Large Blood Vessels Research Articles

Design and Implementation of Brain Surgery Bipolar Electrocautery Simulator Using Haptic Technology

Surgical simulators have been widely used in training and evaluation of physicians and surgeons. Virtual reality augmented with haptic technology has made it feasible to develop more realistic surgical simulators. In this context, we set out to design and develop a brain surgery bipolar electrocautery simulator using haptic technology. A 3D model of brain tissue was generated based on a brain craniotomy image. Bipolar forceps were also modeled to visually assimilate real forceps. An experiment was developed to assess the learning process of the participants. In this experiment, the volunteers were asked to cauterize a large blood vessel in the brain while minimizing the damage done to the brain tissue. The experiment was performed on 20 volunteers, and statistical analysis was conducted on the learning process and error reduction during the surgery. Next, the volunteers were divided into gamer and non-gamer groups. The analysis of the volunteers’ operation demonstrated that, on average, there was a 5 percent reduction in the percentage of applied force error. It was also shown that the results achieved by the gamer and non-gamer group have significant difference with a p value of 0.0001. So, playing computer games would increase hand control, focus, and reflex and positively affect surgery skills.

Application of Artificial Intelligence in Anatomical Structure Recognition of Standard Section of Fetal Heart.

Congenital heart defect (CHD) refers to the overall structural abnormality of the heart or large blood vessels in the chest cavity. It is the most common type of fetal congenital defects. Prenatal diagnosis of congenital heart disease can improve the prognosis of the fetus to a certain extent. At present, prenatal diagnosis of CHD mainly uses 2D ultrasound to directly evaluate the development and function of fetal heart and main structures in the second trimester of pregnancy. Artificial recognition of fetal heart 2D ultrasound is a highly complex and tedious task, which requires a long period of prenatal training and practical experience. Compared with manual scanning, computer automatic identification and classification can significantly save time, ensure efficiency, and improve the accuracy of diagnosis. In this paper, an effective artificial intelligence recognition model is established by combining ultrasound images with artificial intelligence technology to assist ultrasound doctors in prenatal ultrasound fetal heart standard section recognition. The method data in this paper were obtained from the Second Affiliated Hospital of Fujian Medical University. The fetal apical four-chamber heart section, three vessel catheter section, three vessel trachea section, right ventricular outflow tract section, and left ventricular outflow tract section were collected at 20-24 weeks of gestation. 2687 image data were used for model establishment, and 673 image data were used for model validation. The experiment shows that the map value of this method in identifying different anatomical structures reaches 94.30%, the average accuracy rate reaches 94.60%, the average recall rate reaches 91.0%, and the average F1 coefficient reaches 93.40%. The experimental results show that this method can effectively identify the anatomical structures of different fetal heart sections and judge the standard sections according to these anatomical structures, which can provide an auxiliary diagnostic basis for ultrasound doctors to scan and lay a solid foundation for the diagnosis of congenital heart disease.

Protocol for central line care in intensive care unit

A central line is an IV (intravenous) line that goes into a large blood vessel near the center of the body. Central lines are used for giving medications, fluids, IV nutrition and drawing blood. The central line is usually placed in the chest area. Part of the line goes under the skin and enters a blood vessel several inches away. This type of line is called a tunnelled central line. The central line may have a single or double lumen. A single lumen central line has one opening or tube. A double lumen line has two separate tubes within one tubing. There are three veins where we can insert the central line i.e. Internal jugular vein, subclavian vein, femoral vein. [1].

Morphological and histological structure of hepatopancreas in rock goby Gobius paganellus on the western coast of Libya.

The rock goby, Gobius paganellus, is not a commercial species. This species has an essential role in the coastal ecosystem as a biological indicator. Therefore, it has been selected as the study's model species. Due to the insufficient studies that have described the hepatopancreas of G. paganellus, this study aimed to provide information on the anatomical and histological structure of the hepatopancreas of the alimentary canal of this species on the western coast of Libya. Fifty mature G. paganellus specimens were collected from the northwest of Libya (Tajoura, Jodaem, and Farwa Island). Total length and total weight of the samples were measured and performed by using gross anatomy and histology. Then, the histological sections (3-5 µm) were stained with hematoxylin and eosin (H and E). Morphologically, the liver has a large pyriform lobe. The dorsal surface of the liver is shiny and smooth, and the ventral surface contains shallow sulci; each sulus has a large blood vessel. Histologically, the liver is wrapped with a thin capsule of fibro-connective tissue. The hepatic parenchyma is made of hepatocytes with blood sinusoids. The hepatocytes are polygonal-shaped cells and have no hepatic lobules or portal triads. Melano-macrophage centers are distributed next to the blood vessels and bile ducts. The bile ducts are lined by columnar epithelial cells. The exocrine pancreatic tissue was observed in the liver parenchyma, and it consists of acini that are composed of pyramidal cells and contain zymogen granules. The liver of this species has both pancreatic and liver tissue, which was discovered in this investigation for the first time.

