scholarly journals Not All Acute Abdomen Cases in Early Pregnancy Are Ectopic; Expect the Unexpected: Renal Angiomyolipoma Causing Massive Retroperitoneal Haemorrhage

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Muhammad Asim Rana ◽  
Ahmed F. Mady ◽  
Nagesh Jakaraddi ◽  
Shahzad A. Mumtaz ◽  
Habib Ahmad ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Multislice Ct ◽  
Management Plan ◽  
Haemodynamic Instability ◽  
Renal Angiomyolipoma ◽  
Retroperitoneal Haematoma ◽  
Best Management ◽  
Renal Aneurysm ◽  
Arterial Embolisation ◽  
Retroperitoneal Haemorrhage

Retroperitoneal haemorrhage (or retroperitoneal haematoma) refers to an accumulation of blood found in the retroperitoneal space. It is a rare clinical entity with variable aetiology including anticoagulation, ruptured aortic aneurysm, acute pancreatitis, malignancy, and bleeding from renal aneurysm. Diagnosis of retroperitoneal bleed is sometimes missed or delayed as presentation is often nonspecific. Multislice CT and arteriography are important for diagnosis. There is no consensus about the best management plan for patients with retroperitoneal haematoma. Stable patients can be managed with fluid resuscitation, correction of coagulopathy if any, and blood transfusion. Endovascular options involving selective intra-arterial embolisation or stent-grafts are clearly getting more and more popularity. Open repair is usually reserved for cases when there is failure of conservative or endovascular measures to control the bleeding or expertise is unavailable and in cases where the patient is unstable. Mortality of patients with retroperitoneal haematoma remains high if appropriate and timely measures are not taken. Haemorrhage from a benign renal tumour is a rarer entity which is described in this case report which emphasizes that physicians should have a wide index of suspicion when dealing with patients presenting with significant groin, flank, abdominal, or back pain, or haemodynamic instability of unclear cause. Our patient presented with features of acute abdomen and, being pregnant, was thought of having a ruptured ectopic pregnancy.

scholarly journals Spontaneous Retroperitoneal Haematoma due to Polyarteritis Nodosa: Report of a Case and Literature Review

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Emrah Simsek ◽  
Hasan Yilmaz ◽  
Kerem Teke ◽  
Ali Kemal Uslubas ◽  
Mustafa Yuksekkaya
Keyword(s):  
Literature Review ◽  
Polyarteritis Nodosa ◽  
Management Plan ◽  
Clinical Entity ◽  
Rare Clinical Entity ◽  
Precipitating Factors ◽  
Retroperitoneal Haematoma ◽  
Treatment Approaches ◽  
General Consensus ◽  
Best Management

Retroperitoneal haematoma is a rare clinical entity with variable etiology. It can happen spontaneously, without any obvious precipitating factors, the so-called spontaneous retroperitoneal haematoma. There is no general consensus as to the best management plan for patients with retroperitoneal haematoma. Polyarteritis nodosa (PAN) is a rare cause of retroperitoneal haematoma. Here we report relationship between PAN and retroperitoneal haematoma and treatment approaches. However, an accepted and clearly defined treatment has not been established due to its rarity.

scholarly journals 284 Wunderlich Syndrome - Case Report of a Surgical Emergency Due to Spontaneous Non-Traumatic Retroperitoneal Haemorrhage

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Patil ◽  
P Prakash Narayan ◽  
J Henderson
Keyword(s):  
Hypovolemic Shock ◽  
Arterial Embolization ◽  
Rare Condition ◽  
Sudden Onset ◽  
Haemodynamic Instability ◽  
Renal Angiomyolipoma ◽  
Successful Management ◽  
Selective Embolization ◽  
Acute Flank Pain ◽  
Retroperitoneal Haemorrhage

Abstract A 42-year-old female with no other significant co-morbidities presented with complaints of sudden onset abdominal pain, she was in state of shock- her haemoglobin dropped drastically to 6.8g/dl from 11.8g/dl. She was resuscitated and was given blood transfusion. CT Scan was suggestive of retroperitoneal haemorrhage due to rupture of Renal angiomyolipoma (RAML). Patient underwent selective embolization of renal artery the next day and was discharged after 3 days of post-operative stay. Wunderlich Syndrome-is a rare condition in which spontaneous nontraumatic renal haemorrhage occurs into the subcapsular and perirenal spaces is most commonly caused due to spontaneous rupture of RAML.It is characterized by Lenk’s triad – Acute flank pain, flank mass, hypovolemic shock. Size of AML (>4 cm), prothrombotic states such as pregnancy are main causes of AML rupture. Patients are managed conservatively or with help of selective arterial embolization. Nephrectomy is last resort in a hemodynamically unstable patient or in cases of embolization failure. When dealing with acute abdomen with haemodynamic instability in non-traumatic cases it is essential to consider possibility of Wunderlich Syndrome. Early diagnosis, availability of Interventional radiology is key to successful management and potentially avoiding a Nephrectomy.

