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Helmken JC, Camunas JA. Severe case of postpartum-acquired haemophilia A after laparoscopic cholecystectomy. BMJ Case Rep 2024; 17:e258812. [PMID: 38553018 PMCID: PMC10982749 DOI: 10.1136/bcr-2023-258812] [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] [Indexed: 04/02/2024] Open
Abstract
Acquired factor VIII inhibitor, also known as acquired haemophilia A, has been associated with the postpartum state in young females. Treatment of acquired haemophilia A is focused on two goals: control of bleeding and eliminating the factor VIII inhibitor. Management requires successful intervention to accomplish both goals. Here, we describe the presentation and management of a case of acquired haemophilia A resulting in particularly severe and protracted intra-abdominal bleeding after routine laparoscopic cholecystectomy in a young and otherwise healthy female at 3 months postpartum. Due to diffuse intra-abdominal bleeding, she required return to the operating room on five occasions for intra-abdominal packing, reassessment of bleeding and ultimate fascial closure. Her abdomen was open for 5 days. She was treated with activated recombinant human factor VIIa to bypass inhibited factor VIII, and with immunosuppression using steroids, cyclophosphamide and anti-CD20 monoclonal antibody rituximab. She achieved remission after 6 weeks of treatment.
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Affiliation(s)
- John Cord Helmken
- Department of Surgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Joseph A Camunas
- Department of Surgery, Prisma Health Upstate, Greenville, South Carolina, USA
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina, USA
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2
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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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3
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Buseman M, Blong AE, Yuan L, Mochel JP, Walton RAL. Retrospective evaluation of admission total plasma protein as a predictor of red blood cell transfusion requirement in dogs diagnosed with traumatic and nontraumatic hemoabdomen: 90 dogs (2009-2019). J Vet Emerg Crit Care (San Antonio) 2024; 34:76-80. [PMID: 37961036 DOI: 10.1111/vec.13343] [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: 12/08/2021] [Revised: 08/06/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2023]
Abstract
OBJECTIVE To evaluate the association of admission total plasma protein (TPP) and the administration of red blood cell transfusions in dogs with diagnosed hemoabdomen. To secondarily evaluate additional point-of-care parameters associated with red blood cell transfusion administration. DESIGN Retrospective study between 2009 and 2019. SETTING University veterinary teaching hospital. ANIMALS Ninety dogs admitted to a university veterinary teaching hospital after a diagnosis of traumatic or nontraumatic hemoabdomen (NTH). MEASUREMENTS AND MAIN RESULTS Medical records were retrospectively reviewed; signalment, point-of-care diagnostics, and transfusion administration information was recorded. A total of 47 dogs (traumatic hemoabdomen 11/26; NTH 36/64) received packed red blood cell transfusions. For each 1 g/dL unit decrease in TPP, dogs had an increased odds ratio (OR) of 2.14 (95% confidence interval [CI]: 1.44-3.40, P < 0.001) of receiving a red blood cell transfusion. Dogs diagnosed with NTH were more likely to receive a red blood cell transfusion than dogs with a traumatic hemoabdomen (OR: 2.78, 95% CI: 1.11-7.141, P = 0.03). Lower PCV values (OR: 1.08, 95% CI: 1.04-1.12, P < 0.001), bicarbonate values (OR: 1.3, 95% CI: 1.09-1.56, P = 0.003), and base excess (OR: 1.27, 95% CI: 1.1-1.49, P = 0.003) were associated with a higher likelihood of red blood cell transfusion. Additionally, higher lactate (OR: 1.35, 95% CI: 1.16-1.63, P < 0.001) and Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast scores (OR: 1.10, 95% CI: 1.04-1.17, P < 0.001) were associated with increased red blood cell transfusion administration. CONCLUSIONS Low admission TPP, independent of low PCV, was associated with red blood cell transfusions regardless of underlying cause. For each 1 g/dL unit decrease in TPP on presentation, dogs were approximately 2 times more likely to receive a red blood cell transfusion during hospitalization. Other factors that were associated with increased transfusion administration included presenting PCV, PCV/TPP ratio, bicarbonate, base excess, lactate, and APPLEfast scores.
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Affiliation(s)
- Miranda Buseman
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - April E Blong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Lingnan Yuan
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Jonathan P Mochel
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Rebecca A L Walton
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
- VCA West Los Angeles, VCA West Los Angeles Animal Hospital, CA, USA
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Bouzid D, Tran-Dinh A, Lortat-Jacob B, Atchade E, Jean-Baptiste S, Tashk P, Snauwaert A, Zappella N, Augustin P, Pellenc Q, Castier Y, Ribeiro L, Gaudemer A, Khalil A, Montravers P, Tanaka S. Ultrasonography in thoracic and abdominal stab wound injury: results from the FETTHA study. Emerg Med J 2023; 40:821-825. [PMID: 37673644 DOI: 10.1136/emermed-2023-213078] [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: 01/07/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND While the role of Extended Focused Assessment with Sonography in Trauma (eFAST) is well defined in the management of severe blunt trauma, its performance in injuries caused by stab wounds has been poorly assessed. METHODS Prospective single centre study which included all patients with stab wounds to the thorax or abdomen between December 2016 and December 2018. All patients underwent initial investigation with both eFAST and CT scan, except in cases of haemodynamic or respiratory instability, and in cases with a positive diagnosis by eFAST in which case surgery without CT scan was performed. RESULTS Of the 200 consecutive patients included, 14 unstable patients underwent surgery immediately after eFAST. In these 14 patients, 9 had cardiac tamponade identified by eFAST and all were confirmed by surgery. In the remaining 186 patients, the median time between eFAST and CT scan was 30 min (IQR 20-49 min). Test characteristics (including 95% CI) for eFAST compared with reference standard of CT scan for detecting pneumothorax were as follows: sensitivity 77% (54%-92%), specificity 93% (90%-97%), positive predictive value (PPV) 60% (49%-83%), negative predictive value (NPV) 97% (93%-99%). Test characteristics (including 95% CI) for eFAST compared with CT scan for detecting haemothorax were as follows: sensitivity 97% (74%-99%), specificity 96% (92%-98%), PPV 83% (63%-93%) and NPV 99% (96%-100%). Finally, test characteristics (including 95% CI) for eFAST compared with CT scan for detecting haemoperitoneum were as follows: sensitivity 75% (35%-97%), specificity 97% (93%-99%), PPV 55% (23%-83%) and NPV 99% (96%-99%). CONCLUSIONS In patients admitted with stab wounds to the torso, eFAST was not sensitive enough to diagnose pneumothorax and haemoperitoneum, but performed better in the detection of cardiac tamponade and haemothorax than the other injuries. More robust multicentre studies are needed to better define the role of eFAST in this specific population.
