Percutaneous treatment of severe retroperitoneal hematoma after percutaneous coronary intervention

We describe a patient who developed severe retroperitoneal and intraperitoneal bleeding complicating femoral arterial catheterization for Percutaneous coronary intervention. Balloon tamponade of the actively bleeding femoral artery was effective in sealing off the leakage. This management strategy for this problem emphasizing an anatomical based interventional approach if the patient does not stabilize with volume resuscitation.

Treatment of Upper Gastrointestinal Bleeding by Percutaneous Transsplenic Varices Embolization in Chronic Hepatic Schistosomiasis Japonicum Patients

To evaluate percutaneous transsplenic varices embolization (PTSVE) in the treatment of upper gastrointestinal bleeding (UGIB) in patients with chronic hepatic schistosomiasis japonicum (CHS), 29 CHS patients (20 males and 9 females) complicated with UGIB were selected as the investigation subjects. The patients were treated by PTSVE under the guidance of X-ray fluoroscopy. The success rate of PTSVE and the rate of complications were observed. In addition, the degrees of varices before and after PTSVE were evaluated by abdominal computed tomography (CT). Results showed that 26 CHS patients (89.6%) were successfully treated with PTSVE. Three cases (10.3%) failed, and two experienced intraperitoneal bleeding within 1 week after PTSVE. The abdominal CT showed a significant decrease of the varices stage in coronary (P < 0.001), esophageal (P = 0.006), and paraesophageal (P = 0.013) varices, but slightly increased perisplenic varices within 1 month of the intervention (P = 0.014). PTSVE may be a safe and effective procedure for the treatment of UGIB in CHS patients, particularly suitable for those with a widened hepatic fissure and exposed hepatic portal vein trunk and an enlarged spleen.

Sudden death due to non-traumatic rupture of splenic artery aneurysm

Introduction Splenic artery aneurysm is a rare form of vascular pathology that carries a high risk of mortality once it gets ruptured. It has a prevalence of 1% and occurs due to thinning and dilatation of the arterial wall. Case We describe a case of a 35-year-old policeman who died suddenly. At medico-legal autopsy, intraperitoneal clotted blood about 1000 g and liquid blood about 3000 ml were seen. On further exploration, ruptured splenic artery aneurysm about 2.0 cm in diameter became visible near the hilum. Conclusion Rare cases typically present as sudden and unexpected death with intraperitoneal bleed and may be confused with blunt trauma abdomen. Therefore, splenic artery aneurysm is an appropriate differential diagnosis for sudden deaths and intraperitoneal bleeding, respectively.

Spontaneous Haemoperitoneum in Pregnancy (SHiP) with Placenta Percreta in Bicornuate Uterus with Successful Pregnancy Outcome

Intraperitoneal haemorrhage during pregnancy or postpartum without any history of trauma is termed Spontaneous Haemoperitoneum in Pregnancy (SHiP). This is a rare condition, causing significant morbidity and mortality for the mother and the neonate. We report a case of SHiP in a patient who presented to us at 31 weeks of gestation with right iliac fossa pain, pallor and tachycardia. Radiological investigations revealed intraperitoneal bleeding and a right adnexal haematoma. She was managed conservatively with blood transfusion and supportive care. At 36 weeks of gestation, lower segment caesarean section (LSCS) was done and a live baby with good Apgar score was delivered. Per-operatively, she was found to have a bicornuate uterus, placenta percreta at the junction of the horns and a right adnexal haematoma. This case highlights the significance of thorough evaluation of acute abdominal pain in pregnancy in avoiding unnecessary surgical intervention and iatrogenic prematurity. Keywords: Abdominal pain; Caesarean Section; Hemoperitoneum; Placenta accreta; Pregnancy.

Femoral venous catheter: intraperitoneal placement

Central venous cannulation through femoral veins is known to be associated with various complications. Early complications include extravasation and collection of blood, fluid, and/or contrast material in the retroperitoneal spaces or the peritoneal cavity, whereas late complications include abdominal compartment syndrome (ACS). A 30-year-old patient was admitted to the emergency department and brought into the operating room with a preliminary diagnosis of pelvic fracture and acute abdomen. An intravenous catheter was placed into the peripheral vein and a central venous catheter in the femoral vein, in the emergency room through which blood was transfused. At the start of the operation, it was found that intraperitoneal bleeding was caused by a perforation associated with the femoral catheter. We conclude that in the case of acute abdomen, if the femoral venous catheter was already placed in the emergency room, proper placement should be confirmed with ultrasound imaging. Key words: Central venous catheterization; Femoral vein; Complications; Acute abdomen; Ultrasound imaging; Emergency care Citation: Piskinel Y, Sahap M, Balci CA, Gulec H, Erkilic E, But A. Femoral venous catheter: intraperitoneal placement. Anaesth. pain intensive care 2021;25(2):203-205. DOI: 10.35975/apic.v25i2.1466 Received: 23 November 2020. Reviewed: 10 February 2021, Accepted: 1 February 2021

