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McKendrick M, Rajadurai V, Weishaupt J, Kasina V. Hemoperitoneum caused by spontaneous rupture of a leiomyoma: A case report. Case Rep Womens Health 2024; 42:e00609. [PMID: 38646503 PMCID: PMC11031715 DOI: 10.1016/j.crwh.2024.e00609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024] Open
Abstract
Uterine myomas, fibroids or leiomyomas are benign neoplasms that can present as abnormal uterine bleeding and pressure symptoms. Significant complications are infrequent, but they can be life-threatening. This is a case of a ruptured fibroid where excessive intra-abdominal bleeding resulted in hemoperitoneum. In this clinical scenario, timely recognition and intervention were essential to prevent morbidity and mortality. This article discusses the diagnostic challenges and surgical management of a case of hemoperitoneum resulting from spontaneous haemorrhage from a ruptured vessel on the surface of a subserosal leiomyoma. A 42-year-old patient with a known multi-fibroid uterus awaiting elective surgery presented with acute-onset abdominal pain to the emergency department. She had a distended, tender abdomen. Laboratory tests and contrast computerised tomography revealed haemorrhage with no clear source of bleeding. Emergency midline laparotomy revealed active bleeding from the surface of a posterior subserosal leiomyoma with 1950 mL hemoperitoneum. A total abdominal hysterectomy was performed, and the patient had an uncomplicated recovery. The pre-operative haemoglobin level was 80 g/L, which normalized after several blood transfusions. Histopathological examination confirmed multiple leiomyomas and haemorrhage associated with ischaemic changes. Hemoperitoneum from a bleeding degenerating leiomyoma is an exceedingly uncommon complication. The atypical presentation of abdominal pain and the presence of a multi-fibroid uterus posed diagnostic challenges. This case underscores the importance of considering leiomyomas as a potential cause of acute abdominal pain and bleeding. Timely surgical intervention, supported by a multidisciplinary approach, is essential for optimal patient outcome.
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Affiliation(s)
- Michael McKendrick
- Fiona Stanley Hospital, Department of Obstetrics and Gynaecology, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia
| | - Vinita Rajadurai
- Fiona Stanley Hospital, Department of Obstetrics and Gynaecology, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia
| | - Jennifer Weishaupt
- Fiona Stanley Hospital, Department of Obstetrics and Gynaecology, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia
| | - Venkata Kasina
- Fiona Stanley Hospital, Department of Obstetrics and Gynaecology, 11 Robin Warren Drive, Murdoch, Western Australia 6150, Australia
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Bouab M, Wajih O, Gotni A, Assal A, Jalal M, Lamrissi A. Spontaneous heterotopic pregnancy: Diagnosis and surgical management. Int J Surg Case Rep 2024; 118:109582. [PMID: 38631194 PMCID: PMC11035084 DOI: 10.1016/j.ijscr.2024.109582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Heterotopic pregnancy is a rare form of pregnancy, defined by the coexistence of an ectopic and an intrauterine pregnancy. The diagnosis of heterotopic pregnancy remains one of the greatest challenges of the gynecological-obstetrical emergencies. CASE PRESENTATION We report a rare case of spontaneous heterotopic pregnancy of a 28-year-old woman, diagnosed with a heterotopic pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. DISCUSSION Heterotopic pregnancy is a rare form of pregnancy, defined by the coexistence of an ectopic and an intrauterine pregnancy. The most common functional signs are abdominal pain, vaginal bleeding, pelvic mass and peritoneal irritation. The first-line paraclinical examination is suprapubic and transvaginal pelvic ultrasound. Therapeutic management of heterotopic pregnancies involves rapid intervention on the ectopic pregnancy, while respecting the intrauterine pregnancy if it has progressed, in order to preserve the patient's fertility. CONCLUSION Diagnosis of heterotopic pregnancy is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.
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Affiliation(s)
- Maryem Bouab
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Oumaima Wajih
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Aicha Gotni
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Asmaa Assal
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Mohamed Jalal
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Amine Lamrissi
- Obstetrics And Gynecology Department, University Hospital Center Ibn Rochd, Morocco Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
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Vinken J, Emslie E, Smith S. Spontaneous Uterine Artery Rupture in a Nongravid Patient. J Minim Invasive Gynecol 2024:S1553-4650(24)00109-2. [PMID: 38460866 DOI: 10.1016/j.jmig.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Jamie Vinken
- Department of Obstetrics and Gynecology, College of Medicine, University of Saskatchewan, 7344 6th Ave, Regina SK, S4T 0P2.
| | - Ethan Emslie
- Department of Obstetrics and Gynecology, College of Medicine, University of Saskatchewan, 302-2300 Broad Street, Regina, SK, S4P 1Y8.
| | - Sarah Smith
- Department of Obstetrics and Gynecology, College of Medicine, University of Saskatchewan, 606 Victoria Avenue Regina, SK.
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Ishigami A, Inaka S, Ishida Y, Nosaka M, Kuninaka Y, Yamamoto H, Shimada E, Kimura A, Furukawa F, Kondo T. A case of hemoperitoneum after percutaneous radiofrequency ablation in a patient with hepatocellular carcinoma. Forensic Sci Med Pathol 2024; 20:189-193. [PMID: 36943648 DOI: 10.1007/s12024-023-00601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/23/2023]
Abstract
We report a case of hemoperitoneum after percutaneous radiofrequency ablation in a patient with hepatocellular carcinoma. A 60-year-old female was hospitalized for the treatment of thrombasthenia and cirrhosis caused by chronic Hepatitis C, and computed tomography revealed hepatocellular carcinoma, which was treated by percutaneous radiofrequency ablation. After the ablation, hemoperitoneum was suspected because of the low hemoglobin level with abdominal pain. Approximately 6 h after the ablation treatment, the patient suddenly fell into a shock state and died. In this case, medical treatment-related death including malpractice was suspected, and forensic autopsy was performed. The abdominal cavity contained 910 mL of dark red fluid blood and 210 g of soft hemocoagula. Moreover, several puncture marks were observed on the liver surface and diaphragm, and there was no clear damage to the main arteries and veins. Considering the macroscopic and microscopic findings, the cause of death was assumed as hemorrhagic shock due to the hemoperitoneum caused by the damage to the liver by radiofrequency ablation. It is important to consider all the indications and adverse effects of radiofrequency ablation.
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Affiliation(s)
- Akiko Ishigami
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Shogo Inaka
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Yuko Ishida
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Mizuho Nosaka
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Yumi Kuninaka
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Hiroki Yamamoto
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Emi Shimada
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Akihiko Kimura
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Fukumi Furukawa
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan
| | - Toshikazu Kondo
- Department of Forensic Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama, 641-8509, Japan.
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Antoine A, Kondagari L, Okada C, Arvizo C. Large-volume hemoperitoneum and hemodynamic instability in uterine fibroid rupture: A case report. Case Rep Womens Health 2024; 41:e00572. [PMID: 38152572 PMCID: PMC10750031 DOI: 10.1016/j.crwh.2023.e00572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
A perimenopausal woman with a known history of fibroid uterus presented to the emergency department with the chief complaint of three weeks of intermittent abdominal pain with acute worsening for two days. The pain was described as 10/10 "tearing" peri-umbilical pain with radiation to the rectum associated with nausea. Vital signs, laboratory results, and physical examination were largely unremarkable at presentation, aside from diffuse tenderness with rebound. Computed tomography revealed a markedly enlarged uterus and large-volume hemoperitoneum and sentinel clot sign, suggesting fibroid as the source of bleeding. Upon re-examination, the patient was found to be hypotensive and tachycardic with worsening hemoglobin, worsening abdominal distension, and a positive focused assessment with sonography in trauma (FAST) exam. Although the source of bleeding was non-specific, a decision was made by the gynecology and general surgery teams to perform an emergency exploratory laparotomy. A midline vertical incision was made and four liters of blood were evacuated from the peritoneal cavity. The gynecology and general surgery teams thoroughly inspected the abdomen. A myomectomy was performed and good hemostasis was confirmed. The patient was transferred to the surgical intensive care unit, where she had an uncomplicated post-operative course. She was discharged home on postoperative day 4. Uterine fibroid rupture should be on the differential for hemoperitoneum in a patient with known fibroids and should be addressed with a timely multi-specialty approach.
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Affiliation(s)
- Ali Antoine
- Department of Obstetrics and Gynecology, Montefiore Medical Center, United States of America
| | - Laveena Kondagari
- New York Health and Hospital - Jacobi Medical Center Department of Obstetrics and Gynecology, 1400 Pelham Parkway South, Bronx, NY 10461, United States of America
| | - Chihiro Okada
- Albert Einstein School of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, United States of America
| | - Cynthia Arvizo
- New York Health and Hospital - Jacobi Medical Center Department of Obstetrics and Gynecology, 1400 Pelham Parkway South, Bronx, NY 10461, United States of America
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Lu HF, Li JJ, Zhu DB, Mao LQ, Xu LF, Yu J, Yao LH. Postoperative encapsulated hemoperitoneum in a patient with gastric stromal tumor treated by exposed endoscopic full-thickness resection: A case report. World J Gastrointest Surg 2024; 16:601-608. [PMID: 38463350 PMCID: PMC10921194 DOI: 10.4240/wjgs.v16.i2.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Gastric stromal tumors, originating from mesenchymal tissues, are one of the most common tumors of the digestive tract. For stromal tumors originating from the muscularis propria, compared with conventional endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFTR) can remove deep lesions and digestive tract wall tumors completely. However, this technique has major limitations such as perforation, postoperative bleeding, and post-polypectomy syndrome. Herein, we report a case of postoperative serous surface bleeding which formed an encapsulated hemoperitoneum in a patient with gastric stromal tumor that was treated with exposed EFTR. Feasible treatment options to address this complication are described. CASE SUMMARY A 47-year-old male patient had a hemispherical protrusion found during gastric endoscopic ultrasonography, located at the upper gastric curvature adjacent to the stomach fundus, with a smooth surface mucosa and poor mobility. The lesion was 19.3 mm × 16.1 mm in size and originated from the fourth ultrasound layer. Computed tomography (CT) revealed no significant evidence of lymph node enlargement or distant metastasis. Using conventional ESD technology for mucosal pre-resection, exposed EFTR was performed to resect the intact tumor in order to achieve a definitive histopathological diagnosis. Based on its morphology and immunohistochemical expression of CD117 and DOG-1, the lesion was proven to be consistent with a gastric stromal tumor. Six days after exposed EFTR, CT showed a large amount of encapsulated fluid and gas accumulation around the stomach. In addition, gastroscopy suggested intracavitary bleeding and abdominal puncture drainage indicated serosal bleeding. Based on these findings, the patient was diagnosed with serosal bleeding resulting in encapsulated abdominal hemorrhage after exposed EFTR for a gastric stromal tumor. The patient received combined treatments, such as hemostasis under gastroscopy, gastrointestinal decompression, and abdominal drainage. All examinations were normal within six months of follow-up. CONCLUSION This patient developed serous surface bleeding in the gastric cavity following exposed EFTR. Serosal bleeding resulting in an encapsulated hemoperitoneum is rare in clinical practice. The combined treatment may replace certain surgical techniques.