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Affiliation(s)
- Donia Bouzid
- Université Paris Cité, Paris, France
- INSERM UMR1137, IAME, F-75006, Paris, France
- Université de Montpellier, VBMI, INSERM U1047, Nimes, France
- AP-HP Nord, Emergency Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Alexy Tran-Dinh
- Université Paris Cité, Paris, France
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
- INSERM UMR1148, Paris, France
| | - Brice Lortat-Jacob
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Enora Atchade
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Sylvain Jean-Baptiste
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Parvine Tashk
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Aurelie Snauwaert
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Nathalie Zappella
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Pascal Augustin
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Quentin Pellenc
- AP-HP Nord, Thoracic and Vascular Surgery Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Yves Castier
- Université Paris Cité, Paris, France
- INSERM UMR1148, Paris, France
- AP-HP Nord, Thoracic and Vascular Surgery Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Lara Ribeiro
- AP-HP Nord, Visceral Surgery Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Augustin Gaudemer
- AP-HP Nord, Radiology Department, Bichat-Claude Bernard University Hospital, Paris, France
| | - Antoine Khalil
- Université Paris Cité, Paris, France
- AP-HP Nord, Radiology Department, Bichat-Claude Bernard University Hospital, Paris, France
- PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Philippe Montravers
- Université Paris Cité, Paris, France
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
- PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Sebastien Tanaka
- AP-HP Nord, Anesthesiology and Intensive Care Department, Bichat-Claude Bernard University Hospital, Paris, France
- INSERM UMR1188, Saint-Denis de la Réunion, France
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Mendez D, Annira S, Ayyash M, Stanton T. Haemoperitoneum due to ovarian rupture after oocyte retrieval procedure. BMJ Case Rep 2023; 16:e256591. [PMID: 37977832 PMCID: PMC10660813 DOI: 10.1136/bcr-2023-256591] [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] [Indexed: 11/19/2023] Open
Abstract
Transvaginal ultrasound-guided oocyte retrieval is the gold-standard technique for oocyte retrieval that has few associated procedural and post-procedural complications. Rarely, severe complications can occur including haemoperitoneum, for which the incidence reported in the literature is approximately 0.08-0.22%. In this report, we present the case of a nulliparous woman in her late 30s who presented to the hospital with severe abdominal pain following transvaginal ultrasound-guided oocyte retrieval and was found to have extensive haemoperitoneum attributed to ovarian rupture.
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Affiliation(s)
- Devin Mendez
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Samiksha Annira
- Obstetrics & Gynecology, Henry Ford Health, Detroit, Michigan, USA
| | - Mariam Ayyash
- Obstetrics & Gynecology, Henry Ford Health, Detroit, Michigan, USA
| | - Taylor Stanton
- Obstetrics & Gynecology, Henry Ford Health, Detroit, Michigan, USA
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Bromfield B, Tellez R, Hughes DL, Brown R, Andrzejewski M, Bawa A, Lin FP, Tublin M, Triulzi D, Ganoza A, Duarte-Rojo A. TEG-based transfusion protocol is associated with decreased blood product use without increased risk of hemoperitoneum. Hepatol Commun 2023; 7:e0292. [PMID: 37889553 PMCID: PMC10615392 DOI: 10.1097/hc9.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/14/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Thromboelastography (TEG) informs the need for blood product transfusions to prevent procedural bleeding complications in patients with cirrhosis. We aimed to evaluate the impact of using a TEG-based transfusion protocol on blood product utilization before paracentesis and the post-paracentesis hemoperitoneum (PPH) incidence. METHODS We conducted an ambispective analysis of patients with cirrhosis who underwent paracentesis from 2017 to 2021. In May 2019, we enacted a TEG-based transfusion protocol to guide pre-paracentesis blood product use. Patients with platelets < 20,000 or international normalized ratio ≥ 4 underwent TEG and received blood products if r value > 10 min or MA <30 mm. Patients were divided into pre-TEG and post-TEG protocol cohorts based on the date of paracentesis. Pre-paracentesis blood product transfusions in the form of platelets, fresh frozen plasma, and cryoprecipitates were recorded. PPH was defined as a decrease in hemoglobin of ≥1 g and the presence of blood on diagnostic imaging and/or the need for therapeutic intervention. RESULTS A total of 483 patients underwent 1281 paracenteses. The main etiologies of cirrhosis were alcohol (43%) and NASH (25%), and the mean MELD-sodium was 22±6. Pre-TEG and post-TEG protocol cohort sizes were similar: 253 patients and 607 paracenteses versus 230 patients and 674 paracenteses. After TEG-protocol implementation, blood product transfusions decreased significantly (228 vs. 49 products, p<0.001) with associated cost savings. One patient in each cohort developed PPH. CONCLUSION Implementation of a pre-paracentesis TEG-based transfusion protocol for patients with cirrhosis successfully resulted in decreased blood product use with no associated increase in incidence of PPH.
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Affiliation(s)
- Brittany Bromfield
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roberto Tellez
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Dempsey L. Hughes
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Rebecca Brown
- University of Pittsburgh School of Medicine, Pennsylvania, USA
| | - Margaret Andrzejewski
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aditi Bawa
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fei-Pi Lin
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mitchell Tublin
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Darrell Triulzi
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Armando Ganoza
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andres Duarte-Rojo
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
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Cacciatori FA, Rodrigues PD, Fontes PRO. Bleeding hepatocellular adenoma: historical series and outcomes. Rev Col Bras Cir 2023; 50:e20233549. [PMID: 37436285 PMCID: PMC10508653 DOI: 10.1590/0100-6991e-20233549-en] [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: 02/26/2023] [Accepted: 05/01/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION hepatocellular adenoma - AHC - is a rare benign neoplasm of the liver more prevalent in women at reproductive age and its main complication is hemorrhage. In the literature, case series addressing this complication are limited. METHODS between 2010 and 2022, 12 cases of bleeding AHC were attended in a high-complexity university hospital in southern Brazil, whose medical records were retrospectively evaluated. RESULTS all patients were female, with a mean age of 32 years and a BMI of 33kg/m2. The use of oral contraceptives was identified in half of the sample and also half of the patients had a single lesion. The mean diameter of the largest lesion was 9.60cm and the largest lesion was responsible for bleeding in all cases. The presence of hemoperitoneum was documented in 33% of the patients and their age was significantly higher than the patients who did not have hemoperitoneum - 38 vs 30 years, respectively. Surgical resection of the bleeding lesion was performed in 50% of the patients and the median number of days between bleeding and resection was 27 days. In only one case, embolization was used. The relation between ingrowth of the lesions and the time, in months, was not obtained in this study. CONCLUSION it is concluded that the bleeding AHC of the present series shows epidemiological agreement with the literature and may suggest that older patients trend to have hemoperitoneum more frequently, a fact that should be investigated in further studies.
