Acquired ileal diverticulum: an unusual bleeding source

Diagnosis of intraabdominal bleeding caused by spleen injury must be performed in the shortest possible period of time, with little risk for the patient, and with high preciseness. By its simple performance, high preciseness and little risk for the patient, DPL imposes as the predominant method in initial diagnostic of intraabdominal bleeding. Control and monitoring of lavage may duly signalize degree of bleeding. Preciseness of this diagnostic in our series ranges up to 93.3%. DPL method is especially important in a combined neurotrauma. Ultrasonography is a sovereign method in diagnostic of bleeding source as well as in monitoring of bleeding that from the very beginning does not require urgent surgical intervention. Its importance is in monitoring both intrasplenic and subcapsulary hematomas. It is not appliable in disturbed and haemodynamically unstable patients. It is in particular important in children where a maximum conservative attitude with respect to operative treatment has been assumed. CT takes the leading place with respect to preciseness of bleeding area, and the combined thoracoabdominal trauma. Preciseness of CT in our series comes up to 96.6%, but can be applied only in haemodynamically stable patients. Same as US of abdomen so the CT of abdomen represents a prominent method in monitoring of both intrasplenic and subcapsular hematomas, which do not require urgent surgical intervention.

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Management of severe intraoperative hemorrhage during intraventricular neuroendoscopic procedures: the dry field technique

Journal of Neurosurgery ◽

10.3171/2018.4.jns172537 ◽

2019 ◽

Vol 131 (3) ◽

pp. 931-935 ◽

Cited By ~ 3

Author(s):

Joachim Oertel ◽

Stefan Linsler ◽

Akos Csokonay ◽

Henry W. S. Schroeder ◽

Sebastian Senger

Keyword(s):

Endoscopic Surgery ◽

Intraventricular Hemorrhage ◽

Tumor Resection ◽

The Other ◽

Tumor Removal ◽

Reliable Technique ◽

Bleeding Source ◽

Field Technique ◽

Life Threatening ◽

Life Threatening Complication

OBJECTIVEThe unexpected intraoperative intraventricular hemorrhage is a rare but feared and life-threatening complication in neuroendoscopic procedures because of loss of endoscopic vision. The authors present their experience with the so-called “dry field technique” (DFT) for the management of intraventricular hemorrhages during purely endoscopic procedures. This technique requires the aspiration of the entire intraventricular CSF to achieve clear visualization of the bleeding source.METHODSMore than 500 neuroendoscopic intraventricular procedures were retrospectively analyzed over the last 24 years for documented severe hemorrhages, which were treated by the application of the DFT.RESULTSThe technique was required in 6 cases, including tumor resection/biopsy, cyst resection, and intraventricular lavage. Additionally, the technique was applied as part of the planned strategy in 3 cases of endoscopic tumor removal. The hemorrhage was stopped in all cases and no associated postoperative deficits occurred.CONCLUSIONSAlthough severe hemorrhages are rare, the neurosurgeon needs to be aware of them and has to establish strategies for their management. Most hemorrhages can be stopped by constant irrigation and coagulation. In the other rare cases, the DFT is a safe, reliable technique and can be easily incorporated into endoscopic surgery.

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Traumatic hemothorax due to chance fracture requiring emergency surgical management: A report of two cases

SAGE Open Medical Case Reports ◽

10.1177/2050313x18819617 ◽

2018 ◽

Vol 6 ◽

pp. 2050313X1881961 ◽

Cited By ~ 2

Author(s):

Keigo Okamoto ◽

Masutaro Ichinose ◽

Jun Hanaoka

Keyword(s):