The treatment principles and targets for intestinal Behcet's disease.

Behcet's disease (BD) is a chronic and recurrent systemic vasculitis involving large, medium and small blood vessels as well as arteries and veins. BD with predominant gastrointestinal manifestations is diagnosed as intestinal BD, which is associated with severe complications such as massive gastrointestinal hemorrhage, perforation, and obstruction. Recently, treat-to-target (T2T) strategies have been successfully used in many chronic diseases and been suggested in the management of BD, while there are no related reviews about the global treatment strategy including treatment principles and targets for intestinal BD in detail. Herein, we review the treatment principles from the aspects of departments of Rheumatology and Gastroenterology. In addition, treatment targets of intestinal BD are reviewed from three aspects such as evaluable markers, effective markers and potency-ratio markers. Some definitions and conceptions from inflammatory bowel disease (IBD) bring us reference and enlightenments.

Сучасний підхід до лікування хворих на варикозну хворобу нижніх кінцівок та оцінки його ефективності

Introduction. Among the literature data, there are many described methods of treating varicose disease, which dictates the need to define clear indications for each of them. In order to obtain a quality result without further relapse of varicose disease, an individual approach is required in each specific case. The effectiveness of one or another method of treating varicose disease is an urgent issue in vascular surgery. The aim. In order to improve the results of treatment of patients with varicose disease of the lower extremities, conduct a literature analysis of surgical treatment methods with inherent complications for each of them. Materials and methods. The available sources of domestic and foreign literature related to the treatment of patients with varicose disease and the use of various modern methods were analyzed. Research results and their discussion. A rational combination of surgery and phleboscleroobliteration makes it possible to maximize the advantages and eliminate the disadvantages of each of the methods. Today, authoritative phlebologists talk about sclerosurgery – a combined method of treating varicose disease. Thus, scleroobliteration was and remains a very popular method of varicose vein correction. Today, very popular methods of eliminating vertical venous reflux are endovasal thermal obliteration methods. Supporters of such interventions are among domestic and foreign specialists. Unlike surgical treatment, phleboscleroobliteration is certainly less traumatic, economically available, can be performed in an outpatient setting, is accompanied by smaller cosmetic losses and a shorter period of medical and social rehabilitation. The need to perform crossectomy before trunk scleroobliteration increases the likelihood of damage to large blood and lymphatic vessels, lymphorrhea. In this connection, the idea of carrying out the manipulation without a previous crossectomy arose. Conclusions. Surgical and sclerosurgical interventions are most often used in the treatment of patients with VD, an objective comparative assessment of their results is necessary to clarify the effectiveness of the studied methods in the long-term observation period.

Intervention for Chest Trauma and Large Vessel Injury

Trauma is an injury to the body that involves multiple anatomical and pathophysiological changes caused by forces acting from outside the body. The number of patients with trauma is increasing as our society becomes more sophisticated. The importance and demand of traumatology are growing due to the development and spread of treatment and diagnostic technologies. In particular, damage to the large blood vessels of the chest can be life-threatening, and the sequelae are often severe; therefore, diagnostic and therapeutic methods are becoming increasingly important. Trauma to non-aortic vessels of the thorax and aorta results in varying degrees of physical damage depending on the mechanism of the accident and anatomical damage involved. The main damage is hemorrhage from non-aortic vessels of the thorax and aorta, accompanied by hemodynamic instability and coagulation disorders, which can be life-threatening. Immediate diagnosis and rapid therapeutic access can often improve the prognosis. The treatment of trauma can be surgical or interventional, depending on the patient's condition. Among them, interventional procedures are increasingly gaining popularity owing to their convenience, rapidity, and high therapeutic effectiveness, with increasing use in more trauma centers worldwide. Typical interventional procedures for patients with thoracic trauma include embolization for non-aortic injuries and thoracic endovascular aortic repair for aortic injuries. These procedures have many advantages over surgical treatments, such as fewer internal or surgical side effects, and can be performed more quickly than surgical procedures, contributing to improved outcomes for patients with trauma.

