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Mileva B, Georgieva M, Tsranchev II, Goshev M, Gulinac M, Alexandrov A. Abdominal Apoplexy: Sudden Death Due to Massive, Nontraumatic Intra-abdominal Hemorrhage. Cureus 2023; 15:e47335. [PMID: 38021727 PMCID: PMC10657205 DOI: 10.7759/cureus.47335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Abdominal apoplexy or idiopathic spontaneous intraperitoneal hemorrhage (ISIH), the modern way to describe this condition, is a rare phenomenon representing intra-abdominal bleeding with no traumatic origin. The condition is severe and potentially life-threatening. A man in his 70s was found dead at his home. The autopsy revealed a massive hemoperitoneum with no visible traumatic injuries externally or internally. The source of the bleeding was unknown despite the careful examination of the internal organs and splanchnic vessels. The cause of death was attributed to massive exsanguination due to the rupture of a small blood vessel as a complication of generalized arteriosclerosis and hypertensive disease. Despite its rare occurrence, the forensic pathologist should always consider this pathological condition when, during the autopsy, a massive intraabdominal hemorrhage with or without a visible source of the bleeding is discovered in the absence of any visible traumas.
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Affiliation(s)
- Biliana Mileva
- Department of Forensic Medicine and Deontology, Medical University Sofia, Sofia, BGR
| | - Mihaela Georgieva
- Department of Forensic Medicine and Deontology, Medical University Sofia, Sofia, BGR
| | - Ivan I Tsranchev
- Department of Forensic Medicine and Deontology, Medical University of Plovdiv, Plovdiv, BGR
| | - Metodi Goshev
- Department of Forensic Medicine and Deontology, Medical University Sofia, Sofia, BGR
| | - Milena Gulinac
- Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv, BGR
| | - Alexandar Alexandrov
- Department of Forensic Medicine and Deontology, Medical University Sofia, Sofia, BGR
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Chowdary PB, Maheshwari G, Haynes M, Amaechi I, Dickson-Lowe R. Intraperitoneal Haemorrhage Secondary to Rupture of Right Colic Artery Pseudoaneurysm: A Case Report and Literature Review. Cureus 2023; 15:e44634. [PMID: 37799213 PMCID: PMC10548298 DOI: 10.7759/cureus.44634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/07/2023] Open
Abstract
This article presents the case of a 58-year-old woman who presented feeling unwell with pain in the right upper abdomen for three days. She had a history of splenic infarcts, was on lifelong warfarin and had recently returned from a trip to Gambia. She was admitted to the hospital under suspicion of sepsis of unknown origin, and a CT scan later revealed haemoperitoneum along with a pseudoaneurysm of the right colic artery. After initially responding to resuscitation, the patient deteriorated haemodynamically, and a decision was made to perform a laparotomy, revealing a ruptured right colic artery pseudoaneurysm. In this article, the authors highlight the challenges of managing a complex unwell patient with a ruptured right colic artery pseudoaneurysm, emphasising the importance of a multi-disciplinary team approach and shared decision-making and reviewing the available literature.
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Affiliation(s)
| | - Gaurav Maheshwari
- General and Colorectal Surgery, Medway NHS Foundation Trust, Gillingham, GBR
| | - Maria Haynes
- Pathology, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, GBR
| | - Iheoma Amaechi
- Interventional Radiology, Medway NHS Foundation Trust, Gillingham, GBR
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3
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Qaraqe TM, Abou Daher A, Alami RS. Abdominal apoplexy: A rare case of spontaneous middle colic artery rupture with transverse colectomy. Int J Surg Case Rep 2021; 81:105835. [PMID: 33887831 PMCID: PMC8027271 DOI: 10.1016/j.ijscr.2021.105835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/11/2022] Open
Abstract
Idiopathic spontaneous intraperitoneal hemorrhage (ISIH) is a rare but potentially fatal entity. This is a 27-years old male with a massive hemoperitoneum due to ruptured middle colic artery without evidence of prior pathology. The patient’s condition necessitated a damage control exploratory laparotomy for evacuation of the hemoperitoneum, ligation of the middle colic artery and transverse colectomy. The post-operative course was uneventful afterwards and the patient was discharged a week after presentation with full recovery. To our knowledge, this is the third case report in the literature of a spontaneous middle colic artery rupture with no underlying pathology.