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Affiliation(s)
- Hui-Fei Lu
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - Jing-Jing Li
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - De-Bin Zhu
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - Li-Qi Mao
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - Li-Fen Xu
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - Jing Yu
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - Lin-Hua Yao
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
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Ghades S, Daadoucha A, Jemel H, Rouis N, Fatnassi MR. Unrecognized abdominal pregnancy with six months' evolution revealed by acute intestinal obstruction in women with PCOS. JBRA Assist Reprod 2024. [PMID: 38381776 DOI: 10.5935/1518-0557.20230057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Abdominal pregnancy is a rare form of ectopic pregnancy where implantation and development of the egg take place in the peritoneal cavity outside the tubo-uterine mucosa, in contact with intestinal loops. Diagnosis is most often difficult. We report the case of a 32-year-old woman (gravida 1, para 1), with a history of PCOS, diagnosed with abdominal pregnancy at 20 weeks of amenorrhea complicated by acute intestinal obstruction. Diagnosis was confirmed by abdomino-pelvic scan. Surgery was performed with the patient under general anesthesia. She presented a macerated fetus with an infiltration of the placenta causing a perforation of the sigmoid colon and uterus. Hartmann's procedure was performed and the perforation of the uterus was sutured. Abdominal pregnancy remains a rare variety of ectopic pregnancy. Preoperative diagnosis is difficult due to the presence of a variety of non-specific symptoms. This type of ectopic pregnancy remains challenging for gynecologists and radiologists.
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Affiliation(s)
- Sana Ghades
- Department of Gynecology and Obstetrics, University Hospital Ibn El Jazzar, 3100, Kairouan, Tunisia
| | - Abderahmen Daadoucha
- Department of Radiology, University Hospital Ibn El Jazzar, 3100, Kairouan, Tunisia
| | - Hamed Jemel
- Department of Gynecology and Obstetrics, University Hospital Ibn El Jazzar, 3100, Kairouan, Tunisia
| | - Nour Rouis
- Department of Gynecology and Obstetrics, University Hospital Ibn El Jazzar, 3100, Kairouan, Tunisia
| | - Mohamed Ridha Fatnassi
- Department of Gynecology and Obstetrics, University Hospital Ibn El Jazzar, 3100, Kairouan, Tunisia
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Ademi Ibishi V, Rafuna N, Kolgeci K. An Uncommon Instance of Tubal Pregnancy With a Vital Fetus at the Thirteenth Week of Gestation. J Med Cases 2024; 15:15-19. [PMID: 38328806 PMCID: PMC10846497 DOI: 10.14740/jmc4173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Ectopic pregnancy, characterized by the aberrant implantation of blastocysts outside the uterine endometrial lining, typically occurs within the fallopian tube. Clinical presentation of tubal pregnancy ranges from asymptomatic cases to a spectrum of symptoms, including amenorrhea, pelvic pain, vaginal bleeding, and, critically, hemorrhagic shock resulting from tubal rupture. Utilizing serum beta-human chorionic gonadotropin levels and ultrasound examinations is pivotal in confirming the diagnosis. Diagnosing tubal pregnancy during the first trimester is feasible and crucial to prevent rupture, yet reports of fatal cases persist due to delays in diagnosis or misdiagnosis. This paper presents a unique case of an advanced tubal pregnancy at 13 weeks of gestation, featuring a viable fetus. This case underscores the importance of timely and accurate diagnosis to avoid life-threatening complications. It highlights the critical need for heightened medical vigilance and continuous education among healthcare professionals in managing ectopic pregnancies effectively.
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Affiliation(s)
- Vlora Ademi Ibishi
- Medical Faculty, University of Prishtina “Hasan Prishtina”, Prishtina 10000, Kosovo
- Obstetrics and Gynecology Clinic, University Clinical Center of Kosova, Prishtina 10000, Kosovo
| | - Naser Rafuna
- Obstetrics and Gynecology Clinic, University Clinical Center of Kosova, Prishtina 10000, Kosovo
| | - Kaltrina Kolgeci
- Obstetrics and Gynecology Clinic, University Clinical Center of Kosova, Prishtina 10000, Kosovo
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Abad Ribeiro AB, Santoro ML, Duarte MR, Virgulino CC, de Oliveira GSS, França FODS. Hemoperitoneum after a Bothrops snakebite: Case report. Toxicon 2024; 237:107350. [PMID: 38016581 DOI: 10.1016/j.toxicon.2023.107350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
Snakebites are frequent in tropical countries. Brazil has an average of 27,000 cases per year, with a fatality rate of 0.5%, and the Bothrops genus is the most common causative agent, accounting for about 70-90% of the accidents. This report describes a case of human envenomation by a juvenile Bothrops jararaca snake in São Paulo, Brazil, in a 71 years-old man, previously healthy. He presented a life-threatening envenomation, which developed to severe hypotension, acute kidney injury and extensive peritoneal hemorrhage. The hemoperitoneum was diagnosed due to persistent hypotension associated with anemia, pain and gastrointestinal complaints. Abdominal Computed Tomography scans showed a moderate to large amount of presumable hematic material inside the abdominal cavity, predominantly in the perihepatic and perisplenic spaces. The intra-abdominal hemorrhage was not surgically addressed, and the patient was discharged 5 days after hospitalization, with the progressive absorption of the hemoperitoneum. Systemic bleeding is one of the complications and main causes of death in Bothrops envenomations. Acute peritoneal hemorrhage is one of these serious complications that must be carefully addressed since its management must take into account the risk of bleeding caused by toxins that affect hemostasis. The case described highlights the importance of early diagnosis and adequate management of this potentially fatal complication in snakebites.
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Affiliation(s)
| | - Marcelo Larami Santoro
- Biotério Central and Escola Superior do Instituto Butantan (ESIB), Secretaria de Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Marcelo Ribeiro Duarte
- Laboratório de Coleções Zoológicas, Instituto Butantan, Secretaria de Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Cristiana Cruz Virgulino
- Hospital Vital Brazil, Instituto Butantan, Secretaria de Saúde do Estado de São Paulo, São Paulo, Brazil
| | - Gerson Sobrinho Salvador de Oliveira
- Divisão de Clínica Médica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil; Comissão de Controle de Infecção Hospitalar, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Oscar de Siqueira França
- Núcleo de Medicina Tropical, Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Laboratório de Imunologia (LIM48), Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.
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Elouali A, Ouerradi N, Benhaddou H, Kamaoui I, Rkain M, Babakhouya A. Van Wyk-Grumbach syndrome: The importance of thyroid function tests in a child presenting with multicystic ovaries. Int J Surg Case Rep 2024; 114:109097. [PMID: 38039566 PMCID: PMC10730739 DOI: 10.1016/j.ijscr.2023.109097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION Van Wyk-Grumbach syndrome (VWGS) is a rare presentation of long-standing hypothyroidism, characterized by delayed bone age, enlarged bilateral multicystic ovaries, and isosexual precocious puberty. CASE PRESENTATION We report here the clinical details of the case of Van Wyk Grumbach Syndrome in an 11-year-old girl who was first presented to the pediatric surgeon for hemoperitoneum. The patient underwent an emergency exploratory laparotomy, which showed enlarged ovaries with multiple cysts that were bleeding. She also had severe hypothyroidism, hyperprolactinemia, hyperestrogenism, pituitary adenoma, and delayed bone age. Significant improvement in symptoms was noted after thyroid hormone replacement therapy. IMPORTANCE AND CONCLUSION This case highlights that it is crucial to consider thyroid assessment in a patient with multicystic ovaries to avoid misdiagnosis, unnecessary investigations for malignancy and/or surgical intervention, and possible complications.
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Affiliation(s)
- A Elouali
- Departments of Pediatrics, UHC Mohamed VI, University Mohamed I, Oujda, Morocco; Faculty of Medicine and Pharmacy, University Mohamed I, Oujda, Morocco.
| | - N Ouerradi
- Departments of Pediatrics, UHC Mohamed VI, University Mohamed I, Oujda, Morocco; Faculty of Medicine and Pharmacy, University Mohamed I, Oujda, Morocco
| | - H Benhaddou
- Departments of Pediatrics Surgery, UHC Mohamed VI, University Mohamed I, Oujda, Morocco; Faculty of Medicine and Pharmacy, University Mohamed I, Oujda, Morocco
| | - I Kamaoui
- Departments of Radiology, UHC Mohamed VI, University Mohamed I, Oujda, Morocco; Faculty of Medicine and Pharmacy, University Mohamed I, Oujda, Morocco
| | - M Rkain
- Departments of Pediatrics, UHC Mohamed VI, University Mohamed I, Oujda, Morocco; Faculty of Medicine and Pharmacy, University Mohamed I, Oujda, Morocco
| | - A Babakhouya
- Departments of Pediatrics, UHC Mohamed VI, University Mohamed I, Oujda, Morocco; Faculty of Medicine and Pharmacy, University Mohamed I, Oujda, Morocco
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Khatri S, Villegas GE, Smith M. Management of inadvertent puncture of the hepatic capsule accompanied by post-TIPS hemoperitoneum secondary to bleeding diathesis. Radiol Case Rep 2023; 18:3798-3803. [PMID: 37663566 PMCID: PMC10474355 DOI: 10.1016/j.radcr.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/03/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Since its advent, the transjugular intrahepatic portosystemic shunt (TIPS) procedure has been accepted as an effective option to treat patients with complications of portal hypertension. While generally considered a safe procedure, TIPs can be associated with certain complications, including inadvertent puncture of the liver capsule with the needle/catheter combination during needle passes. In addition, the accompanying post-TIPS intraperitoneal hemorrhage has not been well reported and guidelines behind its management are not well described. We present a case of a 33-year-old male with refractory ascites who underwent TIPS, during which the hepatic capsule was inadvertently punctured, leading to the development of hemoperitoneum in the patient due to a bleeding diathesis.
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Affiliation(s)
| | | | - Matthew Smith
- Department of Radiology, NYC Health + Hospital/Queens, Queens, NY, USA
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12
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Tommasa SD, Roth SP, Triebe T, Brehm W, Lohmann KL, Stöckle SD. Successful intra-abdominal resection of a 24 kg ovarian granulosa cell tumor in a Warmblood mare. Open Vet J 2023; 13:1212-1218. [PMID: 37842112 PMCID: PMC10576582 DOI: 10.5455/ovj.2023.v13.i9.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/16/2023] [Indexed: 10/17/2023] Open
Abstract
Background Granulosa cell tumors (GCTs) are the most common ovarian tumors in mares. The classical presentation of a GCT is a unilaterally enlarged ovary appearing as a multicystic honeycomb mass. In rare cases, GCTs cause hemoperitoneum as a result of the rapid growth of the tumor. The clinical diagnosis of GCT is usually based on history, rectal examination, ultrasonographic examination, and serum hormone analysis, and surgical removal of the affected ovary is the treatment of choice. The different surgical approaches are based on the dimension of the GCT. Case Description A 7-year-old mare was referred to the department for horses due to suspicion of a large colon impaction. The mare presented with clinical signs of colic, fever, and signs of hypovolemic shock. Rectal and ultrasonographic examination showed hemoperitoneum and a honey-comb mass within the abdomen, and a GCT as the cause of an acute hemoperitoneum was diagnosed based on the serum level of anti-Müllerian hormone. After stabilization of the mare, the GCT was removed through a ventral midline incision. Because of the enormous dimensions of the GCT, intra-abdominal partial resection of the tumor using a tenotomy knife was necessary to exteriorize the ovarian pedicle. At 3 months follow-up, the mare was ridden for her intended use. Conclusion This report provides an approach to an uncommon case of a very large and heavy GCT.