Upper-Abdominal Cytoreduction for Advanced Ovarian Cancer—Therapeutic Rationale, Surgical Anatomy and Techniques of Cytoreduction

Cytoreductive surgery (CRS) is the cornerstone of treating advanced ovarian cancer. Approximately 60–70% of patients with advanced ovarian cancer will have involvement in the upper abdomen or the supracolic compartment of the abdominal cavity. Though the involvement of this region results in poorer survival compared, complete cytoreduction benefits overall survival, making upper-abdominal cytoreduction an essential component of CRS for advanced ovarian cancer. The upper abdomen constitutes several vital organs and large blood vessels draped with the parietal or visceral peritoneum, common sites of disease in ovarian cancer. A surgeon treating advanced ovarian cancer should be well versed in upper-abdominal cytoreduction techniques, including diaphragmatic peritonectomy and diaphragm resection, lesser omentectomy, splenectomy with or without distal pancreatectomy, liver resection, cholecystectomy, and suprarenal retroperitoneal lymphadenectomy. Other procedures such as clearance of the periportal region, Glisson’s capsulectomy, clearance of the superior recess of the lesser sac, and Morrison’s pouch are essential as these regions are often involved in ovarian cancer. This manuscript covers the surgical anatomy of the upper abdomen, the techniques and therapeutic rationale of upper-abdominal cytoreduction, and specific measures for perioperative management of these patients. The main focus is the description of various peritonectomies and regional lymphadenectomies.

Lateral transperitoneal laparoscopic management for paragangliomas in para-aortic position: Surgical experience from case reports of three patients

Paragangliomas are a type of neuroendocrine tumour with catecholamine secretion outside of the adrenal medulla. These tumours are frequently found in the para-aortic region, which makes them difficult to manage laparoscopically. We herein present a case report of three patients with paragangliomas in a difficult superior para-aortic position. All cases had symptoms of catecholamine release with uncontrolled episodic hypertension and had their tumours successfully removed by transperitoneal laparoscopic management. We have found this method to be a suitable approach because it reveals a wide surgical field and a view over all organs, especially blood vessels around the tumour. Although blood and urine dopamine and noradrenaline levels were not measured postoperatively, all three patients were discharged without complication and they did not display any more clinical symptoms. Lateral transperitoneal laparoscopic surgery provided a wide field of view, which clearly revealed the tumour and surrounding components indicating it is one of the safest and most effective approaches, especially for paragangliomas adjacent to large blood vessels.

Rare variation: the absence of both the celiac trunk artery and the common hepatic artery

BackgroundKnowledge of celiac trunk anatomy is important in gastrointestinal surgery, hepatopancreatobiliary surgery, transplantation and interventional radiology. Variations in the celiac trunk are common and should be predicted prior to these interventions.MethodsA 58-year-old woman was admitted to our department for surgical treatment of gastric cancer (GC) confirmed by gastroduodenoscopy and gastric antrum biopsy. In the contrast-enhanced computed tomography (CT), we found an absence of both the celiac trunk artery (CA) and the common hepatic artery (CHA). Therefore, we used computerized three-dimensional (3D) vascular reconstruction technology to reconstruct the abdominal trunk and its branch vessels before operation.ResultsComputerized 3D vascular reconstruction confirmed an extremely rare vascular anomaly: the absence of both CA and CHA. The splenic artery (SA) and gastroduodenal artery (GDA) originated from the abdominal aorta (AA). The left gastric artery (LGA) originated from the AA directly above the junction of SA and the GDA. The left hepatic artery (LHA) originated from the left gastric artery (LGA). The right hepatic artery (RHA) originated from the superior mesenteric artery (SMA). Laparoscopic radical resection of GC was performed. This anomaly was also confirmed intraoperatively. This patient was discharged on the 10th day after surgery without any postoperative complication. There were no signs of tumor recurrence during the 6-month follow-up.ConclusionCorrect identification of abnormal abdominal large blood vessels and their relationship with tumors before surgery is of great significance to avoid intraoperative blood vessel damage, major postoperative complications and the missing of lymph node dissection.

