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Giannone F, Cinelli L, Bellissard A, Cherkaoui Z, Felli E, Saviano A, Mayer P, Pessaux P. Spontaneous idiopathic liver hemorrhage: a systematic review of a rare entity. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02500-3. [PMID: 38502311 DOI: 10.1007/s00068-024-02500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Spontaneous idiopathic liver hemorrhage (SILH) is a rare life-threatening condition occurring without a clear and specific etiology. A systematic review was performed to provide guidelines for the perioperative management of patients affected by SILH. A case report was also included. METHODS A systematic search of the last 24-year literature was conducted and the manuscript was structured following point-by-point the PRISMA guidelines. RESULTS After an initial selection of 6995 titles, 15 articles were considered for the final qualitative analysis (n = 22 patients, including the present report). Conservative treatment was chosen in 12 cases (54.5%) with stable clinical conditions, while 9 patients (40.9%) required a primary operative approach for emergency presentation at diagnosis. Direct liver resection was the preferred surgical treatment (n = 6), mostly major hepatectomies (n = 4). Hepatic arterial embolization was performed as the primary operative approach in three patients, followed by emergency laparotomy during the same hospitalization because of rebleeding in one case. Contrast-enhanced CT scan was the gold standard for diagnosis (n = 19). CONCLUSIONS Conservative treatment of SILH is mainly based on stable clinical conditions and may be considered even in case of a limited arterial blush found on imaging. The absence of underlying hepatic or systemic disorders seems to correlate with favorable outcomes and no mortality.
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Affiliation(s)
- Fabio Giannone
- Department of Visceral and Digestive Surgery, University Hospital of Strasbourg, Nouvel Hôpital Civil, 1 Place de L'Hôpital, 67100, Strasbourg, France.
- Institute of Image-Guided Surgery, University Hospital Institute (IHU), 1 Place de L'Hôpital, Strasbourg, France.
- Institute of Viral and Liver Disease, Inserm U1110, University of Strasbourg, 1 Place de L'Hôpital, Strasbourg, France.
| | - Lorenzo Cinelli
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
| | - Arielle Bellissard
- Department of Visceral and Digestive Surgery, University Hospital of Strasbourg, Nouvel Hôpital Civil, 1 Place de L'Hôpital, 67100, Strasbourg, France
| | - Zineb Cherkaoui
- Department of Visceral and Digestive Surgery, University Hospital of Strasbourg, Nouvel Hôpital Civil, 1 Place de L'Hôpital, 67100, Strasbourg, France
- Institute of Image-Guided Surgery, University Hospital Institute (IHU), 1 Place de L'Hôpital, Strasbourg, France
- Institute of Viral and Liver Disease, Inserm U1110, University of Strasbourg, 1 Place de L'Hôpital, Strasbourg, France
| | - Emanuele Felli
- Department of Visceral and Digestive Surgery, University Hospital of Strasbourg, Nouvel Hôpital Civil, 1 Place de L'Hôpital, 67100, Strasbourg, France
- Institute of Image-Guided Surgery, University Hospital Institute (IHU), 1 Place de L'Hôpital, Strasbourg, France
- Institute of Viral and Liver Disease, Inserm U1110, University of Strasbourg, 1 Place de L'Hôpital, Strasbourg, France
| | - Antonio Saviano
- Institute of Viral and Liver Disease, Inserm U1110, University of Strasbourg, 1 Place de L'Hôpital, Strasbourg, France
- Gastroenterology and Hepatology Unit, University Hospital of Strasbourg, 1 Place de L'Hôpital, Strasbourg, France
| | - Pierre Mayer
- Gastroenterology and Hepatology Unit, University Hospital of Strasbourg, 1 Place de L'Hôpital, Strasbourg, France
| | - Patrick Pessaux
- Department of Visceral and Digestive Surgery, University Hospital of Strasbourg, Nouvel Hôpital Civil, 1 Place de L'Hôpital, 67100, Strasbourg, France
- Institute of Image-Guided Surgery, University Hospital Institute (IHU), 1 Place de L'Hôpital, Strasbourg, France
- Institute of Viral and Liver Disease, Inserm U1110, University of Strasbourg, 1 Place de L'Hôpital, Strasbourg, France
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Winkelmann MT, Hagen F, Artzner K, Bongers MN, Artzner C. Dual-Energy CT for Accurate Discrimination of Intraperitoneal Hematoma and Intestinal Structures. Diagnostics (Basel) 2022; 12:diagnostics12102542. [PMID: 36292231 PMCID: PMC9601488 DOI: 10.3390/diagnostics12102542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to evaluate the potential of dual-energy CT (DECT) with virtual unenhanced imaging (VNC) and iodine maps (IM) to differentiate between intraperitoneal hematomas (IH) and bowel structures (BS) compared to linearly blended DECT (DE-LB) images (equivalent to single-energy CT). This retrospective study included the DECT of 30 patients (mean age: 64.5 ± 15.1 years, 19 men) with intraperitoneal hematomas and 30 negative controls. VNC, IM, and DE-LB were calculated. Imaging follow-up and surgical reports were used as references. Three readers assessed diagnostic performance and confidence in distinguishing IH and BS for DE-LB, VNC, and IM. Diagnostic confidence was assessed on a five-point Likert scale. The mean values of VNC, IM, and DE-LB were compared with nonparametric tests. Diagnostic accuracy was assessed by calculating receiver operating characteristics (ROC). The results are reported as medians with interquartile ranges. Subjective image analysis showed higher diagnostic performance (sensitivity: 96.7−100% vs. 88.2−96.7%; specificity: 100% vs. 96.7−100%; p < 0.0001; ICC: 0.96−0.99) and confidence (Likert: 5; IRQ [5−5] vs. 4, IRQ [3−4; 4−5]; p < 0.0001; ICC: 0.80−0.96) for DECT compared to DE-LB. On objective image analysis, IM values for DECT showed significant differences between IH (3.9 HU; IQR [1.6, 8.0]) and BS (39.5 HU; IQR [29.2, 43.3]; p ≤ 0.0001). VNC analysis revealed a significantly higher attenuation of hematomas (50.5 HU; IQR [44.4, 59.4]) than BS (26.6 HU; IQR [22.8, 32.4]; p ≤ 0.0001). DE-LB revealed no significant differences between hematomas (60.5 HU, IQR [52.7, 63.9]) and BS (63.9 HU, IQR [58.0, 68.8]; p > 0.05). ROC analysis revealed the highest AUC values and sensitivity for IM (AUC = 100%; threshold by Youden-Index ≤ 19 HU) and VNC (0.93; ≥34.1 HU) compared to DE-LB (0.64; ≤63.8; p < 0.001). DECT is suitable for accurate discrimination between IH and BS by calculating iodine maps and VNC images.
