spread among the tissues including in sacs between tissues where it may coagulate and solidify before blood is ...Post-Surgery FAQs for Dogs A scrotal hematoma is a collection of blood and fluids within the scrotum. It occurs when bleeding resumes after the incision site has been closed due to trauma or other causes. ... Acute and chronic subdural hematoma are the three types of subdural hematoma. This most dangerous type is usually caused by a serious ...The eruption of the Mount Nyiragongo volcano in the Democratic Republic of Congo killed at least 32 people and caused tens of thousands to flee. Why is this volcano so especially d...Aug 20, 2018 · One potential post-surgery complication is a scrotal hematoma—a collection of blood inside the scrotum—and it occurs in approximately two to five percent of vasectomies. Symptoms. Scrotal hematomas typically occur within a few days following a vasectomy procedure. They’re often accompanied by swelling, bruising and pain around the scrotum. In our study, when the pelvic hematoma width was greater than 3.35 cm, angiographic embolization was performed more frequently and the mortality rate also increased. Therefore, more aggressive angiographic embolization is recommended if the pelvic hematoma size measured on the CT scan is greater than 3.35 cm.Treatments for testicular and scrotal conditions usually fall into the following categories: Medications. Antibiotics to treat infections. Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. Other pain relieving medications to reduce pain. Hormone replacement therapy to replace testosterone for hypogonadism.It is defined as the collection or pooling of blood under the skin, in body tissues or an organ. Hematoma is a common potential post-surgery complication, and is commonly seen after a face-lift surgery. When capillaries, arteries or veins rupture, blood oozes out of the blood vessels and flow into the surrounding tissues, causing a pool of blood.Ultrasound. Ultrasound is usually the sole imaging modality used, typically being first line for those with a scrotal swelling or pain following trauma to the scrotum. Unlike a hydrocele, which is anechoic, a haematocele is of increased echogenicity and often has septa within. If the ultrasonographic investigation is performed right after the ... Is a scrotal hematoma dangerous, Treatment. If you experience post-vasectomy discomfort such as significant bruising, swelling and unexpectedly intense pain, you may have developed a scrotal hematoma and will need to see your doctor immediately. Depending on size, hematomas may gradually resolve on their own after a few weeks, and symptoms should diminish as the hematoma shrinks., Testicular trauma is the third most common cause of acute scrotal pain. US is useful in the triage of patients for medical or surgical management because it reliably depicts tunica albuginea rupture, intra- and extratesticular hematomas, and testicular contusions. Color Doppler US allows direct evaluation of testicular perfusion and detection ..., Objective: In order to expand the athletic trainer's awareness of acute scrotal injuries, the objective is to present a case of a collegiate football player sustaining a spermatic cord hematoma injury. Background: Hematomas tend to resolve with conservative management. However, untreated testicular injuries may have serious ramifications, including ischemic atrophy, necrosis, and secondary ..., Edit article. Citation, DOI, disclosures and article data. Scrotal hematoceles are collections of blood within the scrotal sac, but outside of the testis. Pathology. A …, Jun 11, 2023 · In a minority of cases a testicular abscess can result from bacterial infection an existing hematoma (as a result of testicular trauma) or of a region of infarction (secondary to testicular torsion or mumps) 3. If the abscess ruptures through the tunica albuginea then a scrotal abscess may develop. , The diagnosis of a left scrotal hematoma due to bilateral adrenal haemorrhage was considered, and nonoperative therapy was chosen as the course of treatment. After two months, the hematoma had ..., Scrotal hematoma and tenderness; Scrotal ultrasound is the investigation of choice; Management. Urology consult; Reduce a dislocated (luxed) testicle in the ED (i.e. replace it into the scrotal sac) Surgical repair for testicular rupture, hematocoele, non-reducible testicular dislocation and scrotal degloving., Abstract. A 46-year-old man who underwent a vasectomy at his general practitioner presented to the emergency department at a regional hospital with a 6 h history of scrotal swelling and skin discolouration. He was haemodynamically stable on admission, with a large, dark red swelling in his scrotum. The patient was admitted to an acute surgical ..., Scrotal hematoma can lead to signs and symptoms of hemorrhagic shock [4, 5, 7], whereas some may be hemodynamically stable regardless of the significant low level of hemoglobin . Interestingly, one of the reported cases with hemorrhagic shock was successfully managed conservatively with blood transfusions [ 5 ]., Introduction. Scrotal trauma accounts for less than 1% of all trauma-related injuries due to anatomical location and scrotum mobility. 1 Given the exposed nature of the scrotum, its structure is highly vulnerable to traumatic injuries. 2 Scrotal trauma is classified into two types: blunt and penetrating. Blunt trauma is the most frequent, and testicular …, Penile Hematoma Treatment. Several different factors are held accountable for the occurrence of a penile hematoma. Hence the treatment methods also vary for causes related. For a penile hematoma caused due to sexual intercourse, the treatment is achieved; through surgery. The surgery is performed under the effect of anesthesia with …, The differential diagnosis of scrotal swellings is long and includes both benign and malignant conditions. Hematocele is a collection of blood between the parietal and visceral layers of the tunica vaginals of the testis, it could follow trauma or surgery to the scrotum, and however it is the role rather than the exception that in chronic hematocele …, 2. squirrelgirl18. • 8 yr. ago. When I was working at a shelter we had a couple dogs that got scrotal hematomas. One dog's was literally the size of a grapefruit but after a few weeks it went down. Just