A huge haemorrhagic suprarenal pseudocyst: an unusual presentation of a rare condition

Haemorrhagic suprarenal pseudocysts are very rare and are often incidental findings at surgery or autopsy, though they can sometimes present with predominantly gastrointestinal or endocrine symptoms, including intraperitoneal bleeding or sepsis. Our case report is of a 48-year-old man who presented at our primary healthcare centre with 2-month history of predominantly respiratory symptoms of cough and shortness of breath. CT scan revealed a suprarenal cyst measuring 14.2×13.5×13.1 cm for which he was operated and made a full recovery. A detailed literature review reveals that there has never been a case of a haemorrhagic suprarenal pseudocyst presenting with predominantly respiratory symptoms, which is why we decided to document this case report.

Role of indicators of hemodynamics and homeostasis in patients with acute gynecological diseases

In recent years, there has been a significant increase in urgent conditions in gynecology. The use of inadequate and sometimes unjustified surgical interventions due to the peculiarities of the clinical course of the disease, the difficulties of early diagnosis, uncertainty of treatment tactics can lead to complications and even death of the patient. Therefore, improving early diagnosis and emergency care is one of the priorities of modern medicine. The objective: to improve the early diagnosis and comprehensive treatment of acute gynecological conditions to study the structure and features of urgent gynecological diseases in modern conditions; analyze indicators of hemodynamics and homeostasis (including immune) to reduce possible complications in patients with acute gynecological diseases. Materials and methods. A 5-year retrospective clinical and anamnestic analysis of 1261 case histories of patients with various acute gynecological diseases, the most common of which are acute pelvic inflammatory disease (PID), uterine and intraperitoneal bleeding, impaired blood supply to internal tumors. Patients in the comparative groups were comparable in age and course of the pathological process in the genitals. Results. The study found that among acute gynecological diseases dominated by acute PID (41.4%), uterine bleeding (31.6%), intra-abdominal bleeding (20.8%), impaired blood supply to tumors of the internal genitalia (6.2%), and in the last two groups the incidence increased. The age of patients varied significantly depending on the type of pathology. Clinical manifestations of acute PID and impaired blood supply to tumors of the internal genitalia in most cases were characterized by a predominance of pain and intoxication syndromes. Intra-abdominal and uterine bleeding was dominated by symptoms associated with hemodynamic disturbances and posthemorrhagic anemia. A high frequency of anemia of toxic genesis was observed in patients with acute PID and impaired blood supply to tumors of the internal genitalia. Conclusion. In modern conditions, the percentage of patients in need of emergency care is increasing, mainly due to an increase in the number of patients with intraperitoneal bleeding and impaired blood supply to tumors of the uterus and ovaries. The course of urgent gynecological diseases is accompanied by a violation of the adaptive-regulatory mechanisms of detoxification, indicators of homeostasis, immune system, hemodynamics, acid-base state of the blood. Given the clinical picture of the disease and the established diagnosis, it is necessary to develop individual management tactics for each patient. Keywords: emergency gynecology, acute abdomen, intraperitoneal bleeding, pelvic inflammatory disease, uterine bleeding, posthemorrhagic anemia, intoxication syndrome.

Spontaneous hemoperitoneum in pregnancy due to endometriosis

Background: Hemoperitoneum in pregnancy requires urgent evaluation. While spontaneous intraperitoneal bleeding is rare, ectopic endometrial tissue is a frequent cause of this event. Case: A 38-year-old woman with a history of endometriosis presented at 26 weeks gestation with 1 week of vague abdominal pain. Vital signs were within normal limits, and physical exam was notable for left-sided abdominal tenderness. Imaging demonstrated simple free fluid in her pelvis, concern for a uterine fundal defect and an adjacent hematoma. Exploratory laparotomy revealed hemoperitoneum secondary to highly vascularized stage 4 endometriosis. After classical cesarean delivery, a supracervical hysterectomy with bilateral oophorectomy was performed due to ongoing global pelvic hemorrhage. Conclusion: Consider endometriosis as a cause of spontaneous hemoperitoneum in pregnancy. Obstetricians should be prepared for significant maternal morbidity when encountering such pathology.