Spontaneous hepatic haemorrhage secondary to ruptured hepatocellular adenoma in a young male patient

2020 ◽  
Vol 13 (8) ◽  
pp. e235966
Author(s):  
Peter Daechul Yoon ◽  
Andy Ze Lin Chen ◽  
David Tovmassian ◽  
Henry Pleass
Keyword(s):  
Massive Transfusion ◽  
Young Male ◽  
Hepatocellular Adenoma ◽  
Exploratory Laparotomy ◽  
Haemorrhagic Shock ◽  
Function Test ◽  
Normocytic Anaemia ◽  
Well Differentiated ◽  
The Right ◽  
Transfusion Protocol

A 27-year-old man presented with acute right upper quadrant abdominal pain and vomiting. He was clinically in hypovolaemic shock. Investigations revealed normocytic anaemia with a normal bilirubin and moderate liver function test abnormalities. CT abdomen and pelvis demonstrated haemoperitoneum and a large solitary hepatic mass in segments V and VI, suspicious for a ruptured hepatic tumour. Massive transfusion protocol was commenced and angioembolisation of the inferior branch of the right hepatic artery was undertaken. Despite this, his haemorrhagic shock was resistant to resuscitation. Thus, he underwent emergent exploratory laparotomy, which resulted in segments V and VI liver resection and packing. Re-look laparotomy 2 days following initial exploration was performed where haemostasis was confirmed. Histopathology revealed a ruptured well-differentiated hepatocellular adenoma. The patient made a good recovery following a 2-week admission.

scholarly journals Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma

2020 ◽  
Vol 13 (2) ◽  
pp. e231995
Author(s):  
Brittany Sanford ◽  
Catherine Hoeppner ◽  
Tammy Ju ◽  
Brian K Theisen ◽  
Anna BuAbbud ◽  
...  
Keyword(s):  
General Surgery ◽  
Case Reports ◽  
Hepatocellular Adenoma ◽  
Multidisciplinary Care ◽  
Exploratory Laparotomy ◽  
Pregnant Patient ◽  
Haemorrhagic Shock ◽  
Liver Adenoma ◽  
Life Threatening ◽  
Temporary Closure

Management of a ruptured hepatocellular adenoma during pregnancy is a rare and potentially life-threatening entity. Few case reports have described management of the pregnant patient who presents in haemorrhagic shock secondary to a ruptured liver adenoma. A 30-year-old primigravid woman at 31 weeks pregnant presented with abdominal pain and fetal bradycardia. After stat caesarean delivery of the infant, she had continued hemoperitoneum and was in shock secondary to an undiagnosed ruptured liver mass. General surgery was consulted intraoperatively and performed an exploratory laparotomy, packing and temporary closure. She was subsequently taken to interventional radiology (IR) for angioembolisation of the left hepatic artery. After stabilisation, she underwent formal abdominal closure. Management of a ruptured hepatocellular adenoma in pregnancy requires urgent multidisciplinary care including obstetrics gynaecology, general surgery and IR.

scholarly journals Protocol Based Blood Management in Major Obstetric Haemorrhage- A Case Series

2021 ◽  
Author(s):  
Kannammadathy Poulose Biji ◽  
Ravindran Rashmi ◽  
Krishnankutty Rekha ◽  
Prabhakaran Vineetha ◽  
Bengalath Abida
Keyword(s):  
Postpartum Haemorrhage ◽  
Massive Transfusion ◽  
Case Series ◽  
Haemorrhagic Shock ◽  
Severe Anaemia ◽  
Blood Management ◽  
First Line ◽  
Massive Transfusion Protocol ◽  
Obstetric Haemorrhage ◽  
Transfusion Protocol

Major obstetric haemorrhage remains the leading cause of maternal mortality globally. Irrespective of the etiology of haemorrhage, rapid and efficient intervention using proactive standardised protocols should gain precedence in the management of major obstetric haemorrhage. As the available resources vary between institutions, protocol specific to each institution is important for timely intervention. This case series reports a few successfully managed cases of obstetric haemorrhage by the implementation of institution based Massive Transfusion Protocol (MTP). Two antenatally diagnosed patients with placenta percreta had elective hysterectomy with bladder repair. The massive haemorrhages in both these cases were managed efficiently with the use of MTP without any sequelae. Another case of atonic Postpartum Haemorrhage (PPH) which did not respond to first line management also was treated successfully with the prompt activation of protocol. A case of uterine rupture with haemorrhagic shock was managed with massive transfusion according to protocol and vasopressors and she survived with no major side effects. A case of traumatic PPH which presented with severe anaemia (Hb 4.6 gm/dL) could also be successfully resuscitated by the timely activation of MTP.