Computed Tomography ◽

Vertebral Fracture ◽

Elderly Patients ◽

Transcatheter Embolization ◽

Organ Damage ◽

Fusion Surgery ◽

Bleeding Source ◽

Spinal Fusion Surgery ◽

Chance Fracture ◽

Thoracic Organ

Traumatic hemothorax is usually caused by thoracic organ damage. Cases of atypical bleeding sources may be difficult to diagnose. Here we present two surgical cases of vertebral fracture that caused hemothorax. Case 1: an 81-year-old man was admitted to our hospital after a fall. Computed tomography showed right hemothorax without rib fractures. He suddenly developed shock and intrathoracic hemorrhage. Thoracotomy revealed the bleeding source as a transverse laceration in T7. Case 2: an 83-year-old woman fell on her back and was admitted. Computed tomography indicated an L1 vertebral fracture. A few days later, she suddenly developed a right hemothorax. An intrathoracic hemorrhage was sustained after transcatheter embolization. Thoracotomy revealed a diaphragmatic rupture. Total cross-fracture of the vertebral body solely caused the hemothorax. If bleeding source is unclear in elderly patients, this etiology should be considered. We saved both patients by performing spinal fusion surgery at the appropriate time.

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CT-Angiography for the Detection of a Lower Gastrointestinal Bleeding Source

The American Surgeon ◽

10.1177/000313480507100505 ◽

2005 ◽

Vol 71 (5) ◽

pp. 392-397 ◽

Cited By ~ 7

Author(s):

J. Duchesne ◽

T. Jacome ◽

M. Serou ◽

D. Tighe ◽

A. Gonzales ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Ct Angiography ◽

Diagnostic Algorithm ◽

Lower Gastrointestinal Bleeding ◽

Bleeding Source ◽

Early Evaluation ◽

Contrast Volume ◽

Bleeding Area ◽

Contrast Angiography ◽

Venous Bleeding

The evaluation of lower gastrointestinal bleeding (LGIB) often involves the collaborative efforts of the gastroenterologist, radiologist, and surgeon. Efforts to localize the acute LGIB have traditionally involved colonoscopy, technetium-labeled red blood cell (RBC) scintigraphy, angiography, or a combination of these modalities. The sensitivity of each method of diagnosis is limited, with the most common cause of a negative study the spontaneous cessation of hemorrhage. Other technical factors include vasospasm, lack of adequate contrast volume or exposure time, a venous bleeding source, and a large surface bleeding area. We report the use of multidetector computed tomography (MDCT), or CT-angiography (CT-A), in the initial evaluation of LGIB, and speculate on the incorporation of this technique into a diagnostic algorithm to treat LGIB. MDCT may offer a very sensitive means to evaluate the source of acute LGIB, while avoiding some of the morbidity and intense resource use of contrast angiography, and may provide unique morphologic information regarding the type of pathology. Screening with the more rapid and available MDCT, followed by either directed therapeutic angiography or surgical management, may represent a reasonable algorithm for the early evaluation and management of acute LGIB in which an active bleeding source is strongly suspected.

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Hämoptysen: Wann ist die Bronchoskopie besonders wertvoll?

Karger Kompass Pneumologie ◽

10.1159/000499953 ◽

2019 ◽

Vol 7 (3) ◽

pp. 146-148

Author(s):

Manfred Wagner

Keyword(s):