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Affiliation(s)
- Moritz T. Winkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Florian Hagen
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Kerstin Artzner
- Department of Internal Medicine I, Comprehensive Cancer Center, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Malte N. Bongers
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Christoph Artzner
- Department for Diagnostic and Interventional Radiology, University Hospital Tuebingen, 72076 Tuebingen, Germany
- Correspondence:
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A Rare Cause Of Acute Abdomen In Middle-Aged Man: Idiopathic Spontaneous Hemoperitoneum. Int J Surg Case Rep 2022; 99:107691. [PMID: 36152370 PMCID: PMC9568867 DOI: 10.1016/j.ijscr.2022.107691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/18/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Idiopathic spontaneous hemoperitoneum is a rare and often life-threatening condition. It is an uncommon cause of acute abdomen; it represents a real emergency condition and must be considered in any patient with atypical abdominal pain and hemodynamic instability. Case presentation This is a detailed case presentation and non-operative management of idiopathic spontaneous hemoperitoneum with atypical abdominal pain. This is 45-year-old male was admitted with a history of progressive abdominal pain for one year. He denied any history of recent trauma, physical assault, bleeding disorder, or drug abuse. The plain abdominal film was unremarkable, and a computed tomographic scan with intravenous contrast (CT) revealed an intra-peritoneal hemorrhage, while esophagogastroduodenoscopy (EGD) and CT angiography (CTA) revealed no abnormality. The patient was managed non-operatively with a good outcome. Six days later, the patient was discharged with further follow-up in outpatient. The follow-up computed tomographic scan with intravenous contrast revealed complete resolution of the hemoperitoneum, and the patient remained asymptomatic. Clinical discussion Spontaneous hemoperitoneum is usually the result of an unknown cause in the non-traumatic abdomen. Also, in between 30 and 38 % of documented cases, the source of bleeding could not be determined. The pathogenesis remains unclear. The “double-rupture” phenomenon can explain the clinical deterioration after the initial presentation of the hemodynamically stable. Patient. Prognosis is dependent on early diagnosis and intervention. Conclusion Success with non-surgical management of idiopathic spontaneous hemoperitoneum has been reported in limited cases, including the present one. Idiopathic spontaneous hemoperitoneum is a rare cause of acute abdomen. A rare clinical entity necessitates a high clinical index of suspicion. Uncontrolled hypertension is considered a risk factor. The patient's stability is the key to providing the best management. The non-operative strategy is the cornerstone to approaching Idiopathic spontaneous hemoperitoneum in a stable patient.
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Ishigaki K, Nakai Y, Inokuma A, Suzuki Y, Noguchi K, Kanai S, Suzuki T, Sato T, Hakuta R, Saito K, Saito T, Takahara N, Hamada T, Mizuno S, Kogure H, Nakai Y, Fujishiro M. Intra‐abdominal hemorrhage as a rare complication of endoscopic ultrasonography: A case report. DEN OPEN 2022; 2:e80. [PMID: 35310736 PMCID: PMC8828215 DOI: 10.1002/deo2.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/15/2021] [Accepted: 10/31/2021] [Indexed: 11/08/2022]
Abstract
Intra‐abdominal hemorrhage after endoscopic ultrasonography (EUS) is an uncommon complication, which can lead to potentially fatal outcomes. We describe a case of intra‐abdominal hemorrhage due to left gastric arterial bleeding after EUS. The patient developed severe epigastric pain 10 h after diagnostic EUS for pancreatic cysts. Contrast‐enhanced computed tomography revealed extravasation from the left gastric artery as well as a hematoma in the lesser omentum, which was confirmed by emergent angiography. Spontaneous hemostasis was obtained without embolization and the patient did not have further episodes of intra‐abdominal hemorrhage. Endoscopists should be aware of this rare but serious complication after endoscopic procedures.
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Affiliation(s)
- Kazunaga Ishigaki
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
- Department of Chemotherapy Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Yousuke Nakai
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
- Department of Endoscopy and Endoscopic Surgery Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Akiyuki Inokuma
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Yukari Suzuki
- Department of Gastroenterology Japanese Red Cross Medical Center Tokyo Japan
| | - Kensaku Noguchi
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Sachiko Kanai
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Tatsunori Suzuki
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Tatsuya Sato
- Department of Gastroenterology Kanto Central Hospital Tokyo Japan
| | - Ryunosuke Hakuta
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
- Department of Endoscopy and Endoscopic Surgery Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Kei Saito
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Tomotaka Saito
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Naminatsu Takahara
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Suguru Mizuno
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Hirofumi Kogure
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Yudai Nakai
- Department of Radiology Graduate School of Medicine the University of Tokyo Tokyo Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo Japan
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Spontaneous hemoperitoneum as a rare presentation of gastric lesions: Two case reports. Int J Surg Case Rep 2022; 91:106769. [PMID: 35091354 PMCID: PMC8801985 DOI: 10.1016/j.ijscr.2022.106769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Spontaneous hemoperitoneum is a rare but life-threatening condition. Clinical presentation is usually nonspecific. The aim of this report is to document a rare clinical presentation of two different intramural stomach tumors. Clinical cases A 40-year-old patient with 24 h epigastric pain was admitted to the emergency, pale, with signs of peritoneal irritation. Computed tomography showed an hemoperitoneum with active bleeding in the posterior wall of the stomach. A wedge resection was performed. Histological report revealed a plexiform fibromyxoma (PF). The second case presents a 79-year-old patient with 24 h abdominal pain, fullness and dizziness, pale and with signs of peritoneal irritation. A voluminous exophytic lesion on gastric wall with active bleeding was diagnosed. Wedge resection was performed and histological report demonstrated a gastrointestinal stromal tumor (GIST). Discussion Imaging plays a role in the diagnosis of spontaneous hemoperitoneum, in elucidating a cause and detecting active hemorrhage. Tumor hemorrhage may be the first presentation of an underlying mass. The presence of a bleeding gastric mass of uncertain nature may result in a challenging situation for the surgeon, who is forced to perform a gastric resection without knowing the exact nature of the tumor and hence the extent of gastric resection required. To our knowledge, our case is the first of PF presenting as hemoperitoneum. Hemoperitoneum is rare as first presentation of GIST, with few cases reported in literature. Conclusion We report two extremely rare cases of spontaneous hemoperitoneum as first presentation of gastric tumor. For the diagnosis a high level of suspicion is required. Spontaneous hemoperitoneum is a rare but life-threatening condition. Tumor hemorrhage may be the first presentation of an underlying gastric mass. This is the first case of Plexiform fibromyxoma (PF) presenting as hemoperitoneum.