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Affiliation(s)
| | | | - Theresa Triebe
- Department for Horses, University of Leipzig, Leipzig, Germany
| | - Walter Brehm
- Department for Horses, University of Leipzig, Leipzig, Germany
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Romero-Gutiérrez M, Pascual S, Márquez L, Gómez-Rubio M, Miquel M, Alarcón C, Ferrer T, Aracil C, Horta D, Latorre R, González Santiago J, Bernal V, Fernández C, Piqueras B, Gutiérrez ML, Martín A, Morillas J, Morales D, Blanco S, Rendón P, Chico I, Testillano M, Delgado C, Matilla A, Gómez Rodríguez R. Spontaneously ruptured hepatocellular carcinoma on non-cirrhotic liver: A prospective case series. Gastroenterol Hepatol 2023:S0210-5705(23)00395-3. [PMID: 37633519 DOI: 10.1016/j.gastrohep.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND AND AIMS Spontaneous ruptured hepatocellular carcinoma is an uncommon complication, and there are scarce data about non-cirrhotic patients. Tumor treatment is not standardized and the risk of peritoneal dissemination is unclear. AIM we analyzed the treatment and survival in patients with rHCC on non-cirrhotic liver. METHODS One hundred and forty-one non-cirrhotic patients with hepatocellular carcinoma diagnosed by histology were included in a multicenter prospective registry (2018-2022). Seven of them (5%) presented with hemoperitoneum due to spontaneous rupture. RESULTS Liver disease was associated in three patients (42.9%). A single nodule was detected in three cases (42.9%). One patient had vascular invasion and none extrahepatic spread. Initial hemostatic therapy and sequential treatment was individualized. Patients with single nodule were treated: resection (one case) with recurrence at 4 months treated with TACE and sorafenib. TACE/TAE followed by surgery (two cases) one in remission 43 months later, the other had liver recurrence at 18 months and was transplanted. Patients with multiple lesions were treated: TAE/emergency surgery and subsequent systemic therapy (two cases), one received lenvatinib (1-year survival) and the other sorafenib (5-month survival). TAE and surgery with subsequent systemic therapy (one case). Initial hemostatic surgery, dying on admission (one case). No patient developed intraperitoneal metastasis. All patients with multiple lesions died by tumor. The 3-year survival rate was 42.9%. CONCLUSIONS Initial hemostasis was achieved in all patients by TAE/TACE or surgery. Subsequent treatment was individualized, based on tumor characteristics, regardless of rupture. Long-time remission could be achieved in single nodule patients.
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Affiliation(s)
| | - Sonia Pascual
- Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Laura Márquez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Teresa Ferrer
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carles Aracil
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Diana Horta
- Hospital Universitario Mútua de Terrassa, Barcelona, Spain
| | - Raquel Latorre
- Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | | | - Vanesa Bernal
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | - Ana Martín
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | | | - Sonia Blanco
- Hospital Universitario de Basurto, Bilbao, Spain
| | | | | | | | | | - Ana Matilla
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Aiob A, Yousef H, Abu Shqara R, Mustafa Mikhail S, Odeh M, Lowenstein L. Risk factors and prediction of ectopic pregnancy rupture following methotrexate treatment: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 285:181-185. [PMID: 37146508 DOI: 10.1016/j.ejogrb.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Ectopic pregnancy (EP) rupture after methotrexate (MTX) treatment can have severe consequences. We examined clinical characteristics and beta-hCG trends that may predict EP rupture after MTX treatment. STUDY DESIGN In this 10-year retrospective study of 277 women with an EP, we compared clinical, sonographic and beta-hCG trends, before and after MTX treatment, between those who did and did not have an EP rupture after MTX treatment. RESULTS EP rupture was diagnosed in 41 women (15.1%) within 25 days of MTX treatment, and was correlated with higher parity and advanced pregnancy age: 2(0-5) vs. 1(0-6), P = 0.027 and 6.6(4.2-9.8) vs. 6.1(4-9.5), P = 0.045. EP rupture was also correlated with higher beta-hCG levels on days 0, 4 and 7 of MTX treatment: (2063 vs. 920 mIU/ml), (3221 vs. 921 mIU/ml) and (2368 vs. 703 mIU/ml), respectively, P < 0.001, for all. An increase of beta-hCG by>14% during days 0-4 showed a sensitivity of 71.4% CI 95% [55.4%-84.3%] and a specificity of 67.5% CI 95% [61.1%-73.6%] for predicting EP rupture after MTX treatment. Beta-hCG > 910 mIU/ml on day 0 showed a sensitivity of 80.9% CI 95% [66.7%-90.8%] and a specificity of 70.4% CI 95% [64.1%-76.3%] for predicting EP rupture after MTX treatment. A beta-hCG increase by>14% during days 0-4, and a beta-hCG value > 910 mUI/mL on day 0 were associated with increased risks of EP rupture after MTX treatment; the odds ratios were 6.4 and 10.5, respectively. Odds ratios were 8.06 [CI 95% (3.70-17.56)], P < 0.001 for every percent rise in beta-hCG during days 0-4; 1.37 [CI 95% (1.06-1.86)], P = 0.046 for every week change in gestational age; and 1.001 [CI 95% (1.000-1.001)], P < 0.001 for every unit rise in beta-hCG at day 0. CONCLUSION Beta-hCG > 910 mIU/ml at day 0, a rise in beta-hCG by>14% during days 0-4, and more advanced gestational age were associated with EP rupture after MTX treatment.
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Affiliation(s)
- Ala Aiob
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
| | - Haddad Yousef
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel
| | - Raneen Abu Shqara
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Susana Mustafa Mikhail
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Marwan Odeh
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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15
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Peters S, Iloaie C, Guérisse F. [A viral splenic rupture]. Rev Med Liege 2023; 78:181-182. [PMID: 37067831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
A 28-year-old patient is admitted in the emergency department for management of localized pain in the left hypochondrium and left flank that appeared 48 hours before his visit to the emergency room. At the same time, the patient describes the presence of fever, odynophagia and myalgia present for 8 days. The clinical examination highlights the presence of multiple upper cervical and submandibular bilateral and soft adenopathies of about 1.5 cm. There is also an abdominal defense at the level of the left hypochondrium and the left flank. The exploration will attest the presence of a primary EBV infection associated with a splenic rupture complicated by hemoperitoneum without hemodynamic repercussions. This clinical case illustrates the presence of a rare and potentially fatal complication following a very common disease, infectious mononucleosis.
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16
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Sinha R, Gupta A. Late Hemorrhage Following Laparoscopic Cholecystectomy. JSLS 2023; 27:JSLS.2023.00006. [PMID: 37187807 PMCID: PMC10178626 DOI: 10.4293/jsls.2023.00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Background Excruciating generalized abdominal pain with features suggestive of shock, at the end of the first or early second week after laparoscopic cholecystectomy (LC), is a frightening and formidable diagnostic predicament. This is because the early known complications like biliary leak or vascular injuries are unlikely diagnoses. Hemoperitoneum, is not usually considered, but instead more common occurrences like acute pancreatitis, choledocholithiasis, and sepsis are suspected. A delay in diagnosis and subsequent management of hemoperitoneum could have disastrous consequences. Case Studies Two patients presented with hemoperitoneum, in the second week after laparoscopic cholecystectomy. The first was because of a leak from a pseudoaneurysm of the right hepatic artery and the other was a bleed from a subcapsular liver hemangioma as a part of Osler Weber Rendu syndrome. Initially, a clinical assessment in both the patients was diagnostically inconclusive. Ultimately the diagnosis could be made, based on computed tomography angiography and visceral angiography. In the second patient, a positive family history and genetic testing were helpful. The first patient was successfully managed by intravascular embolization, while the second patient was successfully managed conservatively with intraperitoneal drains and conservative management of comorbidities. Conclusions The presentation is to generate awareness that hemorrhage could be a presentation, in the early second week, after LC. A common cause to be considered is a pseudo aneurysmal bleed. Secondary hemorrhage and other rare coincidental unassociated conditions could also be responsible for the hemorrhage. A high index of suspicion, and early and timely management are keys to a successful outcome.
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Affiliation(s)
- Rajeev Sinha
- Department of General and Laparoscopic Surgery, MLB Medical College, Jhansi, India. (Dr. Sinha)
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India. (Dr. Gupta)
| | - Arun Gupta
- Department of General and Laparoscopic Surgery, MLB Medical College, Jhansi, India. (Dr. Sinha)
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India. (Dr. Gupta)
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Vasiliadis K, Simou C, Tzotzou A, Kalinderis N, Valoukas D, Pazarli E, Drakontaidis P, Papavasiliou C. Successful surgical management of massive hemoretroperitoneum caused by spontaneous rupture of retroperitoneal lymph node metastases in a patient with advanced mixed germ cell tumor: a COVID-19 pandemic-related surgical challenge. Surg Case Rep 2023; 9:18. [PMID: 36740640 PMCID: PMC9899871 DOI: 10.1186/s40792-023-01593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/19/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Spontaneous rapture of a germ cell tumor (GCT) metastases causing massive hemoretroperitoneum in a patient without choriocarcinoma component who has not received previous systemic chemotherapy is an exceedingly rare event. In such a devastating case scenario, a high index of clinical suspicion for early diagnosis and appropriate management is crucial. CASE PRESENTATION We report on a 25-year-old male patient with a 4-month history of orchiectomy for testicular GCT (tGCT), who presented in the emergency department with acute abdomen and hemodynamic instability. Urgent computed tomography scan depicted a retroperitoneal mass measuring approximately 13 × 11.4 × 15 cm and massive intraperitoneal hemorrhage. Hemoperitoneum caused by spontaneous rapture of the metastatic retroperitoneal mass was suspected. COVID-19 pandemic-related deviation from the oncologic surveillance standards combined with COVID-19-related patient's emotional distress and self-neglect had led to loss of opportunity for appropriate adjuvant chemotherapy, obviously leading to the development of this devastating complication. An emergency, surgical exploration was decided. The bleeding mass was adequately exposed following a Cattell-Braasch maneuver and active bleeding was controlled by a challenging resection of approximately 80% of the lymph node mass volume. Pathological evaluation of the specimen revealed teratoma with low volume of yolk sac tumor component and extensive necrosis, findings compatible with the patient's history. Postoperative recovery was uneventful, followed by early start of adjuvant chemotherapy. Two years after the operation the patient is doing well with no evidence of recurrent disease. CONCLUSIONS Massive hemoperitoneum is a devastating event that exceedingly rarely can complicate the clinical course of patients with advanced tGCT. Emergency surgical intervention is usually necessary however, sound judgement and careful surgical techniques are required for a positive and uneventful outcome. During COVID-19 pandemic, first-line medical personnel push their limits further not only to ensure health care services standards but also, to manage unpredictable, life-threatening cancer-related complications, associated with COVID-19-related deviation from appropriate oncologic surveillance and care.