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Affiliation(s)
- Felipe Antônio Cacciatori
- - Santa Casa de Misericórdia, Serviço de Cirurgia Hepatobiliopancreática e Transplante Hepático - Porto Alegre - RS - Brasil
| | - Pablo Duarte Rodrigues
- - Santa Casa de Misericórdia, Serviço de Cirurgia Hepatobiliopancreática e Transplante Hepático - Porto Alegre - RS - Brasil
| | - Paulo Roberto Ott Fontes
- - Santa Casa de Misericórdia, Serviço de Cirurgia Hepatobiliopancreática e Transplante Hepático - Porto Alegre - RS - Brasil
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Algeri P, Spazzini DM, Seca M, Garbo S, Villa A. A uterine malformation diagnosed in the shock room: a case report which helps to identify how to avoid a potentially preventable life-threatening event. J Ultrasound 2023; 26:151-154. [PMID: 36030354 PMCID: PMC10063735 DOI: 10.1007/s40477-022-00706-y] [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: 03/28/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
An Indian wonen at her second pregnancy, with a previous preterm labour at 34.5 weeks, presented to the emergency room at 15.6 weeks, shocked due to massive hemoperitoneum. During the urgent surgery, a Mullerian malformation was detected, and a uterine rupture was diagnosed as the cause of the hemoperitoneum. Ultrasound and pelvic magnetic resonance results confirmed the malformation, determining that a unicornuate uterus with a rudimental horn within the pregnancy had taken place. We decided to report our case to underline that Mullerian malformation must be taken into consideration and evaluated at each routinary gynaecological visit or, at least, at the first pregnancy appointment, especially in the cases of women with previous adverse obstetric outcomes. The 2D abdominal ultrasound associated with trans-vaginal evaluation is an adequate procedure to test for suspected uterine malformations (if the operator keeps it in mind and is trained to check this kind of alteration), which is fundamental to reducing the risk of life-threatening events.
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Affiliation(s)
- Paola Algeri
- Department of Obstetrics and Gynaecology, Bolognini Hospital, ASST Bergamo Est, Seriate, Bergamo, Italy.
| | - Donata Maria Spazzini
- Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Marta Seca
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Monza e Brianza, Italy
| | - Stefano Garbo
- Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Antonella Villa
- Department of Obstetrics and Gynaecology, Treviglio Hospital, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
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Abstract
Thrombotic complications during COVID-19 infections occur frequently, and anticoagulants to prevent and treat deep vein thrombosis appear to have a good safety profile in these patients. In addition, haemorrhagic complications during COVID-19 infections have also been reported. Hepatic inflammation can occur in COVID-19 infections as a direct consequence of cellular infection and cytopathy. Spontaneous subcapsular hepatic haematoma is extremely rare and can be life-threatening. A woman in her 40s presented to the hospital with fever and shortness of breath and was diagnosed with COVID-19 infection with respiratory failure requiring intubation. On day 49 of hospitalisation, she developed melena and acute anaemia; her haemoglobin dropped from 97g/L (9.7g/dL) to 56g/L (5.6g/dL). Abdominal and pelvic CT scans showed a large subcapsular liver haematoma with retroperitoneal extension. The patient received blood transfusions and remained haemodynamically stable. She was eventually extubated and discharged home.
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Affiliation(s)
- Busara Songtanin
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Abbie Evans
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Kenneth Nugent
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Tsai YH, Chang HM. Post-Cholecystectomy Right Hepatic Artery Pseudoaneurysm Induced by Generalized Seizure: A Case Report. Medicina (B Aires) 2022; 58:medicina58050568. [PMID: 35629985 PMCID: PMC9144900 DOI: 10.3390/medicina58050568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Pseudoaneurysm is a rare complication of laparoscopic cholecystectomy (LC). In most cases, the patient presents with gastrointestinal bleeding or hemoperitoneum. Here, we present a case with a post-cholecystectomy right hepatic artery pseudoaneurysm (PSA) induced by a generalized seizure. A 39-year-old male was sent to the emergency room with a generalized seizure and a loss of consciousness for approximately 5 min. Diffuse abdominal pain was complained of after consciousness returned. The surgical history of LC 13 days prior was mentioned. Abdominal computer tomography (CT) revealed a lobulated fluid accumulation in the gallbladder fossa with prominent fatty stranding and suspected biloma formation. After admission for one week, sharp abdominal pain was observed. Abdominal CT angiography revealed a right hepatic artery pseudoaneurysm. Transcatheter arterial embolization was performed with a total of seven platinum coils. In conclusion, it is important for doctors to take pseudoaneurysm into consideration in the patient who presents with seizure attack after receiving LC. Late discovery of PSA when it is ruptured can lead to fatal conditions, such as severe hemoperitoneum.
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Affiliation(s)
- Yueh-Hsun Tsai
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Hao-Ming Chang
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence:
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Bodwal J, Chauhan M, Behera C, Byard RW. Glass table tops: An unusual source of lethal domestic injury. Med Sci Law 2021; 61:305-308. [PMID: 33853458 DOI: 10.1177/00258024211005658] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A 42-year-old woman who fell through a glass tabletop had her lower back pierced by a long shard of glass. She rapidly exsanguinated. At autopsy, a single penetrating wound was present in her left lower back, with complete transection of her left kidney and a 3.5 L haematoperitoneum. Death was due to exsanguination following accidental transection of the left kidney by a penetrating glass injury of the lower back. Glass-topped tables are a well-recognised source of injury in a domestic setting There are far more non-lethal than lethal injuries, many of which involve children. Quite long shards may remain undetected in wounds for considerable amounts of time. Non-tempered glass is a particular risk for breakage. Glass-topped tables should not be used as substitutes for chairs, particularly in overweight or obese individuals.
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Affiliation(s)
- Jatin Bodwal
- Department of Forensic Medicine, Deen Dayal Upadhyay Hospital, Hari Nagar, Delhi, India
| | - Mohit Chauhan
- Department of Forensic Medicine and Toxicology, Government Medical College and Hospital, Chandigarh, India
| | - Chittaranjan Behera
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Roger W Byard
- Forensic Science South Australia, Adelaide and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Rolná M, Matlák P, Dvořáčková J. [Placenta percreta as a cause of massive intraabdominal bleeding]. Ceska Gynekol 2017; 82:478-481. [PMID: 29302982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To inform about a rare cause of massive intraabdominal bleeding due to perforation of uterine corner by unrecognized placenta percreta. DESIGN Case report. SETTING Department of Gynecology and Obstetrics, University Hospital Ostrava. CASE REPORT We report a case of acute haemoperitoneum in pregnant woman at 34th week of gestation. We have detected the cause of the bleeding during emergency caesarean section - perforation of left uterine corner by placenta percreta. CONCLUSION Placenta percreta is the most severe form of abnormal placental villous adherence. In rare cases, chorionic villi may penetrate surrounding organs and cause acute intraabdominal bleeding. Due to increasing number of surgical interventions on uterus, these disorders are on the rise. It is crucial to anticipate an abnormal placental villous adherence in women with atypical placenta localization. These women should be thoroughly observed and referred to perinatal center with intermediary or intensive care for further management before delivery.