Atomic Force Microscopy-Based Measurements of Retinal Microvessel Stiffness in Mice with Endothelial-Specific Deletion of CCN1.

Vascular stiffness is an independent predictor of human vascular diseases and is linked to ischemia, diabetes, high blood pressure, hyperlipidemia, and/or aging. Blood vessel stiffening increases owing to changes in the microscale architecture and/or content of extracellular, cytoskeletal, and nuclear matrix proteins. These alterations, while best appreciated in large blood vessels, also gradually occur in the microvasculature and play an important role in the initiation and progression of numerous microangiopathies including diabetic retinopathy. Although macroscopic measurements of arterial stiffness by pulse wave velocity are often used for clinical diagnosis, stiffness changes of intact microvessels and their causative factors have not been characterized. Herein, we describe the use of atomic force microscopy (AFM) to determine stiffness of mouse retinal capillaries and assess its regulation by the cellular communication network (CCN) 1, a stiffness-sensitive gene-encoded matricellular protein. AFM yields reproducible measurements of retinal capillary stiffness in lightly fixed freshly isolated retinal flat mounts. AFM measurements also show significant changes in compliance properties of the retinal microvasculature of mice with endothelial-specific deletion of CCN1, indicating that CCN1 expression, or lack thereof, affects the mechanical properties of microvascular cells in vivo. Thus, AFM has the force sensitivity and the spatial resolution necessary to measure the local modulus of retinal capillaries in situ and eventually to investigate microvascular compliance heterogeneities as key components of disease pathogenesis.

Identification of underexplored mesenchymal and vascular-related cell populations in human skeletal muscle.

Skeletal muscle repair and maintenance are directly and indirectly supported by interstitial cell populations such as vascular cells and fibro-adipogenic progenitors (FAPs), a subset of which express Twist2 and possess direct myogenic potential. Furthermore, work in rodents has highlighted the potential of pericytes to act as progenitor cells, giving rise to muscle cells and transdifferentiating into endothelial cells. However, less is understood about these populations in human skeletal muscle. Here, we performed single-cell RNA sequencing (scRNAseq) on ∼2,000 cells isolated from the human semitendinosus muscle of young individuals. This demonstrated the presence of a vascular-related cell type that expressed pericyte and pan-endothelial genes that we localized to large blood vessels within skeletal muscle cross sections and termed endothelial-like pericytes (ELPCs). RNA velocity analysis indicated that ELPCs may represent a "transition state" between endothelial cells and pericytes. Analysis of published scRNAseq data sets revealed evidence for ELPCs in trunk and heart musculature, which showed transcriptional similarity. In addition, we identified a subset of FAPs expressing TWIST2 mRNA and protein. Human TWIST2-expressing cells were anatomically and transcriptionally comparable to mouse Twist2 cells as they were restricted to the myofiber interstitium, expressed fibrogenic genes but lacked satellite cell markers, and colocalized with the FAPs marker PDGFRα in human muscle cross sections. Taken together, these results highlight the complexity of stromal cells residing in human skeletal muscle and support the utility of scRNAseq for discovery and characterization of poorly described cell populations.

Proximal ear hole injury heals by limited regeneration during the early postnatal phase in mice.

Ear pinna is a particular feature of mammals that shows several repair responses depending on age. Two millimeter hole made in the pinna of middle-aged female mice heals due to partial reconstitution of new tissues (limited regeneration), whereas a hole punched in the ear of young mice forms a scar tissue. In these studies, the injury is made in the center of the ear pinna, but little is known about the type of reparative response along the proximodistal polarity of the ear. This study evaluated the effect of pinna polarity, age, and sex in the ear hole-repairing response in Balb/c mice. Proximal injuries were repaired more efficiently by limited regeneration than wounds made in the middle region. Non-injured ear histological analysis revealed a higher presence of muscle, adipose tissue, cartilage, and larger blood vessels in the proximal ear area, which could influence ear hole closure by limited regeneration. To evaluate the healing response during ear growth, we punched a standard hole in the proximal area of the ear on postnatal day21 and 8-month-old mice (adults). Thirty-five days after the wound, both groups reached the same wound closure, despite the greater proportional size of holes made in the younger mice. Ear growth also improved ear hole closure in male mice. These results suggest that ear growth accelerates hole closure, providing an example of enhanced regenerative abilities in growing structures. Finally, hole closure kinetics in the growing ear indicated an early re-differentiation phase exhibited at 14 days post-wound. In conclusion, ear topography and growth positively influenced the healing response to ear holes, making it a tractable model to study in mammals.