An Uncommon An Uncommon Cause of Acute Abdomen in Underprivileged Communities

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
David Muchuweti ◽  
Hopewell Mungani ◽  
Hopewell Mungani ◽  
Farai Mahomva ◽  
Edwin Gamba Muguti ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Acute Abdomen ◽  
Bowel Obstruction ◽  
Bowel Wall ◽  
Haemodynamic Instability ◽  
Small Bowel Volvulus ◽  
General Surgeons ◽  
Heavy Infestation ◽  
Emergency Abdominal Surgery

Oftentimes general surgeons working in poorly resourced communities carry out emergency abdominal surgery in patients with acute abdomen with no definitive preoperative diagnosis. The definitive diagnosis is made at laparotomy. Perforated small bowel obstruction secondary to heavy Infestation with Ascaris Lumbricoides brings a number of intraoperative challenges requiring correct intraoperative surgical management decisions. We present a case of a 17 year-old patient who was admitted with a diagnosis of small bowel obstruction who at laparotomy was found to have perforated gangrenous small bowel volvulus with heavy worm load visible through the bowel wall. Because of faecal peritoneal contamination and haemodynamic instability she underwent a two staged procedure with good outcome.

Management of Type 2B von Willebrand Disease during Pregnancy

2017 ◽  
Vol 137 (2) ◽  
pp. 89-92 ◽  
Author(s):  
David McLaughlin ◽  
Ron Kerr
Keyword(s):  
Autosomal Dominant ◽  
Case Reports ◽  
Management Plan ◽  
Von Willebrand Disease ◽  
Best Management ◽  
First Case ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
Ristocetin Cofactor ◽  
Platelet Transfusions

Type 2B von Willebrand disease is a rare bleeding condition resulting in thrombocytopenia and a reduction in large VWF multimers. It usually has an autosomal dominant pattern of inheritance. We report the management of a patient with type 2B von Willebrand disease, whose diagnosis was confirmed by demonstration of a R1306W mutation, through her first pregnancy. The patient's von Willebrand factor (VWF) antigen and VWF ristocetin cofactor levels rose throughout pregnancy, with an associated drop in the platelet count. The patient was successfully managed through labour to a surgical delivery with VWF concentrate, platelet transfusions and tranexamic acid. The patient delivered a male baby who was found to have inherited type 2B von Willebrand disease and had a significant cephalhaematoma at delivery. The baby was managed with VWF concentrate and platelet transfusions and made a full recovery. There is a lack of evidence to guide the best management of pregnant patients with type 2B von Willebrand disease. We adopted a pragmatic management plan, in keeping with other published case reports. To the best of our knowledge, this is the first case report in which the child was found to have inherited type 2B von Willebrand disease and encountered bleeding problems, making this case unique amongst the published literature.

scholarly journals Modeling of Phosphorous Load and Transport Pathways in Dhidhessa Catchment, Oromiya, Ethiopia

2019 ◽  
Vol 8 (3) ◽  
pp. 22-33
Author(s):  
Adisu Befekadu Kebede ◽  
Fekadu Fufa Feyessa ◽  
Wakjira Takala Dibaba
Keyword(s):  
Nutrient Loading ◽  
Assessment Tool ◽  
Organic Phosphorus ◽  
Swat Model ◽  
Chemical Properties ◽  
Management Plan ◽  
Transport Pathways ◽  
Best Management ◽  
Run Off ◽  
Physical And Chemical