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Mistry M, Bhatt M, Haque L, Owens O, Maharajan P. Degenerated uterine fibroid with rupture of the surface leading to haemoperitoneum. Eur J Obstet Gynecol Reprod Biol 2016; 211:216-217. [PMID: 27988218 DOI: 10.1016/j.ejogrb.2016.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/03/2016] [Accepted: 12/07/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Minesh Mistry
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK, UK.
| | - Megha Bhatt
- Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, UK, UK
| | - Lubna Haque
- Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, UK, UK
| | - Owen Owens
- Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, UK, UK
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Allen CJ, Meizoso JP, Ray JJ, Teisch LF, Schulman CI, Namias N, Proctor KG. Does Isolated Hemoperitoneum Cause Peritonitis? A Review of 400 Trauma Laparotomies. Am Surg 2016; 82:184-186. [PMID: 26874145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Casey J Allen
- Dewitt Daughtry Department of Surgery, Divisions of Trauma and Surgical Critical Care, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Law EKC, Lee RKL, Hung EHY, Ng AWH. Radiological diagnosis and management of idiopathic spontaneous intra-abdominal haemorrhage (abdominal apoplexy): a case series. ACTA ACUST UNITED AC 2015; 40:343-51. [PMID: 25134802 DOI: 10.1007/s00261-014-0220-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Idiopathic spontaneous intraperitoneal haemorrhage (ISIH), historically known as abdominal apoplexy, is spontaneous haemorrhage due to rupture of an intra-abdominal visceral vessel in the absence of trauma or underlying pathology. It is an exceptionally rare condition, with mostly scattered case reports available. The aim of this study was to describe this rare condition, possible associated risk factors, and usefulness of multislice-CT (MS-CT) angiogram in its diagnosis prior to intervention. METHODS A retrospective review of patients diagnosed with ISIH. Radiological records of haemoperitoneum from a single tertiary hospital in 2006-2013 were analysed, and the cases of ISIH were identified. Demographics (including pre-morbid hypertension status), abdominal aortic calcification as a measure of atherosclerotic changes, MS-CT angiogram +/- conventional digital subtraction angiograph images, surgical records and outcomes were reviewed. RESULTS 425 cases of haemoperitoneum were retrieved from hospital radiology database from 2006 to 2013, and 5 patients (1.1%) diagnosed with ISIH were identified (4 males, 1 female, mean age of 64 years). 4 out of 5 patients (80%) had a history of hypertension (mean 150/90 mmHg) and 3 patients had moderate abdominal aortic atherosclerosis. MS-CT angiogram was able to diagnose the bleeding source in 4 out of 5 patients, while the bleeding source remained occult in the last patient even with both MS-CT and traditional DSA angiography. Patients who underwent either embolization or surgery had no further re-bleeding in clinical follow up, ranging from 5 to 8 years. CONCLUSIONS Hypertension and abdominal aortic atherosclerosis appear to be associated risk factors for ISIH, and MS-CT angiogram has a high sensitivity in detecting the site of haemorrhage. An integrated angiographic and surgical approach is important in managing patients with ISIH.
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Affiliation(s)
- Eric K C Law
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, People's Republic of China,
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Gnisci A, Stefani L, Bottin P, Ohannessian A, Gamerre M, Agostini A. Predictive value of hemoperitoneum for outcome of methotrexate treatment in ectopic pregnancy: an observational comparative study. Ultrasound Obstet Gynecol 2014; 43:698-701. [PMID: 24265158 DOI: 10.1002/uog.13255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 10/28/2013] [Accepted: 11/07/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To assess the predictive value of hemoperitoneum for the outcome of methotrexate (MTX) treatment of ectopic pregnancy (EP). METHODS This observational prospective single-center study included women presenting with EP treated with MTX from November 2007 to November 2009. The percentage of women with hemoperitoneum at the beginning of MTX treatment was compared between two groups: those whose treatment was successful and those whose treatment failed. The rate of hemoperitoneum in each group and its value in predicting the outcome of MTX treatment of EP were assessed. RESULTS MTX treatment was successful in 69 of 93 (74%) cases. The percentage of women with hemoperitoneum at the beginning of treatment was significantly higher in women in whom MTX treatment failed as compared to those in whom it was successful (15/24 (62.5%) vs 17/69 (24.6%); P = 0.001). The likelihood of requiring surgery following treatment with MTX was higher in women with hemoperitoneum (odds ratio, 5.1; 95% CI, 1.74-15.14). Study of the diagnostic performance of hemoperitoneum in predicting the need for surgical treatment after MTX treatment revealed a sensitivity of 0.63, a specificity of 0.76, a positive predictive value of 0.47 and a negative predictive value of 0.85. CONCLUSIONS The presence of hemoperitoneum appears to be a risk factor for MTX treatment failure. It is important to inform women as fully as possible about the risk of such failure. Nonetheless, the predictive value of this sign is insufficient for either routinely excluding women with hemoperitoneum from MTX treatment or omitting post-treatment monitoring.
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Affiliation(s)
- A Gnisci
- Service de Gynécologie Obstétrique, Hôpital La Conception, Marseille, France
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Kim JH, Lee SM, Lee JH, Jo YR, Moon MH, Shin J, Kim BJ, Hwang KR, Lee TS, Bai KB, Jeon HW. Successful conservative management of ruptured ovarian cysts with hemoperitoneum in healthy women. PLoS One 2014; 9:e91171. [PMID: 24608424 PMCID: PMC3946718 DOI: 10.1371/journal.pone.0091171] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/09/2014] [Indexed: 11/29/2022] Open
Abstract
Study Objective To determine the success rate of the “intended conservative management strategy” of ruptured ovarian cysts with hemoperitoneum and the risk factors for surgical interventions in healthy women of reproductive age. Methods Patients who visited the emergency department with abdominal pain and were diagnosed with a ruptured ovarian cyst with hemoperitoneum between August 2008 and June 2013 were included in this retrospective study. The diagnosis of the ruptured ovarian cysts and hemoperitoneum was based on the clinical symptoms, physical examination and ultrasound and CT imaging. The rate of surgical interventions and the risk factors for surgical intervention were determined. Results A total of 78 women were diagnosed with a ruptured ovarian cyst with hemoperitoneum. Most patients (80.8%, 63/78) were managed conservatively, and 19.2% of the patients (15/78) required a surgical intervention. In the multiple logistic regression analysis, the diastolic blood pressure (dBP) (odds ratio [OR] of 0.921 with 95% confidence interval [CI] of 0.855–0.993) and the depth of the total pelvic fluid collection in CT (DTFC_CT) (OR 1.599 with 95% CI 1.092–2.343) were the significant determining factors of surgical intervention after adjustment. The rate of surgical intervention was 6.5% vs. 15.8% vs. 77.8% in the patients with neither dBP≤70 mmHg nor DTFC_CT≥5.6 cm, those with only one of those features, and those with both, respectively. Conclusion Most cases of ruptured ovarian cysts with hemoperitoneum can be managed conservatively. A low diastolic blood pressure and a large amount of hemoperitoneum suggest the need for surgical intervention.
