Spontaneous rupture of the ovarian vein in association with nutcracker syndrome: a case report

Background Nutcracker syndrome is a condition in which the left renal vein is pinched between the abdominal aorta and the superior mesenteric artery, resulting in an increase in renal vein pressure and certain symptoms. We report a very rare case of retroperitoneal hematoma caused by the rupture of varicose veins of the left ovary. Case presentation A 77-year-old Japanese woman, para 7, experienced sudden left lower abdominal pain. She had no history of trauma or treatment complications. Computed tomography revealed a left retroperitoneal hematoma, but her abdominal pain subsided quickly; thus, urgent treatment was not required. We then scheduled her for an assessment regarding the cause of her bleeding. However, 6 days after the pain onset, abdominal pain symptoms recurred, confirming hematoma regrowth. Magnetic resonance imaging and three-dimensional computed tomography revealed an abnormal vascular network from the left side of the uterus to the left adnexa. Subsequent angiography revealed that the retroperitoneal bleeding originated from rupture of the distended left ovarian vein, which caused blood reflux from the left renal vein to the left ovarian vein. Although angiography confirmed a passage between the left renal vein and inferior vena cava, computed tomography showed obvious stenosis in the left renal vein. In accordance with these findings, we diagnosed the cause of the distention and rupture of the left ovarian vein as nutcracker syndrome. She underwent embolization of the left ovarian vein as hemostasis treatment, and had a good course thereafter. Conclusions This is the first report of a spontaneous rupture of the left ovarian vein caused by nutcracker syndrome. Nutcracker syndrome is not yet well known to clinicians and should be considered as part of the differential diagnosis when an abnormal vascular network in the pelvis is found.

Diagnostic Accuracy of CT Scans in Blunt Abdomical Trauma

Background and Aim: Blunt abdominal trauma may lead to a serious situation that necessitates prompt diagnosis and treatment. The intra-abdominal injury effective diagnosis is difficult in patient’s management in such cases. The present study aims to evaluate the diagnostic accuracy of computed tomography scans in active internal bleeding following abdominal trauma. Materials and Methods: This cross-sectional study was carried out on 84 blunt abdominal trauma patients in the Department of Radiology Hayatabad Medical Complex, Peshawar for duration of six months from January 2021 to June 2021. All the patients with no clinical manifestations underwent diagnostic CT scans. Those who had a positive CT scan underwent laparotomy. The remaining patients were monitored for 24 hours and were discharged in case of no serious issues. Demographic details, patient information, trauma mechanism, CT scan indications, and findings, and laparotomy results were recorded. Regarding injured organs, specificity, sensitivity, and diagnostic accuracy of CT scans were determined. For individual cases, CT scans specificity, sensitivity, and accuracy were calculated. SPSS version 20 was used for data analysis. Results: This study included 84 patients, out of which 73 (86.9%) were male and 11(13.1%) were female. Patients aged 20-40 years were more prevalent 47 (56%), followed by those aged over 40 years were 20 (23.8%) and 10 to 19 years old were 17 (20.2%). Liver and spleen injuries had the highest CT scan sensitivity of 87.5% and 96.7% respectively. On the other hand, The CT scan's specificity was high in the injured kidneys (94%) and retroperitoneal hematoma 97.3% compared to other organ’s injuries. The diagnostic accuracy of CT scans in the identification of liver, kidney injuries, spleen, and retroperitoneal hematoma injuries was 93.7%, 92.3%, 96.2%, and 92.3% respectively. Conclusion: Our study found that CT scans are capable of detecting a wide range of injuries. CT scans are exceptionally valuable for assessing blunt abdominal injuries with active internal bleeding patients Furthermore, CT investigation is quick and extensively accessible. CT can produce high-resolution images with MPR and scanning protocol. Keywords: Diagnostic Accuracy; Abdominal Trauma Injuries, Computed Tomography (CT)

Spontaneous Retroperitoneal Hematoma: a Case Report, Review of Literature, and Proposal of Diagnostic and Management Algorithm

Background: Spontaneous retroperitoneal hematoma (SRH) is defined as bleeding in the retroperitoneal space without any triggers such as trauma, invasive procedures, and abdominal aortic aneurysm. Case presentation: A 48-year-old man who experienced sudden abdominal pain, severe hypotension, and decreased hemoglobin (Hb) was diagnosed with SRH. Contrast-enhanced computed tomography (CT) revealed massive left retroperitoneal hematoma; however, neither extravasation nor causative aneurysm was noted. Through conservative management with close monitoring, he was treated and discharged on the 10th hospital day without any morbidity. Conclusions: SRH treatment comprises conservative management, transcatheter arterial embolization, and surgical intervention. The mortality rate of SRH is so high that the optimal treatment timing needs to be carefully judged based on detailed evaluation and management algorithm with clear criteria.