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Affiliation(s)
- Konstantinos Vasiliadis
- grid.417144.3Surgical Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Chrysanthi Simou
- grid.417144.3Surgical Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tzotzou
- grid.417144.3Surgical Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Kalinderis
- grid.4793.900000001094570052Nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Valoukas
- grid.4793.90000000109457005Department of Medical Oncology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elsa Pazarli
- grid.417144.3Department of Pathology, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Paulos Drakontaidis
- grid.417144.3Radiology Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Christos Papavasiliou
- grid.417144.3Surgical Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
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Zachomitros F, Tsakiridis I, Peitsidis N, Michos G, Dagklis T, Kalogiannidis I. Hemoperitoneum due to spontaneous bleeding from a smooth muscle tumor of uncertain malignant potential: A rare case report. Int J Surg Case Rep 2023; 103:107910. [PMID: 36736227 PMCID: PMC9925965 DOI: 10.1016/j.ijscr.2023.107910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/29/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Smooth muscle tumors of uncertain malignant potential (STUMPs) are uncommon tumors representing an extremely rare cause of hemoperitoneum. CASE PRESENTATION We report a case of a 48-year-old Caucasian, premenopausal woman that presented in the emergency department with acute abdominal pain. There was no remarkable past medical and surgical history except from a known uterine leiomyoma. The ultrasound and the computed tomography imaging showed an intraperitoneal fluid collection and a heterogenous uterine mass. The patient underwent emergent exploratory laparotomy; a subserosal uterine tumor was identified with an actively bleeding vessel on its surface. The uterine lesion was completely excised and the histopathology set the diagnosis of a STUMP. After consultation on the significance of this finding with the patient, an abdominal total hysterectomy and bilateral salpingo-oophorectomy were scheduled and performed and the subsequent histopathology detected no malignancy. CLINICAL DISCUSSION This case demonstrates that a STUMP may be a rare cause of acute intraperitoneal bleeding. Careful evaluation of clinical history, imaging findings and, if needed, surgical exploration are important for the diagnosis, while appropriate follow-up is also of major importance for the management of these rare tumors. CONCLUSION We presented an extremely rare case of hemoperitoneum due to spontaneous bleeding from a STUMP. From an oncological perspective, this case poses a diagnostic, management and follow-up challenge.
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Affiliation(s)
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece.
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19
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Sharon NZ, Shiber Y, Vaknin Z, Betser M, Copel L, Maymon R. Endometriosis and pregnancy: a complication to be aware of. Arch Gynecol Obstet 2023; 307:71-72. [PMID: 35569062 DOI: 10.1007/s00404-022-06592-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/22/2022] [Indexed: 02/02/2023]
Affiliation(s)
| | - Yair Shiber
- Shamir Medical Center, Shamir Medical Center Assaf Harofeh, Beer Yaakov, Israel
| | - Zvi Vaknin
- Shamir Medical Center, Shamir Medical Center Assaf Harofeh, Beer Yaakov, Israel
| | - Moshe Betser
- Shamir Medical Center, Shamir Medical Center Assaf Harofeh, Beer Yaakov, Israel
| | - Laurian Copel
- Shamir Medical Center, Shamir Medical Center Assaf Harofeh, Beer Yaakov, Israel
| | - Ron Maymon
- Shamir Medical Center, Shamir Medical Center Assaf Harofeh, Beer Yaakov, Israel
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20
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Schultz C, Huberlant S, Letouzey V, Moranne O. Hemoperitoneum complicating an oocyte puncture in a chronic hemodialysis patient. J Nephrol 2022; 35:2433-5. [PMID: 35239174 DOI: 10.1007/s40620-022-01270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/01/2022] [Indexed: 10/18/2022]
Abstract
We report the case of a 31-year-old patient on chronic hemodialysis for 17 years, after two failed kidney grafts, presently on daily home hemodialysis. She underwent follicle puncture for oocyte retrieval in the context of an in vitro fertilization program. This procedure was complicated by hemoperitoneum, requiring transfusion of 2 units of packed red blood cells and 2 units of fresh-frozen plasma, as well as an emergency laparoscopy to drain the hemoperitoneum and perform local hemostasis of the ovarian bleeding. This complication occurred following the patient's routine hemodialysis session, performed with the usual systemic anticoagulation with unfractionated heparin. The evolution was favorable and there was no recurrence of bleeding or sequelae. A later hematology workup did not reveal any pathology of hemostasis that might have favored bleeding. This case may underline how, even though assisted reproductive procedures are increasingly performed in patients on dialysis, special care should be taken when these procedures are performed in this fragile population.
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21
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Xie X, Jiang S. Corpus luteum hemorrhage with acquired hemophilia A: a case report and literature review. BMC Womens Health 2022; 22:418. [PMID: 36221134 DOI: 10.1186/s12905-022-02000-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Background The rupture of the corpus luteum (CL) may occur at all stages of a woman’s reproductive life. Bleeding of the ruptured CL varies from self-limiting hemorrhage to massive hemoperitoneum, causing the shock and subsequent emergency surgery. But hemoperitoneum secondary to ruptured CL is a rare complication and situation for women with bleeding disorders. Case presentation We here describe a case of severe CL hemorrhage with factor VIII deficiency. We chose conservative management instead of surgery for the abnormal hemostatic condition. With blood product and factor concentrate support, conservative management was successful in avoiding surgery in the episode of bleeding. Conclusion Gynecologist should be alert for the patients with abnormal hemostatic condition. Selective patients presenting with CL hemoperitoneum association with bleeding disorders may undergo conservative management and avoid the risk of surgery.
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22
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Nayak D, Thangavel A, Sagili H. Spontaneous Hemoperitoneum in Third Trimester of Pregnancy-an Enigma. J Obstet Gynaecol India 2022; 72:449-453. [PMID: 36458069 PMCID: PMC9568628 DOI: 10.1007/s13224-021-01522-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022] Open
Abstract
Spontaneous hemoperitoneum in pregnancy is a rare and challenging obstetric emergency. It can present as acute abdomen with features of hypovolemic shock and requires high index of suspicion for diagnosis as various obstetric and non-obstetric causes have similar presenting features. Here we present a case of primigravida at 33 weeks of gestation who presented with acute abdomen, signs of shock and a pathological trace on cardiotocogram. She underwent laparotomy and cesarean section in view of suspicion of abruption placentae. Intraoperatively there was hemoperitoneum of 600 ml with 750 g clots and a small venous bleeder on the posterior surface of the uterus which was secured with hemostatic sutures. Patient got discharged along with the baby on seventh postoperative day. Timely intervention is paramount in reducing maternal morbidity and mortality.
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Affiliation(s)
- Deepthi Nayak
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
| | - Arthi Thangavel
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
| | - Haritha Sagili
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006 India
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Masuda H, Gill AJ, Samra JS. A Rare Cause of Hemoperitoneum. Gastroenterology 2022; 163:e8-e10. [PMID: 35248540 DOI: 10.1053/j.gastro.2022.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Hiro Masuda
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - Anthony J Gill
- Northern Clinical School, University of Sydney, Sydney, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia; Northern Clinical School, University of Sydney, Sydney, Australia
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Golfier F, Pleynet L, Bolze PA. Spontaneous hemoperitoneum in pregnancy: a life-threatening maternal and fetal complication of endometriosis. J Gynecol Obstet Hum Reprod 2022; 51:102415. [PMID: 35667589 DOI: 10.1016/j.jogoh.2022.102415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 04/28/2022] [Accepted: 05/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spontaneous hemoperitoneum in pregnancy (SHiP) is a complication of endometriosis. We describe the clinical characteristics and outcomes of mother and fetus in 11 new cases of SHiP with endometriosis and 43 cases reported in the literature since 1995. MATERIAL AND METHODS The 60 maternity hospitals in the Auvergne-Rhône-Alpes region in France were contacted to identify cases of SHiP associated with endometriosis. . In parallel, a systematic review of the literature used the PRISMA chart to report published cases. RESULTS Fifty-four cases of SHIP associated with endometriosis are presented. Twenty-four patients (44%) conceived with assisted reproductive techniques. Hemoperitoneum occurred before delivery in 47/54 cases (87%).The average gestational age of occurrence was 27 weeks (13 weeks to 40+6 weeks). An hypovolemic shock was present in 24/51 (47%) of patients. Forty-six women (85%) were treated by laparotomy, 5 (9%) by laparoscopy, 2 (2%) by interventional radiology. The hemorrhage site was in the mediolateral compartment of the pelvis in 29 cases (54%), corresponding to bleeding from vessels in the broad ligament in 24/29 (83%) of these cases. The mean estimated blood loss was 1957 mL (150-7500 mL). Emergency peripartum hysterectomy was required in 3/54 cases (6%). There were no maternal deaths. The average gestational age at birth was 30 weeks (13+2 weeks to 42 weeks). The fetus died in 19/64 cases (30%). CONCLUSION SHiP is an underestimated potentially fatal complication of endometriosis. Maternal salvage by emergency laparotomy is usually required to identify and treat the bleeding site. Fetal prognosis remains poor.
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Affiliation(s)
- François Golfier
- Service de gynécologie-obstétrique, hospices civils de Lyon, centre hospitalo-universitaire de Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| | - Léa Pleynet
- Faculté de médecine et de maïeutique Lyon Sud - Charles Mérieux. Université Claude Bernard-Lyon 1
| | - Pierre-Adrien Bolze
- Service de gynécologie-obstétrique, hospices civils de Lyon, centre hospitalo-universitaire de Lyon-Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
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Godbe J, Horowitz JM, Nguyen E, Catania R, Gabriel H, Borhani AA, Watters A, Mazur SL, Uko II, Miller FH, Kelahan LC. Association of CT findings in patients with hemoperitoneum due to ruptured ovarian cysts with subsequent intervention. Emerg Radiol 2022; 29:833-843. [PMID: 35639185 DOI: 10.1007/s10140-022-02062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Hemoperitoneum caused by ovarian cyst rupture may necessitate intervention. The literature is lacking in descriptions of CT findings that help guide patient management. The purpose of this study is to consider CT findings associated with a need for intervention (surgical or interventional radiology management) versus conservative treatment (observation, pain management, and blood transfusions). METHODS Two radiologists retrospectively and independently reviewed 103 CTs of pre-menopausal women who presented with acute hemoperitoneum related to ruptured ovarian cysts between January 2010 and January 2019. The following imaging features were assessed: ovarian cyst characteristics, sentinel clot, contrast extravasation, and hemoperitoneum size. Findings were correlated with patient demographics, clinical parameters, and management with surgery/interventional radiology procedure (intervention group) versus conservative management (conservative group). RESULTS Of the 103 patients with hemoperitoneum from cyst rupture, 16% (n = 16) required intervention, and 84% underwent conservative treatment (n = 87). Length of stay (p = .008) was higher in the intervention group. Statistically significant CT findings in the intervention versus conservative group included (p-value reader 1/p-value reader 2) greatest AP dimension of hemoperitoneum (p = .001/p = 0.02), posterior cul-de-sac AP dimension (p = 0.03/p = .006), total cul-de-sac AP dimension (p = .002/p = .007), and number of spaces with hemoperitoneum (p = .01/p = .02). There was good to excellent inter-reader agreement for these findings (ICC 0.68-0.91). Active contrast extravasation was significant for one reader (p = .02) with poor inter-reader agreement (ICC 0.36). In utilizing ROC curves, thresholds of 107 mm (greatest axial AP dimension of hemoperitoneum) yielded a sensitivity and specificity of 0.81 and 0.62 for reader 1 and 0.69 and 0.55 for reader 2; 45 mm (posterior cul-de-sac AP dimension) yielded a sensitivity and specificity of 0.75 and 0.63 for reader 1 and 0.94 and 0.49 for reader 2; 70 mm (total cul-de-sac AP dimension) yielded a sensitivity and specificity of 0.75 and 0.64 for reader 1 and 0.75 and 0.50 for reader 2; and greater than 5 spaces yielded a sensitivity and specificity of 0.75 and 0.58 for reader 1 and 0.69 and 0.70 for reader 2. CONCLUSION CT findings associated with intervention in hemoperitoneum due to ovarian cyst rupture include size of hemoperitoneum, number of abdominopelvic spaces with hemoperitoneum, and contrast extravasation.