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Affiliation(s)
- Jee Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ji-Hyun Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yu Ri Jo
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Min Hoan Moon
- Department of Diagnostic Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Byoung Jae Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Taek Sang Lee
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang Bum Bai
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hye Won Jeon
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- * E-mail:
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Yaseen O, El Nekidy WS, Ibrahim AR, Jasey BB, Guignard M, Kadri A. Cyclic pseudoperitonitis secondary to endometriosis in a peritoneal dialysis patient. Perit Dial Int 2013; 32:662-4. [PMID: 23212863 DOI: 10.3747/pdi.2012.00099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Affiliation(s)
- Agustin Dietrich
- Department of General Surgery, Hospital Italiano de Buenos Aires, Argentina
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20
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Affiliation(s)
- Mingli Sun
- Department of Emergency, The First Hospital of Jilin University, China
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21
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Podkamenev VV, Pikalo IA, Zaĭtsev AP. [The risk of death from splenic ruptures by polytrauma among children]. Khirurgiia (Mosk) 2013:61-65. [PMID: 23612340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The retrospective analysis of polytrauma with lethal outcome in 105 children showed that splenic injury had 31.4% of children. It was twice more often than liver injury, though the hemoperitoneum volume by liver injury exceeds that by spleen trauma (846.1±753.8 ml vs. 311±270.3 ml; p<0.002). The risk of death of intraabdominal bleeding by the spleen rupture is considerably low (OR 0.16; 95% CI 0.019-1.34; p=0.04). Nevertheless, the hemothorax by the spleen injury was much more significant than hemoperitoneum (977±866.9 ml vs. 311±270.3 ml; p<0.0003). The risk of death of intrathoracic bleeding by the spleen rupture is 45 times higher than of intraabdominal. The degree of splenic injury poorly correlates with the traumatic mechanism and the hemoperitoneum volume. The chances of the immediate death is considerably low (OR 0.09; 95% CI 0.0096-0.84; p<0.017). The main reasons of death by polytrauma remain brain injury, hemorrhagic shock after injury of thoracic cavity and traumatic shock.
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Berveiller P, Vandenbroucke L, Popowski T, Afriat R, Sauvanet E, Giovangrandi Y. [Hepatic subcapsular hematoma: a case report and management update]. J Gynecol Obstet Hum Reprod 2012; 41:378-382. [PMID: 22177755 DOI: 10.1016/j.jgyn.2011.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 10/24/2011] [Accepted: 11/02/2011] [Indexed: 05/31/2023]
Abstract
Hepatic subcapsular hematoma (HSH) is a rare complication of pregnancy that keeps a materno-fetal high mortality rate. Given this severity, HSH management requires a prompt diagnosis and an appropriate care. Before focusing on the current management strategy of HSH, we illustrate this article with a clinical case presenting an original method of abdominal exploration, which has not been described to our knowledge. Thus, taking into account the presence of a moderate hemoperitoneum during a caesarean section procedure for HSH, introduction of laparoscopy through the same incision allowed a satisfactory evaluation of the abdominal cavity and hepatic area without performing an invasive midline laparotomy.
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Affiliation(s)
- P Berveiller
- Service de gynécologie-obstétrique, université Pierre et Marie Curie, hôpital Saint-Antoine, AP-HP, 184 rue du Faubourg-Saint-Antoine, Paris, France.
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Eberle N, von Babo V, Nolte I, Baumgärtner W, Betz D. Splenic masses in dogs. Part 1: Epidemiologic, clinical characteristics as well as histopathologic diagnosis in 249 cases (2000-2011). Tierarztl Prax Ausg K Kleintiere Heimtiere 2012; 40:250-260. [PMID: 22911256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 06/05/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Splenic masses have a high prevalence and are more common than diffuse splenic enlargement in dogs. It was the aim of the present study to retrospectively describe clinical aspects and histopathologic characteristics of dogs with splenic masses. MATERIAL AND METHODS Records of patients with a histologically diagnosed splenic mass between January 2000 and March 2011 were reviewed. RESULTS 249 dogs met the inclusion criteria and could be included in the study. Splenic masses were diagnosed histologically as non-malignant disease (n=117; 47%) and malignant splenic disease (n=132; 53%). Hemangiosarcoma was the most common histological diagnosis (n=97; 73.5%). Other malignant tumors included sarcoma (n=14), fibrohistiocytic nodules (n=9) as well as lymphoma, blastoma and adenocarcinoma. The non-malignant masses consisted of nodular hyperplasia (n=60), splenic hematoma (n=41), and splenitis (n=6). Dogs with hemoperitoneum had a higher frequency of splenic neoplasia. CONCLUSION The results corroborate previous findings that hemangiosarcoma is the most frequent neoplasm of the canine spleen. However, in approximately half of the cases benign lesions were histologically diagnosed. CLINICAL RELEVANCE It is essential that a frank discussion is held with owners regarding the prognosis associated with the treatment of dogs with a splenic mass associated with hemoperitoneum.
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Affiliation(s)
- N Eberle
- Small Animal Hospital, University of Veterinary Medicine Hannover.
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Angthong C, Watthanaapisith T, Chavasiri C. Fatally idiopathic spontaneous hemoperitoneum in a patient with cervical spine injury: a case report and review of the literature. J Med Assoc Thai 2011; 94:882-887. [PMID: 21774298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Idiopathic spontaneous hemoperitoneum has never been reported in patients with associated orthopedic injury. The present report aimed to demonstrate a case of this life-threatening condition concomitant with cervical spine injury. CASE REPORT A 50-year-old male was an illegal immigrant and transferred to the emergency department with the conditions of the bilateral facet subluxation of C5-6 spine, including incomplete cord lesion (American-Spinal-lnjury-Association: grade-C) and without associated injury, caused by falling from a 3-meters-scaffold He underwent anterior cervical discectomy, fusion with iliac bone graft, and plating of C5-6 level at 20-hours after injury His overall conditions recovered gradually with the same neurological deficit as pre-operative status. On postoperative day 15, he developed acute hemodynamic instability and cardiac arrest in an hour without preceding signs. Autopsy showed free intra-peritoneal blood 1000 ml and fresh blood in gastric lumen-small bowels 500 ml without definitive source of bleeding. DISCUSSION The patient in this present report had no complaint of preceding abdominal symptoms in both pre-and-postoperative periods. His visceral sensibility might be lost due to incomplete cord lesion. At this point, he might have an incompetency of detection of intra-abdominal abnormality when it occurred Hence, this patient had no classic symptoms of spontaneous hemoperitoneum. This made the diagnosis of this condition quite difficult in the presented patient. This situation was very uncommon and essentially unique. CONCLUSION The authors recommend "high index of suspicion" of this diagnosis as a cause of hemodynamic instability in patients with neurological deficit, due to spine injury or any cause, which might prevent them to recognize antecedent abdominal symptoms.
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Affiliation(s)
- Chayanin Angthong
- Department of Orthopaedic Surgery, Faculty of Medicine, Thammasat Hospital, Thammasat University, Pathum Thani, Thailand
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Peigné M, Piessen G, Ernst O, Dewailly D, Leroy M. Spontaneous hemoperitoneum during pregnancy: a diagnosis pitfall. Am Surg 2011; 77:E69-E71. [PMID: 21679538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Maëliss Peigné
- Department of Endocrine Gynaecologyand Reproductive Medicine, Lille University Hospital, Lille, France.