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McClintock CM, Byard RW, Sebben R, Langlois NEI. Visceral artery aneurysmal lesion of the omentum - a rare cause of spontaneous fatal intra-abdominal hemorrhage. Forensic Sci Med Pathol 2022; 18:470-473. [PMID: 35648287 PMCID: PMC9636286 DOI: 10.1007/s12024-022-00486-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 12/14/2022]
Abstract
We report unexpected death of a 72-year-old man due to a hemoperitoneum (1.9 L of blood in the abdominal cavity). Postmortem examination revealed that the cause of the hemorrhage was an arterial aneurysmal lesion in the greater omentum. The lesion measured 4 × 4 × 6 cm with a generally smooth wall, but with a focal area of rupture within a hemorrhagic region measuring 1 × 2 cm. There was a substantial feeding artery. Histological examination revealed features in keeping with a pseudoaneurysm, but also with some features of a true aneurysm. There was no history of trauma and the rupture of the aneurysmal lesion that had caused the hematoperitoneum was considered to be spontaneous. Prior to his death the deceased had attended hospital for epigastric pain, which was attributed to dyspepsia, but otherwise he had not had symptoms prior to his death.
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Affiliation(s)
- Claire M McClintock
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, SA, Adelaide, Australia
| | - Roger W Byard
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, SA, Adelaide, Australia
- Forensic Science, Adelaide, SA, Australia
| | - Ruben Sebben
- Queen Elizabeth Hospital, Woodville South, SA, Australia
| | - Neil E I Langlois
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, SA, Adelaide, Australia.
- Forensic Science, Adelaide, SA, Australia.
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O'Brien E, Feroz R, Jasani S. Idiopathic spontaneous haemoperitoneum at 4 weeks gestation. BMJ Case Rep 2021; 14:e244470. [PMID: 34511413 PMCID: PMC8438716 DOI: 10.1136/bcr-2021-244470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/03/2022] Open
Abstract
A 20-year-old nulliparous patient with acute-onset abdominal pain and imaging suggestive of haemoperitoneum was admitted for observation. Though, initially, haemodynamically stable, her clinical picture worsened throughout her hospitalisation and warranted two separate laparoscopies that revealed 1200 mL and 50 mL of haemoperitoneum, respectively, without an identifiable bleeding source. After serial β-human chorionic gonadotropin levels and ultrasound confirmation of a viable pregnancy 23 days later, the patient underwent a normal antenatal course and delivered a healthy infant at 37 weeks gestation. This unusual case highlights the need to consider spontaneous haemoperitoneum in pregnancy as a diagnosis, particularly in the setting of pregnancy of unknown location, even at an early stage of pregnancy.
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Affiliation(s)
- Emily O'Brien
- Obstetrics and Gynecology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Rehan Feroz
- Obstetrics and Gynecology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Sona Jasani
- Obstetrics and Gynecology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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Balalau OD, Conea IM, Bacalbasa N, Dumitriu AS, Paunica S, Vasilache A, Olaru OG. Management of hemoperitoneum due to rupture of the ovarian cyst. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2021. [DOI: 10.25083/2559.5555/6.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Ovarian cyst is the most common female gynecological pathology and it is characteristic of reproductive age. Its rupture causes the sudden onset of pelvic-abdominal pain, often associated with physical exertion or sexual contact. The differential diagnosis is made with other causes of lower abdominal pain: ectopic pregnancy, adnexal torsion, pelvic inflammatory disease or acute appendicitis. The clinical picture may vary depending on the type of ruptured cyst. Dermoid cyst causes severe symptoms due to chemical peritonitis that occurs in response to extravasation of sebaceous contents in the peritoneal cavity.Surgical treatment is indicated for complicated forms of cystic rupture. Most cases have self-limiting, quantitatively reduced bleeding and spontaneous resorption within a few days.Patients diagnosed with ovarian cyst are recommended for regular ultrasound monitoring to prevent complications such as cystic rupture or adnexal torsion.The identification of any ovarian tumor mass in the woman at menopause requires further investigation to rule out the causes of malignancy.
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Scheinfeld MH, Schwartz C, Jain VR, Goldman IA. Non-traumatic hemoperitoneum in the ED setting: causes, characteristics, prevalence and sex differences. Abdom Radiol (NY) 2021; 46:441-448. [PMID: 32766930 DOI: 10.1007/s00261-020-02699-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Prevalence and sex differences of non-traumatic hemoperitoneum in the Emergency Department has not been studied in the literature. METHODS Following IRB approval, multiple keyword searches were used to identify all cases of hemoperitoneum over a 55-month period. Cases were reviewed to confirm and quantify the hemoperitoneum. Maximum attenuation was used to grade blood density. Medical records were reviewed to determine cause, interventions and outcomes in each patient. RESULTS Of the 171 verified cases of non-traumatic hemoperitoneum, 76% of cases were in women. CT exams in women were positive for hemoperitoneum 0.25% of the time, while 0.13% were positive in men. Regarding size, 25.7% were large, 24.5% were moderate and 49.7% were small. Contrast-enhanced studies had HU values of 103 ± 19 (range 47-146) which were significantly higher than for non-enhanced studies with values of 82 ± 19 (range 43-121, p < 0.001). The most common cause of non-traumatic hemoperitoneum was ruptured ovarian cyst which was found in 58% of women (76 cases). Of these, 69 patients received observation, 6 patients underwent surgery and 1 patient received Vitamin K. For the 95 non-ovarian cyst cases, 65% patients were admitted and then discharged, 22% were discharged from the ED, 12% expired and 1% were transferred to a different hospital. Post-procedure hemorrhage was the second to most common cause in women (24/130 = 18%) and the most common etiology in men (14/41 = 34%). CONCLUSIONS In women, ovarian cyst rupture was the most common etiology of hemoperitoneum. Post-procedure hemorrhage was second in women and the most common etiology in men. Although unusual causes of hemoperitoneum will be encountered, understanding the most common causes of hemoperitoneum can provide a reasonable starting point when attempting to determine the most likely etiology of hemoperitoneum in any individual patient.