Introduction and importance Idiopathic spontaneous intraperitoneal hemorrhage (ISIH) is a rare but potentially fatal entity. The majority of the reported cases of ISIH due to middle colic artery rupture are associated with pseudoaneurysm. Our case is unique in that no pathology could be identified. To our knowledge, this is the third case report in the literature of a spontaneous middle colic artery rupture with no underlying pathology. Case presentation In our report, we present the case of a 27-years old male presenting with a hemoperitoneum due to ruptured middle colic artery with no evidence of pseudoaneurysm or any other pathology. The patient’s hemodynamic status deteriorated abruptly requiring a damage control exploratory laparotomy for evacuation of the hemoperitoneum, ligation of the middle colic artery and transverse colectomy. The post-operative course was uneventful afterwards and the patient was discharged a week after presentation with full recovery. Discussion Patients with ISIH might exhibit the “double rupture” phenomenon, compromising their hemodynamic stability and necessitating urgent surgical interventions. CTA can be of paramount importance to guide such interventions if the patient’s clinical status permits. Angiographic embolization is an acceptable alternative approach in specific situations. Conclusion ISIH should be on the differential diagnosis of any young patient presenting to the ED with an acute abdomen, regardless of the identifiable risk factors.
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Affiliation(s)
- Taha M Qaraqe
- Department of Surgery, American University of Beirut Medical Center, Beirut, 1107-2020, Lebanon
| | - Alaa Abou Daher
- Faculty of Medicine, American University of Beirut, Beirut, 1107-2020, Lebanon
| | - Ramzi S Alami
- Department of Surgery, American University of Beirut Medical Center, Beirut, 1107-2020, Lebanon.
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Saeed Y, Farkas Z, Azeez S. Idiopathic Spontaneous Intraperitoneal Hemorrhage due to Rupture of Short Gastric Artery Presenting as Massive Gastrointestinal Bleeding: A Rare Case Presentation and Literature Review. Cureus 2020; 12:e11499. [PMID: 33354445 PMCID: PMC7744231 DOI: 10.7759/cureus.11499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 11/28/2022] Open
Abstract
Idiopathic spontaneous intraperitoneal hemorrhage (ISIH) or abdominal apoplexy is due to the tear of an intra-abdominal visceral vessel spontaneously where no cause can be identified. It is an uncommon but potentially life-threatening condition that generally shows up as a diagnostic dilemma as well as is related to formidable mortality. Among all the reported cases, the extemporaneous tear of short gastric arteries is extremely rare, but it has never been reported to present with massive gastrointestinal bleeding. We report a rare instance of idiopathic spontaneous intraperitoneal hematoma eroding the stomach wall, causing massive gastrointestinal bleeding.
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Affiliation(s)
- Yasir Saeed
- Internal Medicine, Lincoln Medical and Mental Health Center, New York, USA
| | - Zahava Farkas
- Gastroenterology and Hepatology, Westchester Medical Center, New York, USA
| | - Sulaiman Azeez
- Gastroenterology and Hepatology, Lincoln Medical and Mental Health Center, New York, USA
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Xu Y, Zhou Y, Xie J, Yin X, Zhang X. Intraperitoneal hemorrhage during pregnancy and parturition: Case reports and literature review. Medicine (Baltimore) 2019; 98:e16300. [PMID: 31464889 PMCID: PMC6736139 DOI: 10.1097/md.0000000000016300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We aim to investigate the diagnosis, treatment, and prognosis of intraperitoneal hemorrhage during pregnancy and parturition.Three cases with intraperitoneal hemorrhage during pregnancy and parturition admitted to our hospital from Jan. 2008 to Jan. 2018 were included in this study. One case showed fetal distress. Abdominal ultrasonography and abdominal CT showed pyoperitoneum in 2 cases. Abdominal puncture was performed in 2 patients, and noncoagulant blood was collected. The indications of emergency caesarean section in 3 cases were intraperitoneal hemorrhage. The etiology included rupture of posterior wall of uterus, rupture of blood vessel on uterine surface, and rupture of inflammatory vessel on uterine surface, respectively. The average volume of intraperitoneal bleeding was 2630 ml, and the average transfusion volume was 1530 ml. Caesarean section, and suture hemostasis were performed in 3 cases. The gestational age of delivery were 40 weeks, 40 weeks, and 25 weeks, respectively. There were 1 stillborn fetus and 2 live infants. All the puerperas were cured and discharged.Intraperitoneal hemorrhage in pregnancy is rare and is easily misdiagnosed. The mortality of pregnant women and perinatal infant is high. Therefore, early diagnosis, and timely operation is important.
