We present a case of subgaleal hematoma in a previously healthy ten year old girl of Ethiopian Jewish origin as a result of benign but forceful mechanical stress on the scalp, resulting in significant blood loss in the absence of coagulopathy. Our literature review establishes that our case fits the pattern of subgaleal hematoma as a result of hair pulling, including variable and possibly prolonged time to presentation, extensive blood loss, continued oozing after drainage and pressure dressing, and fever as a result of sterile or infected hematoma. Our case presents three areas of complexity in management:
- A conservative approach versus incision and drainage
- Infected hematoma versus aseptic fever due to hematoma absorption
- Abusive versus accidental trauma
We suggest that prolonged hospitalization can ensure the absence of continued oozing even after drainage, and that in the setting of fever a drained hematoma should be cultured prior to starting antibiotics.