Pollution of surface water with harmful chemicals and eutrophication with excess nutrients are recent serious environmental concerns. This lends the need of knowing the nutrient loading and transport mechanism that will occur with different spatial and temporal extent. Thus, effective information regarding the nutrients load and transport mechanisms are important to hydrologists, water use planners, watershed managers and decision makers for water resource projects and planet ecosystem. Our study aimed for modeling of phosphorous loading and its transport pathways and to identify the most vulnerable sub basin responsible for a significant phosphorus load in Dhidhessa catchment using Soil and Water Assessment Tool (SWAT) model. The pathways of phosphorus were identified and found that the organic phosphorus was dominant exporting mechanism accounted for 58.89% of the total path in the study area. For all forms of phosphorus, surface run off was the most dominant means of transport agent. The average annual loading of total phosphorus was identified as 20 kg ha-1. The sub basins 17, 23, and 3 were identified as the highest loading area of total phosphorous in the study catchment. Best management plan which is simple, economical and adaptable over the study catchment for managing severe impact of surface run off on water resources should be adopted. It is better to undergo detail re-examination over the physical and chemical properties of P in fertilizers and manures to propose the minimizing, neutralizing, replacing strategies to reduce at the source.

Treatment of cancer

2018 ◽  
Author(s):  
David Cutter ◽  
Martin Scott-Brown
Keyword(s):  
Management Strategies ◽  
Colon Adenocarcinoma ◽  
Management Plan ◽  
Treatment Modalities ◽  
Management Approach ◽  
Best Management ◽  
Appropriate Treatment ◽  
Wide Range ◽  
Specialist Nurses ◽  
The Individual

The variety of conditions that are considered to be ‘cancer’ is extremely wide, with marked variation in the management approach from disease to disease. A common feature in the management of malignant conditions, however, is the involvement of a wide range of medical professionals at different stages of the patient pathway. This commonly includes physicians, surgeons, radiologists, pathologists, medical oncologists, radiation oncologists, and specialist nurses, as well as a plethora of other allied disciplines. As such, a practice that has been widely adopted is to work as a multidisciplinary team (MDT), with regular meetings to decide the appropriate treatment for each patient with a cancer diagnosis, on an individual and case-by-case basis. The main treatment modalities for the treatment of cancer are surgery, radiotherapy, and chemotherapy. While these are often combined to form a multimodality therapy, they are all, in isolation, potentially radical (curative) therapies for certain conditions. For example, surgery (in the case of a Stage I colon adenocarcinoma), radiotherapy (in the case of early laryngeal squamous cell carcinoma), and chemotherapy (in the case of acute lymphoblastic leukaemia) are all curative as single-modality treatments. It is commonly the case, however, for a patient to require more than one mode of therapy to achieve the best outcome, for example a combination of surgery, chemotherapy, and radiotherapy for early breast cancer. It can also be the case that two or more different management strategies are thought to give equivalent oncological results, for example surgery or radiotherapy for early prostate cancer. In this situation, the MDT and the patient need to decide on the ‘best’ management plan for the individual, based on their personal and professional opinions and on the differing toxicity profiles of the alternate treatments.

When the Conventional Treatment Fails: A Rare Approach to Superior Mesenteric Arterial Embolization

2019 ◽  
Vol 54 (2) ◽  
pp. 169-171 ◽  
Author(s):  
Andrew B. Haymet ◽  
Daniel Lee ◽  
Kevin Ho-Shon ◽  
Richard Waugh
Keyword(s):  
Computed Tomography ◽  
Mesenteric Artery ◽  
Conventional Treatment ◽  
Clinical Presentation ◽  
Arterial Embolization ◽  
Emergency Laparotomy ◽  
Retroperitoneal Haematoma ◽  
Life Threatening ◽  
Retroperitoneal Haemorrhage ◽  
Life Threatening Event

Retroperitoneal haemorrhage is a rare but potentially life-threatening event. It may occur either spontaneously or secondary to percutaneous vascular access procedures, trauma, or ruptured aortic, iliac, or mesenteric aneurysms. As a result, the clinical presentation is variable. Computed tomography and/or angiography are vital for diagnosis. Management may range from conservative treatment for stable patients to emergency laparotomy or embolization for catastrophic haemorrhage. Direct percutaneous puncture of a deep intra-abdominal pseudoaneurysm is an accepted but infrequently performed technique due to a number of diagnostic and technical challenges. We describe the successful percutaneous transabdominal angioembolization of a superior mesenteric artery rupture in a 77-year-old woman with a large retroperitoneal haematoma. This was performed after a conventional femoral transarterial approach was unsuccessful.

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