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Affiliation(s)
- Meir H Scheinfeld
- Division of Emergency Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY, 10467, USA.
| | - Carly Schwartz
- Division of Emergency Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY, 10467, USA
| | - Vineet R Jain
- Division of Emergency Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY, 10467, USA
| | - Inessa A Goldman
- Division of Emergency Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY, 10467, USA
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Huang D, Lowe S, Kumaran P, Choy KT. Ruptured salpingitis isthmica nodosa: a rare cause for spontaneous haemoperitoneum. BMJ Case Rep 2021; 14:14/1/e237860. [PMID: 33500302 PMCID: PMC7839878 DOI: 10.1136/bcr-2020-237860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Salpingitis isthmica nodosa (SIN) is the nodular swelling or diverticulum of the isthmus of the fallopian tube. It is most commonly identified when investigating female infertility or in association with ruptured ectopic pregnancies. We experienced a rare and atypical presentation of SIN. A 33-year-old woman presented with a 1-hour history of acute lower abdominal pain associated with nausea and vomiting. CT and pelvic ultrasound revealed haemoperitoneum with no radiological evidence for its aetiology. Initial beta-human chorionic gonadotropin excluded ectopic pregnancy. A diagnostic laparoscopy was performed following clinical deterioration of the patient. Active bleeding of the right fallopian tube was identified and managed with a right partial salpingectomy, with subsequent histopathology revealing ruptured SIN. There have been no reported cases of SIN being a primary cause for an acute abdomen or haemoperitoneum in the absence of an ectopic pregnancy, making this case a surgical novelty.
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Affiliation(s)
- Dora Huang
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Sandon Lowe
- Department of Surgery, North West Regional Hospital, Burnie, Tasmania, Australia
| | - Pravena Kumaran
- Department of Surgery, North West Regional Hospital, Burnie, Tasmania, Australia
| | - Kay Tai Choy
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
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Kumari J, Harkin R. Abdominal apoplexy during pregnancy. BMJ Case Rep 2020; 13:13/10/e235946. [PMID: 33127691 DOI: 10.1136/bcr-2020-235946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. 'Abdominal apoplexy' (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.
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Affiliation(s)
- Jasmeet Kumari
- Obstetrics and Gynaecology, Our Lady of Lourdes, Drogheda, Ireland
| | - Rosemary Harkin
- Obstetrics and Gynaecology, Our Lady of Lourdes, Drogheda, Ireland
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Joshi U, Upadhaya SR, Agrawal V, Rana A. Pancreatic Tumors Complicating Pregnancy: A Concern for Fetomaternal Well Being. Int Med Case Rep J 2020; 13:255-259. [PMID: 32765121 PMCID: PMC7367919 DOI: 10.2147/imcrj.s263298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/20/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Hemoperitoneum resulting from the rupture of pancreatic tumors is a rare condition, especially during pregnancy. CASE PRESENTATION We report a case of a 21-year-old gravida 2, para 1, at 25+5 weeks of gestation, who presented to the hospital with severe epigastric pain and decreased fetal movement. Ultrasonography showed intrauterine fetal death, a retroperitoneal mass in the epigastric region, and hemoperitoneum. Computed tomography scan revealed a heterogeneously enhancing pancreatic mass suggestive of pancreatic neoplasm. However, the late diagnosis and the delay in treatment resulted in a deterioration of maternal status with eventual mortality. CONCLUSION Diagnostic difficulties occur because of the rarity of the condition and vague clinical presentations. In case of a pregnancy complicated by hemoperitoneum, prompt effort to stop the intraperitoneal bleeding is imperative.
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Affiliation(s)
- Utsav Joshi
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Correspondence: Utsav Joshi Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, PO Box 1524, Kathmandu, NepalTel +977 98 4972 6254Fax +977 1 4423771 Email
| | - Sandesh Raj Upadhaya
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Vishakha Agrawal
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ashma Rana
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Abstract
Abdominal apoplexy, otherwise known as intraperitoneal idiopathic spontaneous haemorrhage, is a rare condition that presents as a diagnostic dilemma and is associated with high mortality. Symptoms and signs typically are similar to other conditions presenting with upper abdominal peritonitis. Intraabdominal haemorrhage can occur from many different causes, including trauma, iatrogenic, ruptured aneurysm, gynaecological conditions, malignancy, and inflammatory or autoimmune processes. Spontaneous or idiopathic causes are much rarer. Prompt diagnosis and ligation of the bleeding vessel usually result in a good outcome. Most cases described involve males in the fifth and sixth decade of life who present in the setting of hypertension and known atherosclerotic disease and are managed with laparotomy or are diagnosed at autopsy. We present a case of abdominal apoplexy managed laparoscopically in a healthy 20-year-old male with no pre-existing medical conditions. This case highlights the importance to consider abdominal apoplexy in any demographic.