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Affiliation(s)
- Jacqueline Godbe
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Edward Nguyen
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Roberta Catania
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Helena Gabriel
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Amir A Borhani
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Amber Watters
- Department of Obstetrics & Gynecology, Northwestern University, Chicago, IL, USA
| | - Stephany L Mazur
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Imo I Uko
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Linda C Kelahan
- Department of Radiology, Northwestern University, Chicago, IL, USA.
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Young H, Bui TL, Cramer SE, O'Connell R, Houshyar R. Ruptured endometrioma in a nonpregnant patient: a case report. J Med Case Rep 2022; 16:161. [PMID: 35459195 PMCID: PMC9034528 DOI: 10.1186/s13256-022-03361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Endometriomas are a type of ovarian cyst composed of degenerated blood products from hemorrhage of ectopic endometrial tissue. Endometriomas can rupture, causing hemoperitoneum, and present with signs and symptoms similar to other, more common abdominal emergencies. Therefore, they are not often diagnosed preoperatively. Ultrasound and cross-sectional imaging can assist in diagnosis of endometriomas. We present a case of ruptured endometrioma causing massive hemoperitoneum that was initially suspected to represent malignancy with carcinomatosis. Case presentation A 32-year-old Hispanic woman presented with sharp abdominal pain and 15-pound unintentional weight loss over 6 months. Laboratory work was significant for a negative pregnancy test and elevated cancer antigen-125. Computed tomography of the abdomen and pelvis demonstrated a 13-cm complex cystic mass in the left adnexa with moderate hyperdense ascites and omental nodularity. Ultrasound demonstrated a large left adnexal complex cystic structure with internal echoes, and chest computed tomography showed no signs of intrathoracic neoplastic or infectious processes. Her presentation was concerning for malignancy with carcinomatosis. Fluid from a paracentesis was sent for culture and cytology. Diagnostic laparoscopy revealed that the left ovary had been completely replaced by an endometrioma, which had a small ruptured area superiorly. Brown deposits of endometriosis were present on the cyst, omentum, and various peritoneal linings. Tissue samples of the endometrium, myometrium, cervix, ovaries, fallopian tubes, peritoneum, omentum, and paracolic spaces were taken and showed no hyperplastic, dysplastic, or malignant cells on pathology. Conclusions Ruptured endometrioma and ruptured hemorrhagic cyst should be included in the differential diagnosis when a premenopausal female presents with hemoperitoneum in combination with complex adnexal cystic masses in the absence of trauma. Cancer antigen-125 and cancer antigen 19-9 can be falsely elevated in the setting of ruptured endometrioma.
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Affiliation(s)
- Hayley Young
- Department of Radiological Sciences, University of California Irvine, 101 The City Dr S Building 55, Box 140, Orange, CA, 92868, USA
| | - Thanh-Lan Bui
- Department of Radiological Sciences, University of California Irvine, 101 The City Dr S Building 55, Box 140, Orange, CA, 92868, USA
| | - Scott E Cramer
- Department of Radiological Sciences, University of California Irvine, 101 The City Dr S Building 55, Box 140, Orange, CA, 92868, USA
| | - Ryan O'Connell
- Department of Pathology, University of California Irvine, 101 The City Dr S Building 1, Rm 3003, Orange, CA, 92868, USA
| | - Roozbeh Houshyar
- Department of Radiological Sciences, University of California Irvine, 101 The City Dr S Building 55, Box 140, Orange, CA, 92868, USA.
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Yu WS, Chang MH, Lee HL, Lee YT, Tsai MC, Wang CC. Recurrent umbilical varix rupture with hemoperitoneum: a case report and review of literature. BMC Gastroenterol 2022; 22:160. [PMID: 35365084 PMCID: PMC8973573 DOI: 10.1186/s12876-022-02167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Non-traumatic hemoperitoneum was a rare event with the risk of sudden death. Spontaneous rupture of hepatocellular carcinoma is the most intuitive diagnosis when hemoperitoneum occurs in cirrhotic patients who are not regularly followed up. However, other etiologies of hemoperitoneum, such as intra-abdominal varix rupture, should be kept in mind.
Case presentation A 44-year-old man with alcoholic liver cirrhosis, Child–Pugh B was sent to our emergency department (ED) because of recurrent abdominal pain and hypovolemic shock. He had similar symptoms one month ago and was diagnosed as hepatocellular carcinoma (HCC) rupture with hemoperitoneum, therefore he underwent trans-arterial embolization (TAE). However, the follow-up magnetic resonance imaging (MRI) showed less possibility of hepatocellular carcinoma. Contrast enhanced abdominal computed tomography (CT) showed possible umbilical vein contrast agent extravasation. Exploratory laparotomy confirmed the diagnosis of rupture umbilical varix with hemoperitoneum. Conclusion Although umbilical varix rupture is a rare cause of hemoperitoneum, it should be kept in mind in cirrhotic patients with unexplained hemoperitoneum. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02167-3.
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Affiliation(s)
- W S Yu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - M H Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - H L Lee
- Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Y T Lee
- Infection Control, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - M C Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - C C Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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Brisinda G, Chiarello MM, Crocco A, Adams NJ, Fransvea P, Vanella S. Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer: A retrospective cohort study. World J Gastroenterol 2022; 28:381-398. [PMID: 35110956 PMCID: PMC8771610 DOI: 10.3748/wjg.v28.i3.381] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/09/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgery for gastric cancer is a complex procedure and lymphadenectomy is often mandatory. Postoperative mortality and morbidity after curative gastric cancer surgery is not insignificant.
AIM To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric cancer.
METHODS A retrospective analysis of clinical data and pathological characteristics (age, sex, primary site of the tumor, Lauren histotype, number of positive lymph nodes resected, number of negative lymph nodes resected, and depth of invasion as defined by the standard nomenclature) was conducted in patients with gastric cancer. For each patient we calculated the Kattan’s score. We arbitrarily divided the study population of patients into two groups based on the nomogram score (< 100 points or ≥ 100 points). Prespecified subgroups in these analyses were defined according to age (≤ 65 years or > 65 years), and number of lymph nodes retrieved (≤ 35 lymph nodes or > 35 lymph nodes). Uni- and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and morbidity.
RESULTS One-hundred and eighty-six patients underwent a curative R0 resection with D2 lymphadenectomy. Perioperative mortality rate was 3.8% (7 patients); a higher mortality rate was observed in patients aged > 65 years (P = 0.002) and in N+ patients (P = 0.04). Following univariate analysis, mortality was related to a Kattan’s score ≥ 100 points (P = 0.04) and the presence of advanced gastric cancer (P = 0.03). Morbidity rate was 21.0% (40 patients). Surgical complications were observed in 17 patients (9.1%). A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested (P = 0.0005).
CONCLUSION Mortality and morbidity rate are higher in N+ and advanced gastric cancer patients. The removal of more than 35 lymph nodes does not lead to an increase in mortality.
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Affiliation(s)
- Giuseppe Brisinda
- Abdominal Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Michela Chiarello
- General Surgery Operative Unit, Azienda Sanitaria Provinciale di Crotone, Ospedale San Giovanni di Dio, Crotone 88900, Italy
| | - Anna Crocco
- Endocrine Surgery Operative Unit, Istituto Nazionale Tumori, IRCCS Fondazione Pascale, Napoli 80100, Italy
| | - Neill James Adams
- Health Sciences, Clinical Microbiology Unit, Magna Grecia University, Catanzaro 88100, Italy
| | - Pietro Fransvea
- Department of Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Serafino Vanella
- Department of General and Oncological Surgery, Azienda Ospedaliera San Giuseppe Moscati, Avellino 83100, Italy
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Gomez E, Horton K, Fishman EK, Johnson PT. CT of acute abdominopelvic hemorrhage: protocols, pearls, and pitfalls. Abdom Radiol (NY) 2022; 47:475-84. [PMID: 34731281 DOI: 10.1007/s00261-021-03336-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
Abdominal and pelvic hemorrhage may be secondary to a number of causes and is often a medical emergency. Patient presentation ranges from obvious trauma with evidence of hemodynamic instability to vague symptoms. CT has become the imaging modality of choice for identifying abdominopelvic hemorrhage. Recognizing acute hemorrhage as well as identifying its location and severity are key to expediting management. In the Emergency Department, ultrasound often used in the initial evaluation of trauma patients, but is not sensitive for subtle bleeds or injuries. CT is the best first-line imaging tool to identify abdominal hemorrhage and, compared with angiography, has been shown to be superior in detecting intra-abdominal bleeding, especially when the bleeding rate is low. Depending on location and etiology, abdominopelvic hemorrhage may have a characteristic appearance, such as the "sentinel clot" sign associated with blunt trauma to the solid organs or the "triangle sign" of a mesenteric bleed. The following pictorial essay reviews CT technique, study interpretation, and interpretative pearls and pitfalls in the recognition of acute abdominopelvic hemorrhage.
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Dryer EA, Abaza M, Almehmi A. Inferior epigastric artery injury after percutaneous imaging-guided peritoneal dialysis catheter placement. Radiol Case Rep 2021; 17:332-335. [PMID: 34876960 PMCID: PMC8633519 DOI: 10.1016/j.radcr.2021.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/24/2021] [Indexed: 11/30/2022] Open
Abstract
Inferior epigastric artery (IEA) injury is a rare clinical entity that is usually associated with abdominal wall procedures and injuries though can also be spontaneous, particularly in individuals with coagulopathy. Of all described mechanisms of injury, percutaneous peritoneal dialysis (PD) catheter insertion is a rarely encountered, particularly in instances where insertion is performed under imaging guidance. While this injury is self-limited, it can be associated with hemodynamic instability and acute blood loss anemia, which can be fatal if left untreated. Computed tomographic (CT) angiography is the diagnostic method of choice. Transcatheter arterial embolization is an effective treatment modality with a high success rate. Here, we describe a 41-year-old female who underwent percutaneous PD catheter insertion that, despite intraprocedural imaging guidance, was complicated by large hemoperitoneum and clinical instability. Prompt identification of IEA injury followed by immediate intervention with coil embolization led to a successful outcome for this patient in the setting of a life-threatening uncommon complication of such procedure. The details of the diagnostic evaluation and management are outlined.
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Affiliation(s)
- Emily A Dryer
- University of Alabama at Birmingham, Dept. of Medicine, Division of Nephrology, Birmingham, AL
| | - Masa Abaza
- University of Alaska at Anchorage, Dept. of Biology, Anchorage, AL
| | - Ammar Almehmi
- University of Alabama at Birmingham, Dept. of Radiology and Medicine, 619 19th Street South, Birmingham, AL 35294
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31
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Santoyo-Villalba J, Triguero-Cabrera J, García-Jiménez A. Acute abdomen secondary to massive bleeding due to rupture of liver metastases of a gastrointestinal stroma tumor. CIR CIR 2021; 89:93-96. [PMID: 34762635 DOI: 10.24875/ciru.20001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hemoperitoneum secondary to non-traumatic liver rupture is a rare cause of an acute abdomen. We present the case of a patient with a hepatic rupture secondary to metastasis of a gastrointestinal stromal tumor (GIST) who required an emergent laparotomy due to hemodynamic instability. Intraoperatively, a lesion of more than 20cm dependent on the posterior gastric wall and a hemoperitoneum secondary to rupture of liver metastases and decapsulation of the Glisson capsule was evidenced. A frequent complication of GIST tumors is its rupture causing gastrointestinal bleeding or hemoperitoneum, as occurred in our case.