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Affiliation(s)
- Yalan Xu
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Yuxiang Zhou
- Department of Obstetrics and Gynecology, Mentougou District Hospital, Beijing, China
| | - Junshu Xie
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Xiuju Yin
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Xiaohong Zhang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
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Smith A, Le D, Guileyardo J, Casanova M. Abdominal apoplexy resulting in small bowel obstruction. Proc (Bayl Univ Med Cent) 2017; 29:404-406. [PMID: 27695177 DOI: 10.1080/08998280.2016.11929488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abdominal apoplexy is a rare hemorrhagic condition involving the small arteries or veins within the abdominal cavity. A high degree of clinical suspicion, followed by appropriate diagnostic workup and therapeutic intervention, is critical, as nonoperative mortality approaches 100%. Contrary to most previously reported cases, which were associated with hemoperitoneum, we present a patient in which gastroduodenal artery dissection resulted in an organized retroperitoneal hematoma with local compression of the duodenum and subsequent bowel obstruction, resulting in vomiting, aspiration, and death.
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Affiliation(s)
- Avery Smith
- Department of Internal Medicine (Smith, Casanova), Department of Pathology (Le, Guileyardo), and Division of Palliative Care (Casanova), Baylor University Medical Center at Dallas, Texas
| | - Don Le
- Department of Internal Medicine (Smith, Casanova), Department of Pathology (Le, Guileyardo), and Division of Palliative Care (Casanova), Baylor University Medical Center at Dallas, Texas
| | - Joseph Guileyardo
- Department of Internal Medicine (Smith, Casanova), Department of Pathology (Le, Guileyardo), and Division of Palliative Care (Casanova), Baylor University Medical Center at Dallas, Texas
| | - Mark Casanova
- Department of Internal Medicine (Smith, Casanova), Department of Pathology (Le, Guileyardo), and Division of Palliative Care (Casanova), Baylor University Medical Center at Dallas, Texas
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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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Wang H, Xiu D. Abdominal apoplexy because of the rupture of gastroduodenal artery and inferior pancreaticoduodenal artery: A case report. Medicine (Baltimore) 2017; 96:e8264. [PMID: 29068993 PMCID: PMC5671826 DOI: 10.1097/md.0000000000008264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Abstract
RATIONALE Abdominal apoplexy is a rare and fatal emergency event, which is coined as a comparison to the cerebrovascular apoplexy. The exact mechanism of abdominal apoplexy was unclear, but arteriosclerosis, hypertension, abdominal aneurysm, and other predisposing angiopathy were considered to be the main reasons of abdominal apoplexy. The development of the imaging technology gave us more opportunities to confirm the diagnosis of abdominal apoplexy. However, the diagnosis and identification of the bleeding sites still continued to be a challenge. PATIENT CONCERNS A 55-year-old man presented to the emergency department with chief complains of sudden severe abdominal pain. DIAGNOSIS The patient was diagnosed as abdominal apoplexy with 2 synchronous bleeding sites. INTERVENTIONS Angiography confirmed diagnosis of abdominal apoplexy and revealed 2 synchronous bleeding sites in gastroduodenal artery (GDA) and inferior pancreaticoduodenal artery (IPDA). Transcatheter embolization was performed immediately. OUTCOMES The patient recovered and was discharged very soon. Two months later, the patient totally recovered and the hematoma disappeared in the CT imaging. LESSONS The reported case is rare, given the very low incidence of abdominal apoplexy with 2 synchronous bleeding sites in GDA and IPDA. The awareness of abdominal apoplexy was still the key point in the management of this disease. Quick diagnosis by the imaging and immediate embolization were very important for the treatment.
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Gero D, Irinel Simion N, Vuilleumier H, Denys A, Guiu B, Demartines N, Bize PE. Arterial embolization in idiopathic spontaneous intra-peritoneal hemorrhage: case report and review. Diagn Interv Imaging 2014; 95:873-5. [PMID: 24581727 DOI: 10.1016/j.diii.2013.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- D Gero
- Department of Visceral Surgery, centre hospitalier universitaire Vaudois (CHUV), University Hospital of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - N Irinel Simion
- Department of Emergency Medicine, centre hospitalier universitaire Vaudois (CHUV), University Hospital of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - H Vuilleumier
- Department of Visceral Surgery, centre hospitalier universitaire Vaudois (CHUV), University Hospital of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - A Denys
- Department of Diagnostic and Interventional Radiology, centre hospitalier universitaire Vaudois (CHUV), University Hospital of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - B Guiu
- Department of Diagnostic and Interventional Radiology, centre hospitalier universitaire Vaudois (CHUV), University Hospital of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, centre hospitalier universitaire Vaudois (CHUV), University Hospital of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - P E Bize
- Department of Diagnostic and Interventional Radiology, centre hospitalier universitaire Vaudois (CHUV), University Hospital of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland.