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Affiliation(s)
- Yang Hwang
- Department of Surgery, Redland Alexandra Hospital, Brisbane, AUS
| | - Richard Gartrell
- Department of Surgery, Princess Alexandra Hospital, Brisbane, AUS
| | - Nicole Winter
- Department of Surgery, Princess Alexandra Hospital, Brisbane, AUS
| | - Harsheet Sethi
- Department of Surgery, Princess Alexandra Hospital, Brisbane, AUS
| | - Chung Kwun Won
- Department of Surgery, Princess Alexandra Hospital, Brisbane, AUS
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14
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Ly VK, Manesh R, Raghavan K, Geha RM. Follow the Beads: Fibromuscular Dysplasia. Am J Med 2019; 132:329-332. [PMID: 30290190 DOI: 10.1016/j.amjmed.2018.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Vy K Ly
- Department of Medicine, University of California, San Francisco.
| | - Reza Manesh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Kesav Raghavan
- Department of Radiology, University of California, San Francisco
| | - Rabih M Geha
- Department of Medicine, University of California, San Francisco; Medical Service, VA Medical Center, San Francisco, Calif
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15
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Lemaire A, Bonnin M, Storme B, Fournet-Fayard A, Rosano G, Vernis L, Cayot S, Accocebery M, Dechelotte P, Boyer L, Gallot D, Futier E, Constantin JM, Bazin JE. Hemoperitoneum in peripartum: A case-series. J Neonatal Perinatal Med 2018; 10:451-454. [PMID: 29286937 DOI: 10.3233/npm-171659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hemorrhages are the first cause of perinatal deaths in French women. Thirteen percent of these deaths are not linked to obstetrical problems but rather to hemoperitoneum. These incidents are under-diagnosed and as a result, treatment is delayed and fetal and maternal mortality increases. We report three cases of patients, all White female in their last trimester of a non-problematic pregnancy presenting with hemoperitoneum and resulting in different outcomes. The analysis of published materials and of our cases leads us to infer that a diagnosis of hemoperitoneum must be considered in pregnant women when abdominal pain, symptoms of shock and a decrease in hemoglobin are associated. An immediate response and intensive care followed by hemostatic surgery give these patients the best chance to survive.
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Affiliation(s)
- A Lemaire
- Anesthésistes Réanimateurs, Pôle MPO, Gynécologie Obstétrique et Reproduction Humaine, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - M Bonnin
- Anesthésistes Réanimateurs, Pôle MPO, Gynécologie Obstétrique et Reproduction Humaine, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - B Storme
- Anesthésistes Réanimateurs, Pôle MPO, Gynécologie Obstétrique et Reproduction Humaine, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - A Fournet-Fayard
- Anesthésistes Réanimateurs, Pôle MPO, Gynécologie Obstétrique et Reproduction Humaine, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - G Rosano
- Anesthésistes Réanimateurs, Pôle MPO, Gynécologie Obstétrique et Reproduction Humaine, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - L Vernis
- Anesthésistes Réanimateurs, Pôle MPO, Gynécologie Obstétrique et Reproduction Humaine, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - S Cayot
- Anesthésistes Réanimateurs, Pôle MPO, Réanimation Adultes, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - M Accocebery
- Gynécologues Obstétriciens, Pôle Gynécologie Obstétrique et Reproduction Humaine, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - P Dechelotte
- Anatomopathologiste, Anatomie et Cytologie Pathologiques, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - L Boyer
- Radiologue, Imagerie Médicale et Radiologie Interventionnelle, Hôpital Gabriel Montpied, Place Henri Dunant, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - D Gallot
- Gynécologues Obstétriciens, Pôle Gynécologie Obstétrique et Reproduction Humaine, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - E Futier
- Anesthésistes Réanimateurs, Pôle MPO, Gynécologie Obstétrique et Reproduction Humaine, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - J M Constantin
- Anesthésistes Réanimateurs, Pôle MPO, Réanimation Adultes, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
| | - J E Bazin
- Anesthésistes Réanimateurs, Pôle MPO, Gynécologie Obstétrique et Reproduction Humaine, Hôpital Estaing, CHU Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
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16
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Abbas AM, Michael A, Nasif F, Ali SS. Spontaneous Rupture of Subserous Uterine Vein in a 35-Weeks Pregnant Woman Who Presented with Massive Hemoperitoneum. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ahmed M. Abbas
- Department of Obstetrics and Gynecology, Woman's Health Hospital, and Faculty of Medicine, Assiut University, Assuit, Egypt
| | - Armia Michael
- Department of Obstetrics and Gynecology, Woman's Health Hospital, and Faculty of Medicine, Assiut University, Assuit, Egypt
| | - Fady Nasif
- Department of Obstetrics and Gynecology, Woman's Health Hospital, and Faculty of Medicine, Assiut University, Assuit, Egypt
| | - Shymaa S. Ali
- Department of Obstetrics and Gynecology, Woman's Health Hospital, and Faculty of Medicine, Assiut University, Assuit, Egypt
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17
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Death due to non-traumatic hemoperitoneum in Milan 2002–2016, with focus on two cases of abdominal apoplexy (idiopathic spontaneous hemoperitoneum) and review of the literature. Leg Med (Tokyo) 2017; 29:13-17. [DOI: 10.1016/j.legalmed.2017.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/12/2017] [Accepted: 09/23/2017] [Indexed: 11/20/2022]
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18
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Schwitkis A, Shen S, Vos E, Torbati SS. Spontaneous Hemoperitoneum from Rupture of Massive Leiomyoma. Clin Pract Cases Emerg Med 2017; 1:148-149. [PMID: 29849383 PMCID: PMC5965420 DOI: 10.5811/cpcem.2017.1.33190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/11/2017] [Accepted: 01/15/2017] [Indexed: 11/17/2022] Open
Affiliation(s)
- Arielle Schwitkis
- Cedars-Sinai Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Steven Shen
- Cedars-Sinai Medical Center, Department of Emergency Medicine, Los Angeles, California
| | - Elaine Vos
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan
| | - Sam S Torbati
- Cedars-Sinai Medical Center, Department of Emergency Medicine, Los Angeles, California
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19
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Choi YM, Jeong SU, Jwa HY, Choi EK, Kim MJ. [Hemoperitoneum from Spontaneous Rupture of a Metastatic Abdominal Lymph Node in Gallbladder Cancer: A Case Report]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 69:79-82. [PMID: 28135796 DOI: 10.4166/kjg.2017.69.1.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Gallbladder (GB) cancer is asymptomatic in nature, making diagnosis and treatment difficult. The lymph node status is the strongest predictor of long-term survival for patients with GB cancer, and a complete removal of regional lymph nodes is important for patients undergoing radical resection of GB cancer. Unfortunately, lymph node metastases are common in the early stages of GB cancer. However, there have only been a few cases describing the symptoms or complications of metastatic lymph nodes in patients with GB cancer. Although hemoperitoneum caused by metastatic lymph nodes can occur with several cancers, it is very rare. To the best of our knowledge, hemoperitoneum from spontaneous ruptures of metastatic lymph nodes with GB cancer has not yet been reported. Herein, we describe such a case in a patient newly diagnosed with GB cancer.