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Affiliation(s)
- Julio Santoyo-Villalba
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Jennifer Triguero-Cabrera
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Alejandro García-Jiménez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de las Nieves, Granada, España
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Zeinalpour A, Aghili A, Gholizadeh B. Abdominal apoplexy due to rupture of inferior pancreaticoduodenal artery: A rare case of acute abdomen. Caspian J Intern Med 2021; 12:S479-S481. [PMID: 34760110 PMCID: PMC8559655 DOI: 10.22088/cjim.12.0.479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/10/2021] [Accepted: 01/18/2021] [Indexed: 10/31/2022]
Abstract
Background Abdominal apoplexy is one of the rare causes of non-traumatic intra-abdominal bleeding. This condition is usually seen in male patients in their 50s with history of hypertension. As soon as abdominal apoplexy is suspected, immediate resuscitation should be performed followed by emergent surgery. The patient's outcome depends entirely on the clinical condition and the time interval between diagnosis and treatment. Case Presentation Herein we present a 63-year-old man with idiopathic spontaneous intraperitoneal hemorrhage (ISIH) caused by spontaneous rupture of non-aneurysmal inferior pancreaticoduodenalartery (IPDA). Conclusion In this report, a case of abdominal apoplexy has been presented caused by spontaneous rupture of non-aneurysmal inferior pancreaticoduodenalartery (IPDA) in a patient without any significant past medical history.
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Affiliation(s)
- Adel Zeinalpour
- Department of General Surgery , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Amirhossein Aghili
- Department of General Surgery , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Barmak Gholizadeh
- Department of General Surgery , Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Liu N, Roth KR, Nesbit DA, Giordano JR, Stirparo JJ, Miller AH. Hemoperitoneum identified by focused assessment with sonography for trauma following cardiopulmonary resuscitation. Radiol Case Rep 2021; 16:3987-3989. [PMID: 34729130 PMCID: PMC8545660 DOI: 10.1016/j.radcr.2021.09.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 01/03/2023] Open
Abstract
It is generally recognized that lives are saved by administering high-quality cardiopulmonary resuscitation (CPR) to patients in cardiac arrest. A focused assessment with sonography for trauma (FAST) examination is an effective and non-invasive method for detecting rare complications of CPR, such as hemorrhage from abdominal visceral injury. We report the case of a 56-year-old female suffering from intra-abdominal hemorrhage caused by a liver laceration following CPR. The hemoperitoneum was diagnosed by a FAST examination. Although severe complications of CPR are rare, they can be easily detected with the use of a FAST examination. A FAST examination should be considered as a post-resuscitation approach to assess for life-threatening complications in all patients following cardiopulmonary resuscitation.
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Affiliation(s)
- Nina Liu
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA
| | - Kevin R. Roth
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA
- Corresponding author.
| | - Danielle A. Nesbit
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA
| | - Justin R. Giordano
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA
| | - Joseph J. Stirparo
- Lehigh Valley Health Network, Department of Surgery/USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA
| | - Andrew H. Miller
- Lehigh Valley Health Network, Department of Emergency and Hospital Medicine/USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA
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Adwan D, Taifour W, Bhsass R, Taifour D. Fundal partial placenta percreta complicated with postpartum hemoperitoneum: A case report. Int J Surg Case Rep 2021; 88:106482. [PMID: 34653894 PMCID: PMC8522481 DOI: 10.1016/j.ijscr.2021.106482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The fundus of the uterus is a rare location for abnormally invasive placenta compared with the common site of abnormally invasive placenta in the lower segment of the uterus. PRESENTATION OF CASE We report a case of a 38-year-old multipara woman who had a fundal partial placenta percreta with no prior cesarean sections, which presented as a retained placenta after preterm labor, and complicated with hemorrhagic shock due to postpartum hemoperitoneum, thus it was diagnosed after surgery and managed by subtotal hysterectomy. DISCUSSION We discuss the most common risk factors for abnormally invasive placenta and its diagnosis and management. We compare the possibility of leading to invasive placenta resulting from curettage trauma and cesarean delivery scars. CONCLUSION History of uterine surgical procedures without prior cesarean delivery must raise suspicion of abnormally invasive placenta regardless of its localization, especially when associates with preterm labor or retained placenta.
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Affiliation(s)
- Dema Adwan
- Damascus University, Gynecology and Obstetrics Hospital, Damascus, Syria
| | - Wessam Taifour
- Damascus University, Gynecology and Obstetrics Hospital, Damascus, Syria.
| | - Rafat Bhsass
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Danny Taifour
- Faculty of Medicine, Damascus University, Damascus, Syria
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Alessia S, Flavia I, Vittoria C, Cosetta M, Raffaella C, Francesco C, Maria N, Gianfranco M, Fabio B. Idiopathic neonatal hemoperitoneum presented as scrotal hematoma: it's a diagnostic challenge? Ital J Pediatr 2021; 47:207. [PMID: 34641915 PMCID: PMC8507181 DOI: 10.1186/s13052-021-01161-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background Idiopathic hemoperitoneum in the newborn is an entity very rarely encountered in clinical practice. Case presentation A case of scrotal hemorrhage (SH) associated with intrabdominal hemorrhaging and acute anemia is presented. Indications for early surgery included a massive scrotal hematoma, rapid onset of severe anemia, and unknown etiology. Conclusion Clinical and diagnostic approaches in a case of neonatal scrotal hematoma should be given careful consideration as abdominal in origin, and a pre-operative computed tomography (CT) scan or magnetic resonance image (MRI) in addition to an abdominal/scrotal ultrasound should be added as part of the diagnostic work-up.
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Affiliation(s)
- Salatto Alessia
- Department of Medical and Surgical Science University of Foggia, Pediatric Surgery Ospedali Riuniti Foggia, Foggia, Italy
| | - Indrio Flavia
- Department of Medical and Surgical Science University of Foggia, Pediatric Surgery Ospedali Riuniti Foggia, Foggia, Italy.
| | - Campanella Vittoria
- Department of Medical and Surgical Science University of Foggia, Pediatric Surgery Ospedali Riuniti Foggia, Foggia, Italy
| | - Maggipinto Cosetta
- Department of Medical and Surgical Science University of Foggia, Pediatric Surgery Ospedali Riuniti Foggia, Foggia, Italy
| | | | - Canale Francesco
- Department of Pediatric Surgery, AUO "Ospedali Riuniti", Foggia, Italy
| | - Nobili Maria
- Department of Pediatric Surgery, AUO "Ospedali Riuniti", Foggia, Italy
| | | | - Bartoli Fabio
- Department of Medical and Surgical Science University of Foggia, Pediatric Surgery Ospedali Riuniti Foggia, Foggia, Italy
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Valenta J, Stach Z, Vagenknechtová E, Hoskovec D. Splenic Rupture and Massive Hemoperitoneum Due to Coagulopathy after Atheris Viper Snakebite. Prague Med Rep 2021; 122:216-221. [PMID: 34606434 DOI: 10.14712/23362936.2021.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Coagulopathy with defibrination is one of symptoms accompanying snakebite envenoming, where life-threatening complications such as massive bleeding and organ hematomas formation can occur. Here, we report a case of hemocoagulation failure due to bite by African Great Lakes bush viper Atheris nitschei with impossibility of specific treatment for absence of antivenom and its life-threatening complication: very rare and unexpected atraumatic splenic rupture with massive hemoperitoneum and necessity of urgent splenectomy.
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Affiliation(s)
- Jiří Valenta
- Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
| | - Zdeněk Stach
- Department of Anesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Eva Vagenknechtová
- Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - David Hoskovec
- 1st Department of Surgery - Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Thannickal A, Maddy B, DeWitt M, Cliby W, Dow M. Dysfunctional labor and hemoperitoneum secondary to an incidentally discovered dysgerminoma: a case report. BMC Pregnancy Childbirth 2021; 21:611. [PMID: 34493243 PMCID: PMC8424888 DOI: 10.1186/s12884-021-04063-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background Ovarian dysgerminoma, a subtype of malignant germ cell tumor (GCT), is a rare ovarian neoplasm that is infrequently found in the gravid patient. When dysgerminomas do occur in pregnancy, the rapidly growing tumors can have a heterogeneous presentation and lead to peripartum complications and morbidity. Due to the rarity of this condition, diagnostic and therapeutic strategies are not well described in the literature. Case presentation A healthy multigravida with an uncomplicated antenatal history presented for elective induction of labor. She had a protracted labor course, persistently abnormal cervical examinations, and eventually developed a worsening Category II tracing that prompted cesarean birth. Intraoperatively, a 26 cm pelvic mass later identified as a Stage IA dysgerminoma was discovered along with a massive hemoperitoneum. The mass was successfully resected, and the patient remains without recurrence 6 months postoperatively. Conclusion Although rare and generally indolent, dysgerminomas can grow rapidly and cause mechanical obstruction of labor and other complications in pregnancy. Pelvic masses, including malignant neoplasms, should be included in as part of a broad differential diagnosis when evaluating even routine intrapartum complications such as abnormal labor progression. Additionally, we demonstrate that adnexal masses can be a source of life-threatening intraabdominal hemorrhage.
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Affiliation(s)
- Aneesa Thannickal
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Brandon Maddy
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Marla DeWitt
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - William Cliby
- Division of Gynecology Oncology, Mayo Clinic, Rochester, MN, USA
| | - Margaret Dow
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
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Cheng YT, Teng W, Lui KW, Hsieh YC, Chen WT, Huang CH, Jeng WJ, Hung CF, Lin CC, Lin CY, Lin SM, Sheen IS. MELD score is the better predictor for 30-day mortality in patients with ruptured hepatocellular carcinoma treated by trans-arterial embolization. Am J Cancer Res 2021; 11:3726-3734. [PMID: 34354871 PMCID: PMC8332870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/13/2021] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND AND AIMS Spontaneous hepatocellular carcinoma (HCC) rupture is a catastrophic life-threatening complication that could be rescued by trans-arterial embolization (TAE). However, deteriorated liver function with total bilirubin more than 3 mg/dL was deemed as a relative contraindication. This study was aimed to re-evaluate this relative contraindication. METHODS Patients with ruptured HCC and treated by TAE between February 2005 and December 2016 in Chang Gung Memorial Hospital, Linkou branch were recruited. Pre-TAE characteristics including age, gender, etiology, liver biochemistry, Child-Pugh classification, Model for End-Stage Liver Disease (MELD) score, the presence of shock, tumor staging and post TAE liver function were compared between patients with and without post-TAE 30-day mortality. RESULTS A total of 186 patients were enrolled. The successful hemostatic rate after embolization was 91.4% and the median overall survival was 224 days. The 30-day cumulative mortality rate is 20.4%. By multivariate logistic regression analysis, male [aOR: 0.25, P=0.034] MELD score [aOR: 13.61, P<0.001], tumor size [aOR: 1.21, P=0.023] are the independent predictors for 30-day mortality. MELD score has better predictability of post-TAE 30-day mortality than total bilirubin level (AUROC: 0.818 vs. 0.668). The cut-off points of MELD score 13 has higher negative predictive value of 95% for post-TAE 30-day mortality. CONCLUSION TAE is effective for the initial hemostasis in patients with HCC rupture. MELD score ≥13 rather than only total bilirubin level >3 mg/dL be more predictive of post TAE 30-day mortality.