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Al-Fraij AK, Dhar PM, Al-Khalejy A, Abu Najem F. Massive hemorrhage from spontaneous ruptured hepatocellular carcinoma controlled by isoamyl 2-cyanoacrylate: a case report. Med Princ Pract 2011; 20:297-9. [PMID: 21455005 DOI: 10.1159/000323833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Accepted: 09/21/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a case of ruptured hepatocellular carcinoma with massive hemoperitoneum which was successfully controlled with isoamyl 2-cyanoacrylate. CLINICAL PRESENTATION AND INTERVENTION A 46-year-old Bangladeshi gentleman presented to our casualty complaining of acute abdominal pain and distension, associated with jaundice. Bedside abdominal ultrasound showed multiple focal lesions in the liver with fluid in the abdomen. The patient was vitally unstable, so he was resuscitated and underwent emergency laparotomy for massive hemoperitoneum due to a ruptured tumor nodule. Isoamyl 2-cyanoacrylate was applied to the ruptured nodule which stopped bleeding within 1-2 min. CONCLUSION This case shows the effectiveness of isoamyl 2-cyanoacrylate in controlling bleeding in ruptured liver tumors.
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Worley TA, Abadin SS, Revesz E, Salti GI. Gastrointestinal stromal tumor with hemoperitoneum masquerading as appendicitis. Int Surg 2010; 95:8-11. [PMID: 20480834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Gastrointestinal stromal tumor (GIST) is a rare condition with an annual worldwide incidence of 11 to 15 cases per million, with nearly 5000 cases occurring in the United States yearly. This tumor is found often when patients present with intraluminal gastrointestinal hemorrhage. Other manifestations include early satiety and unintentional weight loss. Multislice computed tomography is an appropriate modality used to diagnosis a GIST after clinical suspicion warrants such imaging. Hemoperitoneum secondary to ruptured GIST is rare. Our patient presented with classic appendicitis, but the etiology of his right lower-quadrant pain with peritonitis was found to be hemoperitoneum secondary to ruptured GIST originating from the ileum.
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Affiliation(s)
- Todd A Worley
- Department of Surgery, St Joseph Hospital, Chicago, Illinois 60657, USA
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Piccagliani L, D'Arienzo M, Manco G, Luppi D, Rossi A. [Haemoperitoneum secondary to avulsed short gastric arteries after vomiting]. Chir Ital 2009; 61:237-240. [PMID: 19537000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present the case of a rare and serious complication of vomiting. A 25-year-old man presented to the emergency room with acute abdomen secondary to haemoperitoneum. There was no evidence or history of trauma in the previous 30 days. The only antecedent was a history of violent vomiting in the afternoon. Laparoscopy showed a massive haemoperitoneum secondary to avulsed short gastric arteries.
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Affiliation(s)
- Leonardo Piccagliani
- Clinica Chirurgica II, Dipartimento ad Attività Integrata di Chirurgia Generale e Specialità Chirurgiche, Università degli Studi di Modena e Reggio Emilia
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Evangelinakis N, Grammatikakis I, Salamalekis G, Tziortzioti V, Samaras C, Chrelias C, Kassanos D. Prevalence of acute hemoperitoneum in patients with endometriotic ovarian cysts: a 7-year retrospective study. CLIN EXP OBSTET GYN 2009; 36:254-255. [PMID: 20101861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Endometriosis is a quite common condition in women of reproductive age. The purpose of this study is to delineate the association between hemoperitoneum and endometriosis. MATERIALS & METHODS The records of all patients with endometriotic ovarian cysts treated at the 3rd Department of Obstetrics and Gynecology of the University of Athens and at "Lito" Maternity Hospital of Athens from 2000 through 2007 were reviewed. RESULTS During this 7-year period 720 women underwent surgery due to endometriotic ovarian cysts. The average age was 40.9 years (range: 17-70). The median diameter of the cysts was 4.49 cm and 59% were located in the right ovary. Hemoperitoneum was identified in 16 (2.22%) of them. The average age of these women was 28.5 years (range: 22-44). Ten (62.5%) of these women presented with acute and strong abdominal pain and moderate signs of cardiovascular shock. The rest presented with abdominal pain and distension worsening at the onset of menses, nausea and/or vomiting and hemorrhagic fluid in the pelvis. Ultrasound examination was performed in all women and afterwards they underwent laparoscopy to identify the source of bleeding. In all cases a ruptured endometriotic cyst was found. In 68.8% (11/16) the ruptured cyst was located in the left ovary and the rest (31.2%) in the right. A thorough examination did not reveal any other sources of bleeding. No operative complications were observed. DISCUSSION The simultaneous occurrence of ascites and endometriosis is rare. A physician, though, must always take into consideration endometriosis in the differential diagnosis of ascites and acute abdominal pain or pelvic mass.
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Affiliation(s)
- N Evangelinakis
- 3rd Department of Obstetrics and Gynecology, Medical School of Athens, General University Hospital "Attikon", Athens, Greece.
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Sastre López A, Mascarós Ferrer V, Iñigo Vanrell V, Gascó Company JM. [Hemoperitoneum and endocarditis]. Nefrologia 2008; 28:114-115. [PMID: 18336149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
The incidence of hemoperitoneum varies from 6% to 57% in premenopausal women. Bloody peritoneal dialysate may be the result of the peritoneal dialysis procedure or may be due to factors unrelated to renal disease. The Libman-Sacks endocarditis was described for the first time in 1924, is characterized for verrucous lesions in the surfaces valves and has been intimately associated with the presence of antiphospholipid antibodies. We send a case of a patient in program of Dialysis peritoneal that presented an Libman-Sacks endocarditis and hemoperitoneum.
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Rizzuto MI, Oliver R, Odejinmi F. Laparoscopic management of ectopic pregnancy in the presence of a significant haemoperitoneum. Arch Gynecol Obstet 2007; 277:433-6. [PMID: 17906868 DOI: 10.1007/s00404-007-0473-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 09/13/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the trend in the use of operative laparoscopy in the management of patients with ruptured ectopic pregnancy and significant haemoperitoneum. METHOD Four-year prospective observational study of the operative management of women with ruptured ectopic pregnancy and significant haemoperitoneum at the Whipps Cross University Hospital from January 2003 to December 2006. The inclusion criteria were patients with a clinical or laparoscopic assessment of significant haemoperitoneum (>800 ml). The amount of haemoperitoneum was determined at surgery. RESULTS The blood loss ranged from 800 to 3,500 ml. The laparoscopic approach in this specific clinical scenario increased from 40% in 2003 to 100% in 2006. In 2003 there were five patients, two (40%) were treated by laparoscopy, one (20%) was converted from laparoscopy to laparotomy and two (40%) had laparotomy. In 2004 there were six patients, five (85%) underwent laparoscopic management and one (15%) had laparotomy. In 2005 we had 14 patients, ten (72%) had laparoscopic management, 2 (14%) were converted to laparotomy and 2 (14%) had laparotomies. There were 12 patients in 2006 and all (100%) were treated by laparoscopy. CONCLUSION Our study demonstrates that with highly skilled anaesthetic and surgical teams, operative laparoscopy with its recognized advantages over laparotomy and is feasible in women with ruptured ectopic pregnancy and significant haemoperitoneum.
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Affiliation(s)
- M I Rizzuto
- Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Leytonstone, London, UK.