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Abstract
Idiopathic spontaneous intraperitoneal hemorrhage (ISIH), or abdominal apoplexy, is due to nontraumatic, small vessel rupture; excluded by definition is hemorrhage associated with aortic aneurysm, gynecologic conditions (including ruptured ectopic pregnancy), and bleeding tumors. As defined, this condition is rare and etiologically complex. We report a case of ISIH associated with ruptured dissection of the gastroduodenal artery (GDA) which occurred following two paracentesis procedures for ascites due to cirrhosis. Severe acute inflammation of the vessel wall and resolving endocardial thrombosis suggest an infectious or “mycotic” etiology for this arterial dissection. Direct vascular injury during paracentesis was excluded as a cause of death. Small artery hemorrhage may be associated with aneurysmal rupture or other vasculopathies. Visceral small vessel aneurysms are rare, and GDA aneurysms are even less common. Although the regional vascular anatomy is complex and finding a bleeding point within a bloody field with no intravascular pressure may be impossible, careful dissection of the smaller vascular branches can be rewarding. Clinical management of ISIH is also challenging since findings may be nonspecific and limited to hemodynamic instability and atypical abdominal pain; however, immediate exploratory surgery is the treatment of choice, and the non-operative mortality approaches 100%.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology at Baylor University Medical Center in Dallas, TX
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Harbour LN, Koch MS, Louis TH, Fulmer JM, Guileyardo JM. Abdominal apoplexy: two unusual cases of hemoperitoneum. Proc (Bayl Univ Med Cent) 2012; 25:16-9. [PMID: 22275776 DOI: 10.1080/08998280.2012.11928772] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abdominal apoplexy, or idiopathic spontaneous intraperitoneal hemorrhage, is a rare and often fatal condition resulting from a variety of disease processes affecting the arterial and venous abdominal vasculature. Preoperative and intraoperative diagnosis and treatment of abdominal apoplexy are challenging. The source of bleeding may remain elusive even after careful autopsy dissection given the absence of intravascular pressure. Despite these challenges, early diagnosis and rapid treatment remain central to a successful outcome, as nonsurgical mortality has approached 100%. Presented here are two fatal cases of abdominal apoplexy, one involving a patient with arterial dissection of the gastroduodenal artery and one involving rupture of the superior mesenteric-portal venous system with perivascular pseudoaneurysm formation.
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Affiliation(s)
- Lori N Harbour
- Departments of Pathology (Harbour, Koch, Guileyardo) and Radiology (Louis, Fulmer), Baylor University Medical Center at Dallas
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Badri F, Packirisamy K, Aryasinghe L, Al Suwaidi M. Abdominal apoplexy: A rare case of spontaneous rupture of the superior mesenteric artery in a hypertensive patient. Int J Surg Case Rep 2012; 3:614-7. [PMID: 23017492 DOI: 10.1016/j.ijscr.2012.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Spontaneous rupture of an intra-abdominal visceral artery is an exceptionally rare and potentially fatal cause of abdominal apoplexy. PRESENTATION OF CASE We present a case of a 54-year-old hypertensive male who developed hypovolemic shock in our Emergency Department after presenting with abrupt onset of abdominal pain and diarrhea. Intra-operative findings revealed rupture of the superior mesenteric artery with massive hemoperitoneum. The bleeding vessel was ligated and the patient made a full recovery after 3 weeks in the Intensive Care Unit. DISCUSSION High index of suspicion is necessary for early preoperative diagnosis and must be considered in any patient with a history of hypertension presenting with abrupt abdominal pain, signs of peritoneal irritation and unexplained hypovolemic shock. Immediate resuscitation and prompt surgical control of bleeding is paramount in patient prognosis. CONCLUSION The seemingly unpredictable nature of abdominal apoplexy must be noted, a precipitating cause in most cases is untraceable and early diagnosis relies solely on awareness of the condition.
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Affiliation(s)
- Faisal Badri
- General Surgery Department, Rashid Hospital, P.O. Box 4545, Dubai, United Arab Emirates
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Khan TA. Abdominal apoplexy. Br J Surg 2005. [DOI: 10.1002/bjs.1800510619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Two cases of the rare condition of abdominal apoplexy are described. The two main clincial presentations of this condition are discussed as is the aetiology. It is suggested that selective visceral angiography might prove helpful in preoperative diagnosis.
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