Intraoperative ultrasound: "Alternative eye" in lymph nodal dissection in non-small cell lung cancer.

Staging of the mediastinum lymph nodes involvement in patients with non-small cell lung cancer (NSCLC) is an important prognostic factor determining the most appropriate multimodality treatment plan. The objective of this study is to assess ultrasound characteristics of mediastinal lymph nodes metastasis and effectiveness of intraoperative ultrasound-guided mediastinal nodal dissection in patients with resected NSCLC. All patients undergoing video-assisted thoracoscopic surgery lobectomy and pulmonary lymphadenectomy from November 2020 to March 2022 at the thoracic surgery department of the Vanvitelli University of Naples underwent intraoperative ultrasound-guided mediastinal lymph nodal dissection. This study evaluates whether individual B-mode features and a compounding thereof can be used to accurately and reproducibly predict lymph node malignancy. Intraoperative ultrasound, during systematic mediastinal lymph node dissection, is helpful in preventing lesion to mediastinal structures. Pathological nodal sonographic characteristics are round shape, short-axis diameter, echogenicity, margin, the absence or presence of coagulation necrosis sign, and the absence or presence of central hilar structure, increased color Doppler flow, the absence or presence of calcification, and nodal conglomeration. Operating time was not substantially prolonged. The procedure is simple, safe and highly accurate. Ultrasonic techniques allow surgeons to detect the relationship between lymph nodes and surrounding large blood vessels during biopsy, improving the safety and simplicity of the operation, increasing the number of harvested lymph nodes, and reducing the risk of intraoperative injury; it is a fast, easily reproducible, and inexpensive method.

Thermal enhancement and numerical solution of blood nanofluid flow through stenotic artery

The blood flow through stenotic artery is one of the important research area in computational fluid mechanics due to its application in biomedicine. Aim of this research work is to investigate the impact of nanoparticles on the characteristics of human blood flow in a stenosed blood artery. In under consideration problem Newtonian fluid is assumed as human blood. Newtonian fluid flows through large blood vessels (more than 300 μm). The constitutive equations together with the boundary conditions are diminished to non-dimensional form by using boundary layer approximation and similarity transfiguration to attain the solution of velocity and temperature distribution of blood flow through arterial stenosis numerically with the help of Matlab bvp4c. The results for physical quantities at cylindrical surface are calculated and their effects are also presented through tables. The heat transfer rate increases throughout the stenosed artery with the concentration of copper nanoparticle. Velocity curve decreases by increasing the values of flow parameter and nanoparticle volume fraction. Temperature curve increases due to increase in the values of nanoparticle volume fraction and decrease in Prandtl number.

Specific imaging features indicate the clinical features of patients with hepatic perivascular epithelioid cell tumor by comparative analysis of CT and ultrasound imaging.

The objective of the study was to explore the CT and ultrasound features and clinical significance of perivascular epithelioid cell tumor (PEComa) of the liver. Eleven hepatic PEComa patients treated in our hospital were retrospectively analyzed based on the characteristics of the imaging results of the patients, including conventional ultrasound, CDFI, contrast-enhanced ultrasound (CEUS), and contrast-enhanced CT (CECT). CT scans showed that all lesions were hypodense. Ultrasonography showed that lesions were either hyperechoic (4/11, 36.36%), hypoechoic (4/11, 36.36%), isoechoic (1/11, 9.09%), or heterogeneously echoic (2/11, 18.18%). CDFI showed that most of the lesions had an abundant blood supply (9/11, 81.82%). Whether on CT scan or ultrasonography, the margins of the lesions were dominated by clear margins. Ultrasonography revealed more features: hyperechoic patterns around lesions (3/11, 27.27%) and lateral shadow (5/11, 45.45%). The CDFI showed that large blood vessels were observed around the lesions (9/11, 81.82%). CECT shows two enhancement patterns: "fast in and fast out (FIFO)" (8/11, 72.72%) and "fast in and slow out (FISO)" (3/11, 27.27%). CEUS shows that all lesions had the enhancement pattern of "FISO," which was different from CECT. All lesions displayed rapid enhancement during HAP in CEUS during 7-20 s. Four patients (36.36%) washed out at 60-180 s, another four (36.36%) washed out at 180-300 s, and the remaining three patients (27.27%) showed no signs of washout even at 360 s. Some imaging features, such as clear margins, peripheral hyperechoic around the lesion, lateral shadow, the large blood vessels around lesions, and the "FISO" enhancement pattern, may indicate expansive growth of the tumor and be helpful in the diagnosis of PEComa. Ultrasound images may provide more details for clinical reference.