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Affiliation(s)
- Young Min Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Hye Young Jwa
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Kwang Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Min Jung Kim
- Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
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20
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21
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Lopera Toro AR, Correa Ochoa JJ, Martínez González CH. Hemoperitoneo como manifestación inicial de tumor testicular. Rev Urol 2016. [DOI: 10.1016/j.uroco.2015.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Leung A, Roberts MJ, Perera M, Pretorius CF. Fatal intraperitoneal hepatic bleeding due to metastatic deposit of unknown primary: a tribulation for a regional surgeon. ANZ J Surg 2016; 88:E670-E671. [PMID: 27117679 DOI: 10.1111/ans.13629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Amy Leung
- School of Medicine, James Cook University, Townsville, Queensland, Australia.,Department of Surgery, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Matthew J Roberts
- Department of Surgery, Mackay Base Hospital, Mackay, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Marlon Perera
- Department of Surgery, Mackay Base Hospital, Mackay, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Casper F Pretorius
- School of Medicine, James Cook University, Townsville, Queensland, Australia.,Department of Surgery, Mackay Base Hospital, Mackay, Queensland, Australia
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23
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Hemoperitoneo espontáneo secundario a metástasis en el ligamento redondo hepático, una presentación atípica. Cir Esp 2016; 94:184-6. [DOI: 10.1016/j.ciresp.2015.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 10/06/2015] [Indexed: 11/24/2022]
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24
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Massive hemoperitoneum due to a ruptured corpus luteum cyst in a patient with congenital hypofibrinogenemia. Obstet Gynecol Sci 2015; 58:427-30. [PMID: 26430672 PMCID: PMC4588852 DOI: 10.5468/ogs.2015.58.5.427] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/12/2015] [Accepted: 03/13/2015] [Indexed: 11/27/2022] Open
Abstract
Congenital afibrinogenemia/hypofibrinogenemia is a rare inherited hematologic disorder in which a patient lacks or has insufficient level of fibrinogen, the blood coagulation factor I. The incidence of this uncommon disease is 1 to 2 per 1 million individuals. Hence, massive hemoperitoneum caused by ovulation in a woman with congenital afibrogenemia is also a very rare clinical condition. Massive hemoperitoneum usually presents as acute abdominal pain with potential findings of peritonitis including abdominal distention, hypotension and tachycardia with critical consequences. We performed emergent endoscopic surgery for hemoperitoneum caused by a ruptured corpus luteum cyst in a patient with congenital hypofibrinogenemia. To the best of our knowledge, this was the first case report of such treatment in Korea.
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25
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Singh Bhinder N, Zangan SM. Hepatocellular carcinoma rupture following transarterial chemoembolization. Semin Intervent Radiol 2015; 32:49-53. [PMID: 25762848 DOI: 10.1055/s-0034-1396964] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As the incidence of primary and metastatic liver cancer increases, minimally invasive treatment methods such as transarterial chemoembolization (TACE) have gained momentum as their efficacy and safety profile have been validated. Complications of TACE are rare and typically well tolerated. A unique complication is tumor rupture with hemorrhage. Reports of hepatocellular carcinoma (HCC) rupture after TACE are limited. It is critical to recognize this complication and understand the treatment options, which range from conservative to surgical management. This report describes a case of HCC rupture following TACE successfully managed with coil embolization.
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Affiliation(s)
- Nimarta Singh Bhinder
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
| | - Steven M Zangan
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
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26
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George J, Ben-Sassi A, Dixon R. Spontaneous haemoperitoneum due to a sigmoid diverticulum. BMJ Case Rep 2014; 2014:bcr-2014-207849. [PMID: 25480140 DOI: 10.1136/bcr-2014-207849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spontaneous haemoperitoneum is rare. When it occurs it is a life-threatening condition. Common causes of this are gynaecological in nature and rarely due to colonic diverticular perforation. Diverticulitis is a common condition affecting people in western countries. This presentation of spontaneous haemoperitoneum highlights the disproportionate abdominal pain and opioid-induced constipation. Significant bloods on admission included haemoglobin of 148 g/L, C reactive protein (CRP) of 1.1 mg/L, white cell count (WCC) of 12.7×10(9)/L (neutrophils 10.9×10(9)/L). Bloods repeated 10 h later revealed the haemoglobin had dropped to 100 g/L, CRP had increased significantly to 120 mg/L, WCC: 7.4×10(9)/L (neutrophils 5.3×10(9)/L) and a reduced packed cell volume: 0.307 L/L. CT scan revealed free fluid and a possible mass. At laparoscopy, frank haemoperitoneum was seen and a decision was made to open and perform a Hartmann's procedure. The patient did very well postoperatively and was discharged on the ninth postoperative day. He is currently awaiting reversal of the ileostomy.
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Affiliation(s)
- Jayan George
- Respiratory Department, Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Abozed Ben-Sassi
- Department of General Surgical Directorate, Wrexham Maelor Hospital, Wrexham, UK
| | - Rebecca Dixon
- Department of Radiology, Wrexham Maelor Hospital, Wrexham, UK
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27
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Beachler TM, Bailey CS, McKelvey KA, Davis JL, Edwards A, Diaw M, Vasgaard JM, Whitacre MD. Haemoperitoneum in a pregnant mare with an ovarian haematoma. EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T. M. Beachler
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - C. S. Bailey
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - K. A. McKelvey
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - J. L. Davis
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - A. Edwards
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - M. Diaw
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - J. M. Vasgaard
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
| | - M. D. Whitacre
- College of Veterinary Medicine; North Carolina State University; Raleigh USA
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28
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Myers LA, Herr K, Reddy S. Highlights from the scientific and educational abstracts presented at the ASER 2013 Annual Scientific Meeting and Postgraduate Course. Emerg Radiol 2014; 21:279-97. [DOI: 10.1007/s10140-014-1213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
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29
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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] [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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Liu YH, Ma HX, Ji B, Cao DB. Spontaneous hemoperitoneum from hepatic metastatic trophoblastic tumor. World J Gastroenterol 2012; 18:4237-40. [PMID: 22919261 PMCID: PMC3422809 DOI: 10.3748/wjg.v18.i31.4237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 04/25/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
Spontaneous hemoperitoneum (SP) is defined as the presence of blood within the peritoneal cavity that is unrelated to trauma. Although there is a vast array of etiologies for SP, primary hepatocellular carcinoma and hepatic adenoma are considered to be the most common causes. Hepatic metastatic tumor associated with spontaneous rupture is rare. SP from hepatic metastatic trophoblastic tumor may initially present with a sudden onset of abdominal pain. Abdominal computed tomography (CT) plays an important role in establishing the diagnosis of SP, indicating its origin and etiology, and determining subsequent management. Herein, we report an uncommon case of hemoperitoneum from spontaneous rupture of a hepatic metastatic trophoblastic tumor in a young female patient. Interestingly, the contrast-enhanced CT findings demonstrated hypervascular hepatic masses with persistent enhancement at all phases, which were completely different from the common appearances of hepatic metastases. For SP resulting from hepatic metastatic tumors, surgical intervention is still the predominant therapeutic method, but the prognosis is very poor.