be sure he isn't irritating it too much and it should heal on it's own. If after a week you notice it has not shrunk at all give you vet a call., This is a dangerous attitude and can result in missing the signs of a complication early on. The period immediately following a vasectomy is when you're most likely to develop a problem, so you need to be on high alert. ... Scrotal hematoma: Definition, causes and treatment options July 7, 2020 A scrotal hematoma is a post-vasectomy ..., View Scrotal hematoma & more Canis resources at Vetlexicon. Over 28,000 peer-reviewed resources: Bovis, Equis, Felis, Lapis & Exotis., Penoscrotal haematoma, one of the complications, is a very well documented complication following inguinal hernia repair, however, massive penoscrotal …, 1. Introduction. Scrotal hematoma in the neonate, though a rare condition, warrants prompt diagnosis and urgent intervention. It commonly results from testicular torsion, adrenal hemorrhage, and birth trauma. However, in some cases no cause may be discernable. Since Putnam recorded his first experience in 1989 [ 1 ], few other cases of neonatal ..., Introduction: Acute swelling and discoloration of the scrotum in a newborn is a rare condition and can have several causes such as testicular torsion, trauma, inguinal hernia, hydrocele, or adrenal hemorrhage. Case presentation: We report a neonate of adrenal hemorrhage presenting clinically as the acute scrotum. Definitive diagnosis was defined by ultrasonography and computed tomography scan ..., Scrotal Hematoma or Hematocele. Extratesticular hematoceles, or collections of blood within the tunica vaginalis, are the most common finding in the scrotum after blunt trauma . Micallef et al. noted such findings in 11 of 15 patients. Extratesticular soft tissues, such as the scrotal wall, tunica albuginea, and epididymis, may also be involved., Ultrasound. Ultrasound is usually the sole imaging modality used, typically being first line for those with a scrotal swelling or pain following trauma to the scrotum. Unlike a hydrocele, which is anechoic, a hematocele is of increased echogenicity and often has septa within. If the ultrasonographic investigation is performed right after the ..., The operation usually takes 20 to 50 minutes. Your surgeon will make a small cut on your scrotum. For a hydrocele, your surgeon will remove the fluid from the sheath. To prevent the fluid from coming back, your surgeon will either remove the sheath or stitch it together. Your surgeon will remove an epididymal cyst., Bleeding or a blood clot (hematoma) inside the scrotum; Blood in your semen; Bruising of your scrotum; Infection of the surgery site; Mild pain or discomfort; ... Make a small cut (incision) in the upper part of your scrotum once the surgery area is numb. Or with the "no-scalpel" technique, make a small puncture in the scrotum instead of an ..., The scrotal hematoma was evacuated and right testis was reposed back to the scrotum without fixation. At 6-month follow up, both the testes were equal sized and in their normal intrascrotal position. ... a potential danger which necessitates post-reduction Doppler to exclude it. We do not find any need for additional testicular fixation after ..., The scrotal hematoma can happen following testicular torsion, adrenal hemorrhage, or birth trauma.1 Moreover, idiopathic scrotal hematoma was also reported.1, 2 To the best of our knowledge, our case was the first report regarding scrotal hematoma following puncture of the femoral artery. The present case may indicate the importance of quick ..., Abstract . Title: Routine Drain Placement during Scrotal Hydrocelectomy: The Tradeoff Between Hematoma Formation and Surgical Site Infection. Objective Scrotal hydroceles are a common benign condition affecting many men. Though benign, many men have symptomatic hydroceles and opt for surgical excision. Scrotal hydrocelectomy is …, Scrotal hematoma is a challenging complication of penile prosthesis surgery. We characterize the risk of hematoma formation with implementation of standardized techniques to mitigate hematomas and ..., You have a scrotal hematoma. The blood oozing from the incision is not active bleeding but probably a portion of the clot dissolving. Urologists as a rule do not recommend exploring the area or removing the hematoma. We recommend neosporin ointment to the incision and dressings as necessary. Complete resolution is the most common outcome but it ..., It is more likely that this is a scrotal hematoma. These typically do resolve in their own, but it can take weeks. Keep his activity level as low as possible to discourage more swelling, continue the anti inflammatory medication, make sure he cannot bite or lick it by using a “cone” if needed. , Penile Hematoma Treatment. Several different factors are held accountable for the occurrence of a penile hematoma. Hence the treatment methods also vary for causes related. For a penile hematoma caused due to sexual intercourse, the treatment is achieved; through surgery. The surgery is performed under the effect of anesthesia with …, US of the scrotum is the recommended imaging modality for testicular trauma. Management of Blunt Testicular Trauma 1 Blunt trauma is often unilateral and can be managed conservatively in most cases. 2 The absence of scrotal swelling or haematoma does not preclude a testicular injury. 3 Arrange urgent scrotal US to assess the testicle and ..., Abstract. Neonatal scrotal hematoma is a rare genitourinary emergency. Some cases have underlining aetiologic factors such as testicular torsion, adrenal hemorrhage, or birth trauma, and others are idiopathic. Previously, immediate scrotal exploration was considered imperative for diagnosis and treatment., In addition to black spots on your scrotum, FD can cause: sharp pain in your hands and feet, especially after strenuous activity or exercise. not sweating enough ( hypohidrosis) ringing sounds in ..., Abstract . Title: Routine Drain Placement during Scrotal Hydrocelectomy: The Tradeoff Between Hematoma Formation and Surgical Site Infection. Objective Scrotal hydroceles are a common benign condition affecting many men. Though benign, many men have symptomatic hydroceles and opt for surgical excision. Scrotal hydrocelectomy is the gold standard surgical option with potential complications ...