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Affiliation(s)
- Ya-Ting Cheng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Wei Teng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Kar-Wai Lui
- Department of Medical Imaging and Intervention, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Yi-Chung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Wei-Ting Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Chien-Hao Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Chien-Fu Hung
- Department of Medical Imaging and Intervention, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - Shi-Ming Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
| | - I-Shyan Sheen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial HospitalLinkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung UniversityTaoyuan, Taiwan
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Honmyo N, Kohashi T, Hakoda K, Oishi K, Nakashima A, Shintakuya R, Hihara J. Spontaneous rupture of the umbilical vein associated with liver cirrhosis: A case report. Int J Surg Case Rep 2021; 85:106183. [PMID: 34252642 PMCID: PMC8369298 DOI: 10.1016/j.ijscr.2021.106183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction A decompensated cirrhosis sometimes develops collateral circulation due to severe fibrosis. Rupture of this collateral circulation can induce a fatal situation. Case presentation A 59-year-old man with alcoholic cirrhosis was admitted to our emergency department with a chief complaint of impaired consciousness. The patient had hypotension upon arrival, and enhanced computed tomography (CT) revealed a massive hemoperitoneum. Imaging examinations, including interventional radiography, could not identify the source of bleeding preoperatively; therefore, emergency surgery was performed. Intraoperatively, a collapsed small vessel connecting liver segment 4 and the expanded umbilical vein as collateral circulation due to portal hypertension was detected as the source of bleeding. Ligating the stump of the small vessel and postoperative intensive care saved the patient's life. The patient was discharged from our hospital 14 days after the surgery. Clinical discussion A rupture of the umbilical vein associated with cirrhosis is rare and causes a critical situation because of the fast blood flow in the collateral circulation caused by portal hypertension. Moreover, the amount of bleeding tends to increase since the abdominal cavity is a free space and patients with cirrhosis have coagulopathies, including thrombocytopenia and prolonged prothrombin time. Although a retrospective review of the enhanced CT image could identify the minute findings, arterial portography was insufficient to detect bleeding from the umbilical vein. Therefore, emergency exploratory laparotomy was required for the diagnosis and treatment. Conclusion Rupture of the reopened umbilical vein can cause idiopathic spontaneous hemoperitoneum in patients with decompensated cirrhosis. A rupture of the umbilical vein due to cirrhosis can induce fatal hemoperitoneum. Interventional radiology could not detect the source of bleeding. Emergency surgery is required for idiopathic hemoperitoneum in liver cirrhosis.
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Affiliation(s)
- Naruhiko Honmyo
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan.
| | - Toshihiko Kohashi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan; Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Keishi Hakoda
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan
| | - Koichi Oishi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan
| | - Akira Nakashima
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan
| | - Ryuta Shintakuya
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan
| | - Jun Hihara
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima 731-0293, Japan
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Huang H, Takai Y, Samejima K, Gomi Y, Narita T, Ichinose S, Itaya Y, Ono Y, Matsunaga S, Saitoh M, Seki H. Severe hemoperitoneum resulting from restart of letrozole after oocyte retrieval procedure: a case report. J Med Case Rep 2021; 15:327. [PMID: 34174941 PMCID: PMC8236175 DOI: 10.1186/s13256-021-02938-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the field of oncofertility, patients with breast cancer are often administered letrozole as an adjuvant drug before and after oocyte retrieval to prevent an increase in circulating estradiol. CASE PRESENTATION We report a case of abdominal hemorrhage due to an ovarian rupture in a 29-year-old Japanese patient who restarted letrozole 2 days after an oocyte retrieval procedure in which 14 mature oocytes were retrieved. The patient had sought embryo cryopreservation as a fertility preservation option before undergoing treatment for recurrent breast cancer. A day after restarting letrozole treatment, the patient unexpectedly developed severe abdominal pain. Laparoscopic hemostasis was performed to manage the ovarian swelling and hemorrhage. CONCLUSIONS The ovaries can be restimulated by restart letrozole after an oocyte retrieval procedure. Therefore, reproductive-medicine practitioners should understand the potential complications of letrozole administration in such cases and take steps to ensure that they are minimized.
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Affiliation(s)
- Haipeng Huang
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan.
| | - Yasushi Takai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan
| | - Kouki Samejima
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan
| | - Yosuke Gomi
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan
| | - Tatsuya Narita
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan
| | - Shunichiro Ichinose
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan
| | - Yukiko Itaya
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan
| | - Yosihisa Ono
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan
| | - Sigetaka Matsunaga
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan
| | - Masahiro Saitoh
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan
| | - Hiroyuki Seki
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-3550, Japan
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Ozeki Y, Miwa H, Sugimori K, Goda Y, Hirotani A, Sanga K, Tezuka S, Numata K, Sekikawa Z, Maeda S. Hemoperitoneum due to a ruptured right gastroepiploic artery following non-interventional endoscopic ultrasonography: a case report. Clin J Gastroenterol 2021; 14:1371-1375. [PMID: 34143377 DOI: 10.1007/s12328-021-01466-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
Endoscopic ultrasonography has become a routine procedure in clinical practice and is widely accepted as a safe procedure. Previous studies have reported that severe bleeding rarely occurs even when performing fine-needle aspiration biopsy. Severe hemorrhage following non-interventional endoscopic ultrasonography has never been reported. We herein report a case of hemorrhagic shock due to hemoperitoneum caused by a ruptured right gastroepiploic artery consequent to a diagnostic endoscopic ultrasonography. The patient was administered two antithrombotic agents. An extensive diagnostic workup contributed to the correct diagnosis, which led to a successful treatment by transcatheter arterial embolization. Endoscopists should be aware of this rare, but potentially fatal, adverse event of endoscopic ultrasonography.
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Affiliation(s)
- Yuichiro Ozeki
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, 232-0024, Japan.
| | - Haruo Miwa
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, 232-0024, Japan
| | - Kazuya Sugimori
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, 232-0024, Japan
| | - Yoshihiro Goda
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, 232-0024, Japan
| | - Akane Hirotani
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, 232-0024, Japan
| | - Katsuyuki Sanga
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, 232-0024, Japan
| | - Shun Tezuka
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, 232-0024, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama, 232-0024, Japan
| | - Zenjiro Sekikawa
- Department of Radiology, Yokohama City University Medical Center, Yokohama, 232-0024, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, 236-0004, Japan
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Zamani M, Alizadeh S, Mollabashi M. Fertility-sparing uterine lesion resection in a woman with hemoperitoneum due to invasive mole: A rare case report. Int J Surg Case Rep 2021; 84:106117. [PMID: 34167070 PMCID: PMC8239455 DOI: 10.1016/j.ijscr.2021.106117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Gestational trophoblastic neoplasia comprises a unique group of human neoplastic diseases that derive from fetal trophoblastic tissues. The hydatidiform mole is the most common form of GTD, representing 80 % of cases. An invasive mole is a hydatidiform mole characterized by the enlarged hydropic villi invading into the myometrium, into vascular spaces, or into extrauterine sites. Case presentation Here is a case with invasive mole after the evacuation of complete molar pregnancy, presented with an acute abdomen. We desired to preserve the uterine because our 21 years old patient doesn't have a child. Clinical discussion An emergency abdominal ultrasound scan showed a 47 ∗ 34 ∗ 55 mm ill-defined hyperechoic heterogeneous mass with anechoic cystic vascular spaces within it, in the posterior wall of the uterus away from the endometrium that extended to the serous layer of the uterus. Laparotomy was done. After the evacuation of 2 L of hemoperitoneum, an approximately 5 × 4 metastatic, vesicular mass was seen in the posterior wall of the uterus, which was resected and uterine preservation was successful. Conclusion This case report describes the clinical, imaging, surgical and histopathological findings of Invasive mole after a hydatidiform molar pregnancy. Our case highlights the feasibility of fertility-preserving surgery in the case who experienced life-threatening hemorrhage due to a ruptured uterus. An invasive mole rarely presents as hemoperitoneum. Ultrasound scan and color flow Doppler are particularly useful for diagnosis in GTN. Fertility-preserving surgery in life-threatening hemorrhage due to a ruptured uterus is challenging.
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Affiliation(s)
- Mehrangiz Zamani
- Department of Obstetrics & Gynecology, Hamadan University of Medical Science, Hamadan, Iran
| | - Shima Alizadeh
- Obstetrician & Gynecologist, Board Certified at Tehran University of Medical Science, Tehran, Iran
| | - Mina Mollabashi
- Department of Radiology, Hamadan University of Medical Science, Hamadan, Iran.
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Namikawa T, Yokota K, Yamaguchi S, Fukudome I, Munekage M, Uemura S, Maeda H, Kitagawa H, Mibu K, Kobayashi M, Hanazaki K. Spontaneous intra-abdominal hemorrhage of a well-differentiated, grade 3 gastric neuroendocrine tumor during drug-based treatment. Clin J Gastroenterol 2021; 14:1244-1249. [PMID: 33977396 DOI: 10.1007/s12328-021-01433-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/02/2021] [Indexed: 02/08/2023]
Abstract
Grade 3, well-differentiated, gastric neuroendocrine tumors (NET G3) are extremely rare. Herein, we report the case of a 64-year-old man with a grade 3 neuroendocrine tumor of the stomach who experienced intra-abdominal bleeding during the course of drug treatment. The patient was referred to our hospital for examination of a gastric tumor that was initially diagnosed by a local medical doctor. Esophagogastroduodenoscopy revealed an elevated lesion with a central ulcer in the upper body of the stomach, and biopsy specimens confirmed the pathological diagnosis of NET G3. Abdominal contrast-enhanced computed tomography (CT) showed a 25-cm, well-defined mass lesion showing heterogeneous enhancement in the liver. A clinical diagnosis of NET G3 with multiple liver metastases was given, after which everolimus was administered in combination with a somatostatin analogue. However, the patient developed sudden-onset epigastric abdominal pain and general fatigue 2 months later, and emergency abdominal contrast-enhanced CT confirmed the presence of intra-abdominal hemorrhage. Following blood transfusion, the patient's symptoms and general condition improved. Although the patient was treated with streptozocin, abdominal CT indicated progression of the liver metastases. Unfortunately, despite receiving best supportive care, the patient died 8 months after the initial of the treatment. To the best of our knowledge, this is the first case of a patient who developed spontaneous hemoperitoneum during drug treatment for a NET G3 to be reported in the English literature. It is essential that additional data be obtained to determine the optimal treatment for this disease.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sachi Yamaguchi
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Ian Fukudome
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kiyo Mibu
- Nursing Department, Kochi Medical School Hospital, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Choi JH, Liu HJ, Heo SM, Kim SA. Hemoperitoneum Caused by Spontaneous Rupture of Uterine Leiomyoma in a Perimenopausal Woman. J Menopausal Med 2021; 27:42-45. [PMID: 33942589 PMCID: PMC8102813 DOI: 10.6118/jmm.20037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/27/2021] [Accepted: 03/29/2021] [Indexed: 11/05/2022] Open
Abstract
Uterine fibroid, or leiomyoma, is a common benign neoplasm in women, but serious complications are rarely reported. We present the case of a 48-year-old woman with acute onset of abdominal pain. She was hemodynamically unstable, and computed tomography revealed abundant fluid collection in the peritoneal cavity, suggesting hemoperitoneum. During emergency exploratory laparotomy, the subserosal vein overlying a uterine fibroid was identified as the source of bleeding. Hemostasis was accomplished with fibroid excision. Spontaneous hemorrhage originating from a uterine fibroid is extremely rare, but may lead to life-threatening conditions. Therefore, in female patients with acute abdominal pain and hemoperitoneum, uterine fibroid may be a potential etiology and emergency exploratory laparotomy should be considered.