scholarly journals Compartment Syndrome: an Acute Femoral Stress Fracture in a Young Male Athlete

2021 ◽  
Author(s):  
Amelie Kanovsky ◽  
Ernst J. Mueller
Keyword(s):  
Compartment Syndrome ◽  
Muscle Mass ◽  
Stress Fracture ◽  
Acute Stress ◽  
Young Male ◽  
Young Males ◽  
Fatigued Muscle ◽  
Fracture Osteosynthesis ◽  
Initial Fracture ◽  
The Right

AbstractThe incidence of an acute compartment syndrome (ACS) of the thigh is less than 1%. It is most common in the setting of muscle overuse or muscle injury, as well as secondary to trauma, such as a femoral fracture. We present a case of an ACS in a young, healthy, and semiprofessional athlete with normal coagulation who sustained an acute stress fracture of the distal femur. After the initial fracture osteosynthesis, the patient suffered from a compartment syndrome in the right anterior aspect of the distal thigh. Following rapid surgical fasciotomy, the case was uneventful, and he returned to his preinjury sport level without any neurological consequences. This case confirms that ACS in the thigh is rare, but mainly occurs in young males with a large muscle mass due to participation in various athletic programs. We hypothesize that constant muscle over-usage primes for a larger amount of contused and protruding muscle mass in the small femoral compartment. Hence, the fatigued muscle subjects the bone to an increased mechanical force resulting in an overloading process. This ensues the accumulation of femoral microfractures and primes for the occurrence of an increased rate of stress fractures and an ACS in the thigh.

scholarly journals Peritoneal well-differentiated papillary mesothelioma associated with infertility in a 37-year-old woman

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098668
Author(s):  
Bo Pang ◽  
Cong Hu ◽  
Qian Liu ◽  
Jinyu Yu ◽  
Zhentong Wei ◽  
...  
Keyword(s):  
Benign Tumors ◽  
Free Fluid ◽  
Adenomatoid Tumor ◽  
Cancer Antigen 125 ◽  
Immunohistochemical Markers ◽  
Serum Ca125 ◽  
Life Threatening ◽  
Well Differentiated ◽  
The Right

Well-differentiated papillary mesothelioma (WDPM) is an uncommon mesothelial tumor. The lesions may be single or multiple and usually behave in a benign or indolent fashion, sometimes persisting for many years. In the present case, a 37-year-old woman had experienced primary infertility for 12 years, and a diagnostic laparoscopy was performed. Approximately 200 mL of dark red, free fluid in the pelvis and more than 10 yellow-white nodules on the surface of the right round ligament, sacrum ligament, right fallopian tube, and both sides of the uterus were found. A lesionectomy was performed and immunohistochemical markers indicated WDPM with adenomatoid tumor. The patient was monitored by computed tomography and serum CA125 (cancer antigen 125) levels for 49 months with no recurrence. WDPM and adenomatoid tumor are both benign tumors of mesothelial origin. Because of the lack of effective radical treatment, regular follow-up is sufficient. However, the effects of estrogen and progesterone on WDPM and adenomatoid tumors during ovulation or pregnancy remains unclear. Although WDPM is not life threatening, a strategy to fulfill the fertility requirements of women with this condition is a new challenge for infertility doctors.

scholarly journals Aortic Valve Endocarditis with Anomalous Origin of the Right Coronary Artery and Unknown Infected Thrombus in the Dissected Descending Thoracic Aorta

Aorta ◽  
2020 ◽  
Vol 08 (03) ◽  
pp. 076-079
Author(s):  
Juan Caceres ◽  
Vikram Sood ◽  
Linda Farhat ◽  
Bo Yang
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Aortic Root ◽  
Recurrent Infection ◽  
Young Male ◽  
Descending Thoracic Aorta ◽  
Native Valve ◽  
Aggressive Approach ◽  
Aortic Thrombus ◽  
The Right

AbstractWe report an intricate aortic root replacement in a young male patient suffering from native valve infective endocarditis due to Serratia marcescens. Further complicating the total root replacement, there was an unknown infected aortic thrombus and a concomitant anomalous right coronary artery with an intramural course. As a result of our more aggressive approach, we believe that we lowered the risk of recurrent infection of the bioprosthesis of the aortic root.