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Lew SQ. Hemoperitoneum: bloody peritoneal dialysate in ESRD patients receiving peritoneal dialysis. Perit Dial Int 2007; 27:226-33. [PMID: 17468466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Hemoperitoneum is seen in patients receiving peritoneal dialysis (PD) because the PD catheter provides a window to the peritoneum. Gynecological associated phenomena account for the majority of cases. Intra-abdominal pathology of solid organs such as the kidney, liver, and spleen as well as the gastrointestinal tract is recognized. Unique to PD patients, hemoperitoneum may be associated with the catheter itself, uremic bleeding, or peritonitis. A successful PD program requires nephrologists, PD nurses, and patients assess and manage hemoperitoneum in a systematic fashion. This paper reviews hemoperitoneum in adult PD patients.
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Affiliation(s)
- Susie Q Lew
- Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, 2150 Pennsylvania Avenue NW, Washington, DC 20037, USA.
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33
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Bouwman LH, Schmidt GB. [Diagnostic image (313). A woman with peracute abdominal pain in the right lower quadrant]. Ned Tijdschr Geneeskd 2007; 151:535. [PMID: 17373395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A 29-year-old woman presented with peracute pain in the right lower quadrant of her abdomen, which at diagnostic laparoscopy appeared to be related to hematoperitoneum caused by bleeding ofa corpus rubrum.
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Affiliation(s)
- L H Bouwman
- Leids Universitair Medisch Centrum, afd. Heelkunde, K6R, Postbus 9600, 2300 RC Leiden.
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Lin CH, Hsieh HF, Yu JC, Hsu SD, Chen CW, Liao GS, Hsieh CB. Spontaneous rupture of a large exogastric hemangioma complicated by hemoperitoneum and sepsis. J Formos Med Assoc 2007; 105:1027-30. [PMID: 17185247 DOI: 10.1016/s0929-6646(09)60289-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hemangiomas are benign congenital tumors of mature blood vessels and usually consist of dense masses of capillaries or larger blood vessels. Hemangioma of the stomach presenting with spontaneous rupture and sepsis is rare. We report a 22-year-old male who presented at the emergency room with sudden-onset epigastric pain, intractable nausea, and vomiting. Fever, tachycardia, leukocytosis and peritonitis were found on examination after admission. Computed tomography revealed a single, well-defined homogeneous lesion measuring approximately 6 x 8 x 9 cm in size over the left upper abdomen and hemoperitoneum. Laparotomy was performed because of intra-abdominal hemorrhage, peritonitis, and fever. During the operation, a dark red tumor was found on the greater curvature side of the stomach, accompanied by bleeding and hemoperitoneum. The tumor was removed and a wedge resection of the stomach and partial omentectomy were performed. Histopathologic examination of the excised tumor revealed mixed cavernous-capillary hemangioma with central necrosis. The postoperative course was uncomplicated. The pathogenesis of spontaneous rupture and sepsis in this case may have resulted from pedicle torsion accompanied by ischemia, central necrosis, rupture of hemangioma and subsequent peritonitis and sepsis.
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Affiliation(s)
- Chien-Hua Lin
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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35
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Asensio Martín MJ, Pavón Benito A, Salvador Bravo M, García Pérez G. [Burst suppression entropy response to moderate hypothermia in a patient receiving a massive transfusion]. Rev Esp Anestesiol Reanim 2006; 53:665-6. [PMID: 17302083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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36
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Weissberg D. What is a spontaneous hemothorax? Ann Thorac Surg 2006; 82:384; author reply 384. [PMID: 16798269 DOI: 10.1016/j.athoracsur.2005.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 10/30/2005] [Accepted: 12/06/2005] [Indexed: 10/24/2022]
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37
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Stöllberger C, Segall L, Finsterer J. Comments on a case of left ventricular hypertrabeculation/noncompaction. Br J Anaesth 2006; 96:802; author reply 802-3. [PMID: 16698870 DOI: 10.1093/bja/ael087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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38
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Habek D, Kulas T, Bobić MV. Hoffstäter-Cullen-Hellendal sign in ruptured tubal pregnancy in a patient with uterus didelphys and vagina duplex. Eur J Obstet Gynecol Reprod Biol 2006; 126:131-2. [PMID: 16413956 DOI: 10.1016/j.ejogrb.2005.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 10/13/2005] [Accepted: 11/14/2005] [Indexed: 11/22/2022]
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Nikolov A, Dimitrov A, Iliev D, Khadzhiev E. [Pregnancy after treatment of primary sterility with zoladex in patient with essential thrombocytopenia]. Akush Ginekol (Sofiia) 2006; 45:52-6. [PMID: 16637321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We have a patient with essential /idiopathic/ thrombocitopeny and primary sterility, who becomes pregnant after medical and operative treatment. With the beginning of the menarche her menstrual cycle goes irregular with menstrual bleeding duration from 8 to 20 days, cystic ovaries, non-ovulation cycles, trombocytopeny and anemia. A laparotomy was performed twice, because of the existence of hemoperitoneum, caused by a rupture of the corpus luteum. After achieving a amenorrhoea with Zoladex treatment, a splenectomia was performed. As a result we observe a physiological recovery of the menstrual cycle, the ovulation cycle and the pregnancy. The patient's hematology and hemostaseology statuses went back to normal.
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Errando CL, Tatay J, Serrano-Romero A, Gudín-Uriel M, Revert M, Peiró CM. Splenic rupture and haemoperitoneum in a patient with non-compaction of the left ventricular myocardium. Br J Anaesth 2005; 95:358-61. [PMID: 16040634 DOI: 10.1093/bja/aei207] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The anaesthetic and critical care management of blunt abdominal trauma in a patient previously diagnosed with non-compaction of the left ventricular myocardium (a rare autosomal dominant inherited disease) is reported. The management was influenced by the presence of an implanted automated internal defibrillator and treatment with anticoagulants because of the high frequency of severe arrhythmias and systemic embolism. The pathophysiology of ventricular non-compaction is reviewed briefly.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Avenida Tres Cruces s/n, 46014-Valencia, Spain.
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41
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Merchán Rodríguez R, Moralejo Alonso ML, Martín Sánchez MJ, Fuertes Martín A. [Hypovolemic shock as a presentation of an ovarian tumor]. An Med Interna 2005; 22:304-5. [PMID: 16145737 DOI: 10.4321/s0212-71992005000600018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Affiliation(s)
- Sheree Kuo
- Division of Neonatology, Department of Pediatrics, University of Hawaii and Kapi'olani Medical Center for Women and Children, Honolulu, HI 96826, USA.
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43
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Samyn M, Hadzic N, Davenport M, Verma A, Karani J, Portmann B, Mieli-Vergani G. Peliosis hepatis in childhood: case report and review of the literature. J Pediatr Gastroenterol Nutr 2004; 39:431-4. [PMID: 15448437 DOI: 10.1097/00005176-200410000-00024] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- M Samyn
- Department of Child Health, King's College Hospital, Denmark Hill, London, United Kingdom.
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Bataille L, Baillieux J, Remy P, Gustin RM, Denié C. Spontaneous rupture of omental varices: an uncommon cause of hypovolemic shock in cirrhosis. Acta Gastroenterol Belg 2004; 67:351-4. [PMID: 15727080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In cirrhotic patients, esophageal and esophagogastric varices are the most common sites of bleeding, often responsible for hypovolemic shock. Hepatocellular carcinoma, blunt abdominal trauma and postprocedural complications are classical causes of hemoperitoneum in hepatic cirrhosis. Rupture of omental varices is another and rarely reported cause of shock in cirrhosis. We report a case of hypovolemic shock caused by ruptured omental varices. Selective review of literature regarding presentation, diagnosis and management of ruptured intraabdominal varices is also part of presentation.