Diagnostic Accuracy ◽

Detection Rate ◽

Diagnostic Yield ◽

Secondary Analysis ◽

Endoscopic Examination ◽

P Value ◽

Etiological Diagnosis ◽

Bleeding Source ◽

Total Cohort ◽

The Ideal

Background: Bronchoscopy plays a key role to diagnose the etiology, to localize the site, and to identify the sources of the bleeding in patients with hemoptysis, but the ideal timing of an endoscopic examination is still unclear. Methods: We performed a secondary analysis of an observational and multicenter study, aimed at evaluating the epidemiology of hemoptysis in Italy and the diagnostic yield of the most frequently prescribed examinations. The aim of the study was to evaluate whether an early bronchoscopy (i.e., performed during active bleeding/≤48 h after hemoptysis stopped) helps localize bleeding (i.e., site, lobe, lung) and increase diagnostic yield in comparison with a delayed examination. Results: Four hundred eighty-six consecutive adult patients (69.2% males; median [IQR] age: 67 [53-76] years) with hemoptysis requiring an etiological diagnosis and undergoing bronchoscopy were recruited. Bleeding focus could be located more frequently in case of moderate-severe bleedings than in cases of mild hemoptysis (site: 70/154, 45.4%, VS. 73/330, 22.1%; p-value < 0.0001; lobe: 95/155, 61.3%, VS. 95/331, 28.7%; p-value < 0.0001; lung: 101/155, 65.1%, VS. 111/331, 33.5%; p-value < 0.0001). Early bronchoscopy showed a higher detection rate of bleeding source in comparison with delayed examination (site: 76/214, 35.5%, VS. 67/272, 24.6%; p-value = 0.01; lobe: 98/214, 45.8%, VS. 92/272, 33.8%; p-value = 0.007; lung: 110/214, 51.4%, VS. 102/272, 37.5%; p-value = 0.002). Early bronchoscopy did not provide any advantages in terms of increased diagnostic yield, in the total cohort (113/214, 52.8%, VS. 123/272, 45.2%; p-value = 0.10) and in the severity subtypes (mild: 56/128, 43.8%, VS. 88/203, 43.4%; p-value = 0.94; moderate-severe: 57/86, 66.2%, VS. 35/69, 50.7%; p-value = 0.051). Conclusions: Early bronchoscopy helps detect bleeding sources, particularly in cases of moderate-severe hemoptysis, without increasing diagnostic accuracy. Trial registration: ClinicalTrials.gov (identifier: NCT02045394).

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Superficial siderosis: bleeding from the bone marrow after laminectomy for spinal tumor removal

Journal of Neurosurgery Spine ◽

10.3171/2014.8.spine13328 ◽

2014 ◽

Vol 21 (6) ◽

pp. 905-908 ◽

Cited By ~ 4

Author(s):

Junichi Yokosuka ◽

Keisuke Takai ◽

Takashi Komori ◽

Makoto Taniguchi

Keyword(s):

Bone Marrow ◽

Residual Tumor ◽

Spinal Tumor ◽

Neurological Deficits ◽

Superficial Siderosis ◽

Dural Defect ◽

Bleeding Source ◽

Subarachnoid Bleeding ◽

Surgical Data ◽

Intrathecal Space

Superficial siderosis of the CNS is a rare disease characterized by the deposition of hemosiderin in the subpial layers of the CNS as the result of chronic subarachnoid bleeding. The arrest of bleeding is important for preventing the progression of this disease; however, the exact source of bleeding remains unknown in most cases because of a lack of objective surgical data. The authors of this report have described a unique case of superficial siderosis following cervical laminectomy and autograft fusion for the removal of a spinal schwannoma; the bleeding source was verified by intraoperative and histopathological findings. The patient exhibited no obvious neurological deficits, such as hearing loss or cerebellar ataxia, when the superficial siderosis was diagnosed, although there were the social impairments associated with schizophrenia. During repair surgery, the bleeding source was revealed as the bone marrow vasculature of the remaining vertebral arch, and not the fragile vessels at the dural defect or the residual tumor. Chronic bleeding was stopped before the onset of irreversible neurological deficits in this case. Bone marrow exposed to the intrathecal space may represent a chronic bleeding source in patients with superficial siderosis following CNS surgery including laminectomy or craniotomy. The following recommendations have been proposed for superficial siderosis of the CNS from both a preventative and a therapeutic perspective: 1) During CNS surgery, neurosurgeons should make every effort to prevent exposing bone marrow to the intrathecal space to avoid the risk of chronic subarachnoid bleeding. 2) In the case of a large dural defect and pseudomeningocele following CNS surgery, bone marrow around the dural defect should be considered as the bleeding source of superficial siderosis, and such cases should undergo revision surgery before the progression of this disease.

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