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Shintani H, Oura S. A presumed pathological complete response of ruptured hepatocellular carcinoma showing retained intratumoral blood flow after trans-arterial chemo-embolization. Radiol Case Rep 2023; 18:3791-3794. [PMID: 37663557 PMCID: PMC10474350 DOI: 10.1016/j.radcr.2023.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
A 74-year-old women with abdominal pain emergently visited our hospital in a shock status. After hemodynamics stabilization with intravenous fluid/albumin administration and blood transfusion, image evaluation showed perihepatic presumed blood retention and an intrahepatic large tumor. Angiography showed a tumor stain in the liver and no active leakage of the contrast medium from the tumor. These findings led to the diagnosis of ruptured hepatocellular carcinoma (HCC) without active bleeding. The patient, therefore, was treated not with trans-arterial embolization (TAE) but with trans-arterial chemo-embolization (TACE) using 10 mg of epirubicin. Post-TACE images showed marked tumor shrinkage with retained intratumoral blood flow. Under the tentative diagnosis of shrunken but viable HCC, the patient underwent laparoscopic segmentectomy for the HCC. Postoperative pathological study showed coagulative and lytic necrosis, intratumoral bleeding, hemosiderin deposits, massive collagen fiber, infiltration of inflammatory cells, and no viable cancer cells in the resected tumor. These pathological findings highly suggested that chemotherapeutic effect of epirubicin had brought about complete cancer cell death in the area not affected by TAE. Physicians should treat the patients with ruptured HCC, especially when showing stable hemodynamics, not by TAE but by TACE for better clinical outcome. Oncologists should further note that a complete pathological response of HCC could be observed even in cases of retained intratumoral blood flow.
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Affiliation(s)
- Hiroshi Shintani
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada-city, Japan
| | - Shoji Oura
- Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada-city, Japan
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Yumoto S, Doi K, Higashi T, Shimao Y, Ueda M, Ishihara A, Adachi Y, Ishiodori H, Honda S, Baba H. Intra-abdominal bleeding caused by amyloid transthyretin amyloidosis in the gastrointestinal tract: a case report. Clin J Gastroenterol 2021; 15:140-145. [PMID: 34797488 DOI: 10.1007/s12328-021-01551-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/30/2021] [Indexed: 11/28/2022]
Abstract
Diagnosis of gastrointestinal (GI) amyloidosis is often very difficult because of its nonspecific symptoms. However, a few reports have indicated that serious symptoms such as fatal GI bleeding and obstruction or perforation sometimes lead to a diagnosis of GI amyloidosis. A 79-year-old man was transported to our emergency department with a 1-week history of worsening abdominal pain. Abdominal contrast-enhanced computed tomography showed extravasation from part of the transverse colon wall and moderate ascites. Because intra-abdominal bleeding was suspected, the patient urgently underwent partial resection of the transverse colon, which was the source of the bleeding. Postoperative pathological examination of the tissue specimens led to a diagnosis of amyloid transthyretin amyloidosis. This is the first reported case in which intra-abdominal bleeding led to a diagnosis of GI amyloidosis. We should consider the possibility of GI amyloidosis when intraperitoneal bleeding is observed in elderly patients.
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Affiliation(s)
- Shinsei Yumoto
- Department of Surgery, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Koichi Doi
- Department of Surgery, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Takaaki Higashi
- Department of Surgery, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Yoshiya Shimao
- Department of Pathology, Miyazaki Prefectural Nobeoka Hospital, 2-1-10 Shinkouji, Nobeoka, Miyazaki, 882-0835, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Akira Ishihara
- Department of Pathology, Junwakai Memorial Hospital, Miyazaki, Japan
| | - Yuki Adachi
- Department of Surgery, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Hiroyuki Ishiodori
- Department of Surgery, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Shinobu Honda
- Department of Surgery, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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Bhattacharya P, Zakaria R, Stonelake S, Butler B, Sarma D, Maheswari M, Zaman S. Haemorrhagic shock from solid tumours of the adrenal gland: a case of bleeding primary adrenal lymphoma. Ann R Coll Surg Engl 2021; 103:e101-e105. [PMID: 33645269 DOI: 10.1308/rcsann.2020.7040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Suprarenal or adrenal gland haemorrhage is an uncommon but potentially lethal condition if unrecognised. Adrenal masses rarely present with haemorrhage, but they remain an important differential aetiology for adrenal bleeding. We present a novel case of primary adrenal lymphoma with adrenal haemorrhage in a middle-aged woman who presented with right-sided abdominal pain and class 1 haemorrhagic shock. She was found to have spontaneous unilateral adrenal gland haemorrhage in the absence of any underlying previous pathology. Presenting features, diagnosis and subsequent oncological management are reported.