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Affiliation(s)
- L Bataille
- Hepatogastroenterology Unit, Centre Hospitalier du Grand-Hornu, Hornu, Belgium.
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45
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Liu BM, Ko SF, Liu JW. Appendicitis complicated by hemoperitoneum. J Formos Med Assoc 2003; 102:893-5. [PMID: 14976571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Differential diagnosis of acute appendicitis in women of childbearing age is a challenge because of the range of gynecologic and obstetric problems with similar manifestations. We report a case of acute appendicitis with the rarely encountered complication of hemoperitoneum in a sexually active 32-year-old woman. The patient presented with right lower quadrant pain and a positive culdocentesis with non-clotting blood. Hemorrhagic corpus luteal cyst was the initial impression. Ruptured appendicitis with abscess formation and complicated hemoperitoneum was diagnosed later with the aid of abdominal computed tomographic scan, and was confirmed during operation. Hemoperitoneum may be a complication of appendicitis with abscess formation; a detailed medical history and physical examination are helpful in making the diagnosis.
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Affiliation(s)
- Ber-Ming Liu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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46
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Eastridge BJ, Starr A, Minei JP, O'Keefe GE, Scalea TM. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma 2002; 53:446-50; discussion 450-1. [PMID: 12352479 DOI: 10.1097/00005373-200209000-00009] [Citation(s) in RCA: 263] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pelvic fractures may be associated with significant hemorrhage. Although this hemorrhage may emanate from the pelvic vasculature, it may also be secondary to abdominal visceral injury. The purpose of this study was to determine factors associated with pelvic and/or abdominal visceral bleeding in hypotensive patients with pelvic fractures to guide the appropriate therapeutic intervention sequence for these difficult-to-manage patients. METHODS Medical records of all hypotensive (systolic blood pressure < or = 90 mm Hg) patients with pelvic fractures seen at a Level I trauma center from January 1995 to December 1999 were evaluated. Records were abstracted for age, base deficit, 24-hour blood requirement, hemoperitoneum (positive ultrasound, diagnostic peritoneal lavage, or computed tomographic scan), abdominal hemorrhage discovered at celiotomy, pelvic hemorrhage discovered at angiography, emergency department disposition, Injury Severity Score, and mortality. Pelvic fracture categories were derived by adapting the Young-Burgess pelvic fracture classification scheme. Lateral compression (LC) I and anteroposterior compression (APC) I fractures were characterized as stable fracture patterns (SFPs), and APC II, APC III, LC II, LC III, and vertical shear were characterized as unstable fracture patterns (UFPs). RESULTS Of 231 hypotensive patients, 38 patients died in the emergency department, leaving 193 surviving initial resuscitation. One hundred seven patients stabilized (group I) and were transferred to the intensive care unit. Eighty-six patients (group II) required ongoing resuscitation and underwent celiotomy and/or angiography in an attempt to manage their hemorrhage. Within group II, in the SFP population, abdominal hemorrhage was responsible for hypotension in 34 of 40 (85%), and 10 patients died (25%). In patients with UFP injury, hemorrhage was predominantly from a pelvic source, as shown by 27 positive angiograms in the 46 patients (59%). Twenty-four of 46 (52%) UFP patients died. In patients with a UFP, 14 had both angiography and celiotomy. Four patients underwent angiography before celiotomy and one of four (mortality, 25%) died. In contrast, 10 patients underwent celiotomy before angiography and 6 of 10 died (mortality, 60%). CONCLUSION Patients with signs of ongoing shock with SFP pelvic injury and hemoperitoneum require celiotomy as the initial intervention, as the hemorrhagic focus is predominantly intraperitoneal. In patients with UFP, even in the presence of hemoperitoneum, consideration should be given to angiography before celiotomy.
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Affiliation(s)
- Brian J Eastridge
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75390, USA.
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48
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Sharpe RP, Pryor JP, Gandhi RR, Stafford PW, Nance ML. Abdominal compartment syndrome in the pediatric blunt trauma patient treated with paracentesis: report of two cases. J Trauma 2002; 53:380-2. [PMID: 12169953 DOI: 10.1097/00005373-200208000-00034] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Richard P Sharpe
- Department of Pediatric General and Thoracic Surgery, Children's Hospital of Philadelphia, Pennsylvania, 19104, USA
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49
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Pommier C, Perrin C, Dorne R, De Roissard JP, Arnould P. [Hemoperitoneum and pregnancy in a patient with von Willebrand's disease type 3]. Ann Fr Anesth Reanim 2002; 21:436-9. [PMID: 12078440 DOI: 10.1016/s0750-7658(02)00639-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 24-year-old woman with type 3 (characterised by a blood level of von Willebrand factor less than 1%) was admitted to the surgical intensive care unit with an haemorrhagic shock. She was pregnant (Beta HCG = 115 Ul.L-1), the echography of the abdomen, soon after admission, revealed a haemoperitoeum. She underwent abdominal surgery after substitution treatment. The surgeon found an ovarian haemorrhagic cyst. Later the course of pregnancy was normal and she was delivered by caesarean section. We describe the therapeutic strategy of that care.
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Affiliation(s)
- C Pommier
- Service de réanimation polyvalente, hôpital St Joseph-St Luc, 9, rue du Pr Grignard, 69007 Lyon, France.
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50
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Abstract
A review of the literature describing the management of hepatic and splenic injuries indicates that as many as 67% of exploratory celiotomies for blunt trauma are reported as nontherapeutic. Avoiding unnecessary surgery through nonoperative management offers an attractive alternative. Nonetheless, nonoperative management should not be considered unless the patient meets the following criteria: (1) hemodynamic stability, with or without minimal fluid resuscitation; (2) no demonstrable peritoneal signs on abdominal examination; and (3) the absence on computed tomography (CT) scan of any intraperitoneal or retroperitoneal injuries that require operative intervention. Although a patient may meet these criteria, several additional factors can serve as predictors of failure of nonoperative management. Such predictors among patients with hepatic injuries are hemodynamic instability, liver injury of American Association for the Surgery of Trauma grades IV and V (especially when accompanied by hemodynamic instability), and pooling of contrast on CT scan. Formerly thought to be a predictor of failure of nonoperative management, periportal tracking has not been cited as such in recent reports of hepatic injuries. Among patients with blunt splenic injuries, such predictors include hemodynamic instability, injury of grade IV or higher, large associated hemoperitoneum, and contrast blush on CT scan. Although preexisting splenic disease and age older than 55 years have traditionally been considered predictors of failure, recent reports have shown that these characteristics do not appear to be associated with an increased need for surgical intervention.
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Affiliation(s)
- M G Ochsner
- Trauma Services and Surgical/Critical Care, Department of Surgical Education, Memorial Health University Medical Center, Mercer University School of Medicine, Savannah, Georgia 31404, USA.
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