Primary Angiomatoid Melanomas in Dogs

Melanocyte-derived tumours are common in humans and animals and their spontaneous occurrence in dogs and the clinicopathological progression in malignant presentations is comparable with humans. Melanomas are a heterogeneous group of malignant neoplasms and several subtypes have been classified, including angiomatoid melanoma, of which only five cases have been reported in humans but none in animals. We now document cases of primary angiomatoid melanoma in the skin and oral cavity of two dogs. Neoplastic cells resembling endothelial cells that lined large blood vessels in the tumours were immunonegative for CD34 but intensely positive for SOX10.

Validating a simulation model for laser-induced thermotherapy using MR thermometry

Objectives We want to investigate whether temperature measurements obtained from MR thermometry are accurate and reliable enough to aid the development and validation of simulation models for Laser-induced interstitial thermotherapy (LITT). Methods Laser-induced interstitial thermotherapy (LITT) is applied to ex-vivo porcine livers. An artificial blood vessel is used to study the cooling effect of large blood vessels in proximity to the ablation zone. The experimental setting is simulated using a model based on partial differential equations (PDEs) for temperature, radiation, and tissue damage. The simulated temperature distributions are compared to temperature data obtained from MR thermometry. Results The overall agreement between measurement and simulation is good for two of our four test cases, while for the remaining cases drift problems with the thermometry data have been an issue. At higher temperatures local deviations between simulation and measurement occur in close proximity to the laser applicator and the vessel. This suggests that certain aspects of the model may need some refinement. Conclusion Thermometry data is well-suited for aiding the development of simulations models since it shows where refinements are necessary and enables the validation of such models.

Long-Term Functional Hyperemia after Uncomplicated Phacoemulsification: Benefits beyond Restoring Vision.

The purpose of the study was to investigate the long-term effects of uncomplicated phacoemulsification on macular perfusion using optical coherence tomography angiography (OCTA) in healthy aging subjects. OCTA was performed before phacoemulsification and 1 week, 1 month, 3 months, and 6 months after. Superficial vascular complex (formed of nerve fiber layer vascular plexus and superficial vascular plexus), deep vascular complex (formed of intermediate capillary plexus and deep capillary plexus), as well as choriocapillaris (CC) and large choroidal blood vessels were recorded. Significant changes of vascular parameters in 95 eyes of 95 patients reached plateau 1 week after surgery and remained stable up to 6 months, occurring in all retinal layers but not in choroid and CC. Statistically significant increases in retinal vessels area, vessels percentage area, total number of junctions, junctions density, and total and average vessels length were found, followed by the total number of end points and mean lacunarity decline, proving an increase in blood supply. The study confirmed that uncomplicated phacoemulsification leads to a long-term increase in macular retinal perfusion. The results might ease the decision regarding timing for cataract surgery as long-term perfusion benefits can be achieved. Furthermore, study results provide a normative database of retinal and choroidal vasculature in healthy aging patients.

Spontaneous Rupture of Exogastric Hemangioma:Case Report

Hemangiomas are benign congenital tumors of mature blood vessels and usually consist of dense masses of capillaries or larger blood vessels. Hemangiomas of the gastrointestinal tract are uncommon and account for only 0.05% of all intestinal neoplasms; gastric hemangiomas constitute less than 2% of benign gastric neoplasms. Gascoyen first described gastric hemangioma in 1860, and only 45 cases have been reported.1–5 Hemangioma of the stomach presenting with spontaneous rupture is rare. We describe a 41-year-old male who had rupture of abdominal hemangioma and subsequent hemoperitoneum. presented to the emergency unit of our hospital Al-Karama general hospital Al-Kut city with acute abdominal pain and distention where he was examined resuscitated, investigated , and explored for profuse hemoperitoneum and an exogastric ruptured mass were resected and submitted for histopathological examination. Which confirmed the diagnosis of hemangioma.