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Affiliation(s)
- P Bhattacharya
- Department of General Surgery, Sandwell and West Birmingham Hospital, West Bromwich, UK
| | - R Zakaria
- Department of General Surgery, Sandwell and West Birmingham Hospital, West Bromwich, UK
| | - S Stonelake
- Department of General Surgery, Sandwell and West Birmingham Hospital, West Bromwich, UK
| | - B Butler
- Department of General Surgery, Sandwell and West Birmingham Hospital, West Bromwich, UK
| | - D Sarma
- Department of Colorectal Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - M Maheswari
- Department of General Surgery, Sandwell and West Birmingham Hospital, West Bromwich, UK
| | - S Zaman
- Department of General Surgery, Sandwell and West Birmingham Hospital, West Bromwich, UK
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Sato Y, Satta Y, Yasuda H, Kiyokawa H, Yamashita M, Matsuo Y, Itoh F. Intra-abdominal bleeding as a rare complication after colonic endoscopic mucosal resection in a patient taking direct oral anticoagulants. Clin J Gastroenterol 2020; 13:794-798. [PMID: 32648244 DOI: 10.1007/s12328-020-01181-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
We describe the case of an 84-year old female who was taking rivaroxaban 30 mg/day and had a medical history of atrial fibrillation. She underwent endoscopic mucosal resection of a 5-mm adenoma located in the hepatic flexure of the transverse colon. Following the procedure, she developed gradually intensifying abdominal pain, with the appearance of small amount of blood in the feces. For that reason, she visited our facility on the 5th day post-endoscopic mucosal resection. At the time of the visit, contrast-enhanced abdominal computed tomography revealed no extravasation or free air; however, bloody ascites was confirmed in the peritoneal cavity. Thus, the patient was diagnosed with post-endoscopic mucosal resection intra-abdominal hemorrhage and hospitalized the same day. After admission, rivaroxaban was discontinued and patient condition monitored. Because subsequent abdominal computed tomography revealed no distinct increase in bloody ascites, no interventional radiological or surgical procedure was performed, and the patient was discharged after providing only conservative treatment. While hemorrhage and perforation are the main complications after colonic endoscopic mucosal resection, so far, there have been a few reports on the occurrence of intra-abdominal hemorrhage following endoscopic mucosal resection. Emergency treatment is sometimes required in patients with intra-abdominal hemorrhage. It is important to keep in mind that this complication, although very rare, may occur, particularly in patients taking anticoagulants.
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Affiliation(s)
- Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Yusuke Satta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hiroshi Yasuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hirofumi Kiyokawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Masaki Yamashita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yasumasa Matsuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Fumio Itoh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Sugao Street 2-16-1, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
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Wei AL, Guo Q, Wang MJ, Hu WM, Zhang ZD. Early complications after interventions in patients with acute pancreatitis. World J Gastroenterol 2016; 22:2828-2836. [PMID: 26973421 PMCID: PMC4778005 DOI: 10.3748/wjg.v22.i9.2828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/04/2015] [Accepted: 11/24/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify the possible predictors of early complications after the initial intervention in acute necrotizing pancreatitis.
METHODS: We collected the medical records of 334 patients with acute necrotizing pancreatitis who received initial intervention in our center. Complications associated with predictors were analyzed.
RESULTS: The postoperative mortality rate was 16% (53/334). Up to 31% of patients were successfully treated with percutaneous catheter drainage alone. The rates of intra-abdominal bleeding, colonic fistula, and progressive infection were 15% (50/334), 20% (68/334), and 26% (87/334), respectively. Multivariate analysis indicated that Marshall score upon admission, multiple organ failure, preoperative respiratory infection, and sepsis were the predictors of postoperative progressive infection (P < 0.05). Single organ failure, systemic inflammatory response syndrome upon admission, and C-reactive protein level upon admission were the risk factors of postoperative colonic fistula (P < 0.05). Moreover, preoperative Marshall score, organ failure, sepsis, and preoperative systemic inflammatory response syndrome were the risk factors of postoperative intra-abdominal bleeding (P < 0.05).
CONCLUSION: Marshall score, organ failures, preoperative respiratory infection, sepsis, preoperative systemic inflammatory response syndrome, and C-reactive protein level upon admission are associated with postoperative complications.
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