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Lee JH, Cho SH, Kim SH, Chae WS, Jin HC. Quadriceps muscle rupture mimicking lumbar radiculopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21 Suppl 4:S545-8. [PMID: 22349970 DOI: 10.1007/s00586-012-2191-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 01/05/2012] [Accepted: 02/02/2012] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To report an unusual case of vastus lateralis muscle rupture not accompanied by any history of major trauma or the presence of a risk factor in a patient with spinal stenosis. Isolated vastus lateralis muscle rupture without an obvious cause is very rare. Localized pain and claudication are the most common symptoms and can be misdiagnosed as lumbar radiculopathy. METHODS A 70-year-old patient presented with right lower extremity and back pain, diagnosed as spinal stenosis. He was initially treated with caudal epidural block and transforaminal epidural block, which resulted in nearly complete relief of his symptoms. However, he subsequently experienced a pain that was no longer responsive to treatment. The ultrasonographic exam revealed a partial tear of the right vastus lateralis muscle. RESULT Injection of local anesthetics relieved the patient's symptoms. At 1-month follow-up, he remained pain-free. CONCLUSIONS In patients with lower back and leg pain, physicians should consider non-spinal conditions that can cause signs and symptoms mimicking lumbar radiculopathy.
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Affiliation(s)
- Joon-Ho Lee
- Department of Anesthesiology and Pain Medicine, University of Soonchunhyang, Bucheon Hospital, 1174 Jung-Dong, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do, 420-767, Korea.
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32
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Unexpected natural death secondary to intra-abdominal bleeding: Report of one idiopathic spontaneous intraperitoneal hemorrhage case. Forensic Sci Int 2012; 214:e43-6. [DOI: 10.1016/j.forsciint.2011.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 08/01/2011] [Accepted: 08/03/2011] [Indexed: 11/15/2022]
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33
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Abundant intraperitoneal bleeding after colonoscopy. Clin Res Hepatol Gastroenterol 2011; 35:599-600. [PMID: 21659014 DOI: 10.1016/j.clinre.2011.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 05/09/2011] [Indexed: 02/04/2023]
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34
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Laparoscopic Internal Iliac Artery Ligation for Postpartum Spontaneous Hemoperitoneum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:1172-1175. [DOI: 10.1016/s1701-2163(16)34742-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Freeman BB, Critchlow JF, Cohen S, Edlow JA. Spontaneous intraperitoneal hemorrhage as the initial presentation of a gastrointestinal stromal tumor: a case report. Int J Emerg Med 2010; 3:53-6. [PMID: 20414383 PMCID: PMC2850982 DOI: 10.1007/s12245-009-0141-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 11/04/2009] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Spontaneous hemoperitoneum is rare. The most common etiologies are gynecologic, splenic, and hepatic. Gastrointestinal stromal tumors (GISTs) are commonly associated with intraluminal bleeding, but rarely with spontaneous hemoperitoneum. We report a case of spontaneous hemoperitoneum caused by a gastric GIST. CASE REPORT A 54-year-old male presented with the acute onset of abdominal pain and a drop in hemoglobin. Subsequent evaluation, including a CT, MRI, and EUS, revealed a 1.2-cm mass along the greater curvature of the stomach and associated hemoperitoneum. The patient was taken electively to the operating room for laparoscopic removal of the mass. Pathology confirmed that it was a GIST. CONCLUSION GIST is a rare clinical entity that infrequently presents with spontaneous hemoperitoneum. Emergent treatment should be guided towards treating the spontaneous hemoperitoneum.
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Affiliation(s)
- Benjamin B. Freeman
- Department of Internal Medicine, Robert Wood Johnson University Hospital, 1 Robert Wood Johnson Place, New Brunswick, NJ USA
- 518 Trinity Place, Westfield, NJ 07090 USA
| | - Jonathan F. Critchlow
- Department of Surgery, Beth Israel Deaconess Medical Center, 300 Brookline Avenue, Boston, MA USA
| | - Steven Cohen
- Department of Medicine (Gastroenterology), Beth Israel Deaconess Medical Center, Needham campus, Needham, MA USA
| | - Jonathan A. Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 300 Brookline Avenue, Boston, MA USA
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Baek JB, Seong SH, Won DY, Bae KS, Kim IY. Spontaneous Hemoperitoneum in Patients Taking Anticoagulants. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.78.6.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jong Bum Baek
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung Hoon Seong
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dal Yeon Won
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Keum Seok Bae
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ik Yong Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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Caroselli C, Tomezzoli A, Caroselli C, Longo D, Bruno G. It is never too late: a deceitful gastric ulcer. Intern Emerg Med 2009; 4:409-12. [PMID: 19588224 DOI: 10.1007/s11739-009-0278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 06/08/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Costantino Caroselli
- Dipartimento di Emergenza e Accettazione, Ospedale Civile Maggiore, Azienda Ospedaliera-Istituti Ospitalieri, Piazzale A. Stefani, 1, 37126 Verona, Italy.