Blood Provision for Cardiac Ablation (CA) Procedures in the Catheterization Laboratory; a Veteran Affairs Medical Center (VAMC) Experience in a Non-Trauma Center Setting

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S167-S168
Author(s):  
J M Petersen ◽  
V Patel ◽  
D Jhala
Keyword(s):  
Quality Assurance ◽  
Massive Transfusion ◽  
Medical Center ◽  
Case Series ◽  
Blood Bank ◽  
Cardiac Ablation ◽  
Cardiac Perforation ◽  
Catheterization Laboratory ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol

Abstract Introduction/Objective Cardiac perforation is a life-threatening complication (~1% risk, with reported rates between 0.2% to 5%) of CA procedures. As cardiac perforation may lead to extensive bleeding, it would be reasonable for a medical center carrying out CA to be capable of arranging for a massive transfusion protocol and for surgical repair as required. However, there is sparse literature to guide a non-trauma medical center implementing a CA program on what the number of red blood cell (RBC) units for crossmatch should be for each case. Methods In interdisciplinary collaborative meetings, the CA program logistics were agreed to between the multiple clinical services. Given the case series on the amount of drained blood in complicated cases, there was agreement that three units of RBCs would be crossmatched for each case. Education was provided on the massive transfusion protocol and on blood bank procedures. As part of quality assurance/quality improvement, records were reviewed from the beginning of the CA program (10/1/2019) to 1/31/2019 to determine number of patient cases, crossmatched units, and transfused units for quality assurance purposes. Results A total of fifteen patients underwent CA procedures, for which three units were crossmatched for each patient. As there were no cardiac perforations with the cardiac ablation procedures so far, no units were transfused. The organized approach for ensuring adequate blood bank support and education led to the reassurance, alleviation of clinical anxiety, and building of a successful CA program. Education sessions completed with thorough understanding of blood bank procedures including the massive transfusion protocol, labeling of blood bank specimens, and on ordering of blood for crossmatch. Conclusion This study provides a reference that may provide helpful guidance to other blood banks on what the number of RBCs to be crossmatched prior to each CA procedure. Multidisciplinary collaborative meetings in advance are an essential component for ensuring adequate support for CA procedures or any new service that requires blood product support. Thorough education of clinical staff on blood bank procedures particularly the massive transfusion protocol is also recommended. This procedure for massive transfusion should be available to be referred to in real time.

scholarly journals Venipuncture Induced Complex Regional Pain Syndrome Presenting as Inflammatory Arthritis

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Punit Pruthi ◽  
Pramod Arora ◽  
Manoj Mittal ◽  
Anugrah Nair ◽  
Waqia Sultana
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Inflammatory Arthritis ◽  
Young Male ◽  
Pain Syndrome ◽  
Poor Response ◽  
History Of ◽  
Diagnostic Modalities ◽  
Musculoskeletal Ultrasonography ◽  
The Right

Venipuncture is one of the most commonly done medical procedures. We report a unique case of a 23-year-old young male who presented with features suggestive of inflammatory arthritis. The symptoms, which initially started on the right side, also involved the other side after a few weeks. Although the patient’s symptoms and signs were simulating inflammatory arthritis, he had atypical features like poor response to anti-inflammatory medicines and normal laboratory parameters. His musculoskeletal ultrasonography was also not suggestive of arthritis. His history was reviewed and on direct questioning he revealed a history of venipuncture for blood sample withdrawal, done from right antecubital region for routine health check on the day prior to the onset of symptoms. Complex regional pain syndrome was suspected and triple-phase radioisotope bone scan was done which was highly suggestive of this diagnosis. The patient was managed with multidimensional approach and responded very well to the treatment. Complex regional pain syndrome is usually not thought of in the initial differential diagnosis of inflammatory arthritis. In this report we highlight the need to elicit the often overlooked history of trivial trauma like venipuncture, especially in atypical cases of arthritis. Also the role of newer diagnostic modalities in such cases is emphasized.

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