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Affiliation(s)
- Ji Hyun Choi
- Department of Obstetrics and Gynecology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea
| | - Hyun Ju Liu
- Department of Obstetrics and Gynecology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea
| | - Soo Min Heo
- Department of Obstetrics and Gynecology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea
| | - Soo Ah Kim
- Department of Obstetrics and Gynecology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Korea.
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Nawata A, Nakamura A, Taba M, Kosaka S, Kawabe A, Miyata H, Matsuki Y, Tanaka Y, Hisaoka M. Fatal hemoperitoneum due to rupture of mesenteric artery in remission state of microscopic polyangiitis, concomitant with severe hypertension and posterior reversible encephalopathy syndrome: an autopsy case report. CEN Case Rep 2021; 10:549-558. [PMID: 33948871 DOI: 10.1007/s13730-021-00606-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022] Open
Abstract
Microscopic polyangiitis (MPA) is a type of necrotizing vasculitis associated with high levels of myeloperoxidase-specific antineutrophil cytoplasmic antibody (MPO-ANCA). While generally associated with renal dysfunction, MPA can also cause intraabdominal hemorrhage in rare cases. A 66-year-old man was admitted to our hospital for renal dysfunction, numbness, and weight loss for 3 months. He had no significant medical history. Renal biopsy revealed crescentic glomerulonephritis with necrotizing vasculitis, which was associated with a high serum titer of MPO-ANCA, leading to a diagnosis of MPA. Remission-induction treatment with glucocorticoids and rituximab was initiated, which improved the patient's general condition and renal failure. His blood pressure was elevated and was controlled by amlodipine treatment. Two months after discharge, he visited the emergency department because of chest pain. A diagnosis of acute cardiovascular syndrome was suggested; however, his cardiac artery was not stenotic. The patient's blood pressure was high despite antihypertensive therapy, and he developed posterior reversible encephalopathy syndrome (PRES). Despite intensive treatment, the patient died 3 days later. An autopsy revealed that the cause of death was hypovolemic shock due to massive intra-abdominal hemorrhage from the ruptured mesenteric artery involved in vasculitis. In cases of MPA with sudden-onset chest or abdominal pain, a ruptured intra-abdominal artery should be considered. Secondary hypertension associated with vasculitis should be carefully managed to prevent hemorrhagic complications and PRES.
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Affiliation(s)
- Aya Nawata
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan. .,The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | - Ayane Nakamura
- Department of Internal Medicine, Kenwakai Otemachi Hospital, Kitakyushu, Japan
| | - Masanao Taba
- Department of Internal Medicine, Kenwakai Otemachi Hospital, Kitakyushu, Japan
| | - Shumpei Kosaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akio Kawabe
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroko Miyata
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasumasa Matsuki
- Department of Pathology, Kenwakai Otemachi Hospital, Kitakyushu, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
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Park C, Park DE. Ruptured Pancreaticoduodenal Artery Aneurysm with Pancreatitis Treated Using Endovascular and Endoscopic Methods. Korean J Gastroenterol 2021; 77:194-198. [PMID: 33896906 DOI: 10.4166/kjg.2021.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/03/2022]
Abstract
Pancreaticoduodenal artery aneurysm (PDAA) is a rare form of abdominal visceral aneurysm that accounts for approximately 2% of all cases. Most cases of PDAA are associated with celiac artery stenosis (CAS). Regardless of the size, there is a risk of rupture. Therefore, treatment should be performed immediately after discovery, even though the need to treat the accompanying CAS, if present, is controversial. The authors report a case of ruptured PDAA and accompanying pancreatitis treated using endovascular and endoscopic methods without treatment of CAS. A 50-year-old man was admitted to the emergency department of Wonkwang University Hospital with epigastric pain and hypovolemic shock. CT revealed a ruptured PDAA and a large volume hemoperitoneum. Emergency angiography was performed, and angioembolization of the PDAA was performed successfully. Follow-up CT revealed infection and pancreatitis, which were treated by surgical drainage and pancreatic duct stenting with ERCP. Because the degree of stenosis was not severe, it was decided to follow-up the accompanying CAS. After discharge, the patient was followed up without complications.
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Affiliation(s)
- Chan Park
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Dong Eun Park
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea
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Qaraqe TM, Abou Daher A, Alami RS. Abdominal apoplexy: A rare case of spontaneous middle colic artery rupture with transverse colectomy. Int J Surg Case Rep 2021; 81:105835. [PMID: 33887831 PMCID: PMC8027271 DOI: 10.1016/j.ijscr.2021.105835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/11/2022] Open
Abstract
Idiopathic spontaneous intraperitoneal hemorrhage (ISIH) is a rare but potentially fatal entity. This is a 27-years old male with a massive hemoperitoneum due to ruptured middle colic artery without evidence of prior pathology. The patient’s condition necessitated a damage control exploratory laparotomy for evacuation of the hemoperitoneum, ligation of the middle colic artery and transverse colectomy. The post-operative course was uneventful afterwards and the patient was discharged a week after presentation with full recovery. To our knowledge, this is the third case report in the literature of a spontaneous middle colic artery rupture with no underlying pathology.
Introduction and importance Idiopathic spontaneous intraperitoneal hemorrhage (ISIH) is a rare but potentially fatal entity. The majority of the reported cases of ISIH due to middle colic artery rupture are associated with pseudoaneurysm. Our case is unique in that no pathology could be identified. To our knowledge, this is the third case report in the literature of a spontaneous middle colic artery rupture with no underlying pathology. Case presentation In our report, we present the case of a 27-years old male presenting with a hemoperitoneum due to ruptured middle colic artery with no evidence of pseudoaneurysm or any other pathology. The patient’s hemodynamic status deteriorated abruptly requiring a damage control exploratory laparotomy for evacuation of the hemoperitoneum, ligation of the middle colic artery and transverse colectomy. The post-operative course was uneventful afterwards and the patient was discharged a week after presentation with full recovery. Discussion Patients with ISIH might exhibit the “double rupture” phenomenon, compromising their hemodynamic stability and necessitating urgent surgical interventions. CTA can be of paramount importance to guide such interventions if the patient’s clinical status permits. Angiographic embolization is an acceptable alternative approach in specific situations. Conclusion ISIH should be on the differential diagnosis of any young patient presenting to the ED with an acute abdomen, regardless of the identifiable risk factors.
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Affiliation(s)
- Taha M Qaraqe
- Department of Surgery, American University of Beirut Medical Center, Beirut, 1107-2020, Lebanon
| | - Alaa Abou Daher
- Faculty of Medicine, American University of Beirut, Beirut, 1107-2020, Lebanon
| | - Ramzi S Alami
- Department of Surgery, American University of Beirut Medical Center, Beirut, 1107-2020, Lebanon.
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Ferreira MM, Guimarães N, Mónica IB, Oliveira S, Pais D, Andrade S, Fonseca A, Couceiro A, Borges I, Cecílio JV. Hemoperitoneum secondary to mesenteric laceration after abdominal trauma - Case report. Trauma Case Rep 2021; 32:100424. [PMID: 33665317 PMCID: PMC7897987 DOI: 10.1016/j.tcr.2021.100424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/01/2022] Open
Abstract
Mesenteric laceration is an uncommon cause of hemoperitoneum, with nonspecific signs and symptoms and frequently is camouflaged by the signs of other traumatic lesions. There is a high risk to go unnoticed increasing morbidity and mortality. We report a case of a 43-year-old man, who was involved in a motorcycle accident, with thoraco-abdomino-pelvic trauma, but without evidence of intra-abdominal lesions on exams, with exception of hemoperitoneum. Due to hemodynamic instability, it was performed an exploratory laparotomy. Intraoperative findings were mesenteric lacerations affecting a small bowel segment. This case demonstrates that a high index of suspicion is necessary to diagnose and treat lesions like mesenteric laceration, not visible early on imaging but potentially fatal, with high risk of complications.
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Affiliation(s)
| | | | | | - Simone Oliveira
- District Hospital of Figueira da Foz, Figueira da Foz, Portugal
| | - Daniela Pais
- District Hospital of Figueira da Foz, Figueira da Foz, Portugal
| | - Sara Andrade
- District Hospital of Figueira da Foz, Figueira da Foz, Portugal
| | - Alice Fonseca
- District Hospital of Figueira da Foz, Figueira da Foz, Portugal
| | - Ana Couceiro
- District Hospital of Figueira da Foz, Figueira da Foz, Portugal
| | - Isabel Borges
- District Hospital of Figueira da Foz, Figueira da Foz, Portugal
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Huang LY, Hsu PY, Chiang CT, Chen HW, Wu MH. Endometriosis-related spontaneous hemoperitoneum in the early second trimester: A case report. Taiwan J Obstet Gynecol 2021; 60:328-30. [PMID: 33678336 DOI: 10.1016/j.tjog.2021.01.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To present a rare case of endometriosis-related spontaneous hemoperitoneum in pregnancy (SHiP) with atypical subacute symptoms, which is likely to be mistaken as an infectious disease initially. CASE REPORT A 35-year-old primigravid woman presented with diffuse lower abdominal pain and signs of peritoneal irritation for five days at 18 weeks' gestation, and the initial diagnosis was acute peritonitis. An abrupt deterioration with maternal shock and stillbirth of fetus was found in spite of close observation in emergent department. Emergent laparotomy was performed for delay-appeared hemoperitoneum. Bleeding from decidualized endometriotic tissue over posterior uterine surface was found, and hemostasis was achieved with uterine preservation. The patient recovered smoothly. CONCLUSION SHiP is a serious obstetric complication of endometriosis with diagnostic difficulty. Its initial presentation may mimic infectious disease, so close monitoring for possible abrupt deterioration is crucial. Early detection and timely management are the key to avoid adverse pregnancy outcomes.
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Muroni M, Butoyi JMV, Shimirimana M, Mulemangabo M, Nkurunziza J, Caravaggi P. Hemoperitoneum during removal of the placenta in advanced abdominal pregnancy with live fetus delivered at 37 weeks of gestation. A case report in a low-resource setting and literature review. Int J Surg Case Rep 2021; 80:105694. [PMID: 33676289 PMCID: PMC7982487 DOI: 10.1016/j.ijscr.2021.105694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Advanced abdominal pregnancy (> 20 weeks gestation) is a rare condition life-threatening for mother and fetus. CASE PRESENTATION A 31-years-old African woman presented from a rural district to Mutoyi Hospital for first gynecological evaluation after 37 weeks of amenorrhea, abdominal pain and vaginal bleeding. An ultrasound revealed an extra-uterine fetus. Laparotomy was done and a live fetus weighing 1980 g was delivered. Removal of the placenta, triggered massive bleeding (5000 mL) with shock. After re-laparotomy for post-operative ileus and hemoperitoneum, the mother and infant were discharged in good health. CLINICAL DISCUSSION Viable fetus can be delivered after an advanced abdominal pregnancy. Removal of the placenta is controversial. We review currently medical literature on advanced abdominal pregnancy and propose a management of the placenta in these patients. CONCLUSION We recommended to leave the placenta in situ, to avoid intraoperative bleeding. Placenta involution during follow-up can be revealed by ultrasound, colordoppler and β-hCG serum level decrease.
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Affiliation(s)
- Mirko Muroni
- Mutoyi Hospital, General Surgery Department, Gitega, Burundi.
| | | | | | | | - Joel Nkurunziza
- Mutoyi Hospital, General Surgery Department, Gitega, Burundi
| | - Paola Caravaggi
- Mutoyi Hospital, Obstetrics and Gynecology Department, Gitega, Burundi
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