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Spontaneous hemoperitoneum from a ruptured mesenteric branch arterial aneurysm: report of a case. Surg Today 2009; 39:721-4. [PMID: 19639443 DOI: 10.1007/s00595-008-3892-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 06/02/2008] [Indexed: 11/27/2022]
Abstract
We report a case of spontaneous intraperitoneal hemorrhage from a ruptured mesenteric branch artery aneurysm in a patient presenting with syncope. A 54-year-old woman was brought to our emergency department as a medical code, following two syncopal episodes. Computed tomography, carried out to rule out aortic aneurysmal disease, revealed hemoperitoneum without evidence of solid organ injury. Emergency exploratory laparotomy revealed a large jejunal mesenteric hematoma accompanying a ruptured mesenteric branch artery aneurysm with active extravasation. We ligated and excised the lesion and diagnosis was confirmed on final pathologic examination. We report this case because general surgeons should be aware of these vascular lesions and the basic guidelines for treatment.
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Durai R, Hoque H, Davies TW. Primary haemoperitoneum. Int J Clin Pract 2009; 63:823-5. [PMID: 19392930 DOI: 10.1111/j.1742-1241.2008.01952.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Tseng C, Tsai J, Chen C, Su C, Lin H. Hemoperitoneum: A Problem in PD Patients with Hepatic Tumors. Perit Dial Int 2009. [DOI: 10.1177/089686080902900222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- C.W. Tseng
- Division of Gastroenterology Department of Medicine Taipei Veterans General Hospital
| | - J.J. Tsai
- Division of Gastroenterology Department of Medicine Taipei Veterans General Hospital
| | - C.C. Chen
- Division of Gastroenterology Department of Medicine Taipei Veterans General Hospital
- Faculty of Medicine National Yang-Ming University Taipei, Taiwan
| | - C.W. Su
- Division of Gastroenterology Department of Medicine Taipei Veterans General Hospital
- Faculty of Medicine National Yang-Ming University Taipei, Taiwan
- Institute of Clinical Medicine National Yang-Ming University Taipei, Taiwan
| | - H.C. Lin
- Division of Gastroenterology Department of Medicine Taipei Veterans General Hospital
- Faculty of Medicine National Yang-Ming University Taipei, Taiwan
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Bae JM, Kim SW. Hemoperitoneum due to Ruptured Gastric Gastrointestinal Stromal Tumor. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2009; 54:123-5. [DOI: 10.4166/kjg.2009.54.2.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jung Min Bae
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Se Won Kim
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
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[Spontaneous intra-abdominal bleeding in twin pregnancy--case report]. SRP ARK CELOK LEK 2008; 136:299-301. [PMID: 18792631 DOI: 10.2298/sarh0806299b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Spontaneous rupture of utero-ovarian vessels is a rare cause of haemoperitoneum in pregnancy, leading to significant maternal and foetal morbidity and mortality. Aetiopathogenesis of this condition is still unclear. Establishing clinical diagnosis of this condition is difficult, but very important. Clinical symptoms are nonspecific, and the diagnosis is usually made at laparotomy. CASE OUTLINE We report a case of spontaneous haematoperitoneum in the third trimester of twin pregnancy. Differential diagnosis included uterine rupture and placental abruption. Due to the deteriorated condition of the patient, it was decided to perform laparotomy which established the diagnosis of ruptured venous varices on the posterior uterine wall. Delivery was performed by caesarean section. The postoperative period was uneventful. CONCLUSION The clinical presentation of spontaneous rupture of utero-ovarian blood vessels is not specific and clinical examination and ultrasonographic scanning may be insufficient for diagnosis. Once the diagnosis of spontaneous haematoperitoneum in pregnancy is established, emergency laparotomy is indicated. Following caesarean delivery, it is necessary to establish surgical haemostasis. There are some authors who suggest leaving the pregnancy intact in cases when the foetus is not viable, although one must have in mind the possibility of recurrent bleeding. The safety of this procedure requires further investigation. It is necessary to have in mind the possibility of blood vessel rupture in all cases of abdominal pain and hypotension of unknown origin during pregnancy.
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Lubner M, Menias C, Rucker C, Bhalla S, Peterson CM, Wang L, Gratz B. Blood in the belly: CT findings of hemoperitoneum. Radiographics 2007; 27:109-25. [PMID: 17235002 DOI: 10.1148/rg.271065042] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hemoperitoneum may occur in various emergent conditions. In the trauma setting, evidence of intraperitoneal blood depicted at computed tomography (CT) should lead the radiologist to conduct a careful search of images for the injured visceral organ (the liver or spleen). Specific CT signs, such as a sentinel clot or extravasation of intravascular contrast material, may indicate the source of bleeding and help direct management. In addition, the configuration of accumulated blood may help identify the injured organ; for example, triangular fluid collections are observed in the mesentery most often in the setting of bowel or mesenteric injury. Less commonly, hemoperitoneum may have a nontraumatic origin. Iatrogenic hemoperitoneum may occur as a complication of surgery or other interventional procedures in the abdominal cavity or as a result of anticoagulation therapy. Hemoperitoneum also may be seen in the setting of blood dyscrasias such as hemophilia and polycythemia vera. Tumor-associated hemorrhage, which most often occurs in hepatocellular carcinoma, hepatic adenoma, or vascular metastatic disease, also may produce hemoperitoneum. Other potential causes of nontraumatic hemoperitoneum are gynecologic conditions such as hemorrhage or rupture of an ovarian cyst and rupture of the gestational sac in ectopic pregnancy, and hepatic hematoma in syndromic hemolysis with elevated liver enzymes and low platelet count (HELLP syndrome). Vascular lesions (visceral artery aneurysms and pseudoaneurysms) that occur in systemic vascular diseases such as Ehlers-Danlos syndrome or in pancreatitis are another less common source of hemoperitoneum.
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Affiliation(s)
- Meghan Lubner
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110, USA.
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Hung SW, Ma HP, Lin ACM, Wang TL, Chong CF, Chen CC. A potentially fatal mystery in acute abdomen: abdominal apoplexy. Am J Emerg Med 2006; 24:740-1. [PMID: 16984849 DOI: 10.1016/j.ajem.2006.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 01/26/2006] [Indexed: 11/17/2022] Open
Affiliation(s)
- Shih-Wen Hung
- Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei 111, Taiwan, ROC.
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