Massive Hemoperitoneum Research Articles

Fallopian tube deciduosis with massive hemoperitoneum in a second-trimester pregnancy: a case report of ultrasound findings

Fallopian tube deciduosis with massive hemoperitoneum in a second-trimester pregnancy: a case report of ultrasound findings

Surgical Outcomes and Trends in Incidence of Ectopic Pregnancy.

We aimed to evaluate the surgical results for ectopic pregnancy (EP) treated at Fukushima Red Cross Hospital for over a 20-year period from 2002 to 2021. We evaluated the incidence, surgical procedures, site of implantation, amount of hemoperitoneum, and the proportion of cases with risk factors of EP. Two hundred and fifty-nine cases of EP were treated surgically. The incidence of EP seemed to be gradually decreasing in recent years. By pregnancy site, 235 (90.7%) of EPs were tubal pregnancies (TPs), 13 in interstitial pregnancies (IPs), 7 in ovarian pregnancies, and 4 in peritoneal pregnancies. For IPs, human chorionic gonadotropin (hCG) levels were statistically higher than with TP and intraperitoneal bleeding was less than with other EP sites. Thirty-nine patients (15.0%) were with massive hemoperitoneum (>500 mL), and laparoscopic surgery was performed in all patients with massive hemoperitoneum except in two patients. The proportion of cases with risk factors for EP such as Chlamydia trachomatis infection or history of smoking was 5.4% and 40.6%, respectively. Epidemiological research shows that the number of patients with chlamydia infection, rates of smokers, or the occurrence of EP with assisted reproductive technology has been decreasing in recent years in Japan. Appropriate surgical intervention should be selected while considering such as facility capabilities, context, and surgeon skill, especially in critical cases, such as cases involving massive hemoperitoneum and hemorrhagic shock. The recent presumed decrease in the occurrence of EP may partly be associated with the decrease in the occurrence of risk factors.

Life-Threatening Obstetrical Emergency: Spontaneous Uterine Rupture Associated with Placenta Percreta in the First Trimester of Pregnancy—Case Report and Literature Review

Background: The greatest risk for the occurrence of the placenta accreta spectrum (PAS) is represented by uterine scars, which most frequently result after cesarean sections. Uterine rupture is a rare condition and appears mainly in the third trimester of pregnancy. The association between these two conditions is extremely rare in the first trimester of pregnancy. Methods: We performed a systematic review of abnormal placental adhesions and spontaneous uterine ruptures in the first trimester of pregnancy. We also reported a case of spontaneous uterine rupture in a 12-week pregnancy that presented with massive hemoperitoneum and hemorrhagic shock. Results: A 33-year-old patient with two previous cesarean sections, at the twelfth week of pregnancy at the time to this visit to the emergency room, presented with syncope and intense pelvic–abdominal pain. A clinical examination and ultrasound scan established the diagnosis of hemoperitoneum and hemorrhagic shock. Surgical exploration was performed, uterine rupture was identified, and hemostasis hysterectomy was necessary. The histopathological results showed placenta percreta. There have been eight reported cases of spontaneous uterine rupture in the first trimester of pregnancy associated with PAS. In these cases, it was found that 62.5% of the patients had undergone at least one cesarean section in the past; in 75% of the cases, hysterectomy was performed; and, in 87.5% of the cases, the presence of placenta percreta was confirmed. Conclusions: A high rate of cesarean sections determines the increase in the incidence of placenta accreta spectrum disorders. The possible life-threatening complications caused by this pathology can be observed in early pregnancies.

Successful Conservative Management of Massive Hemoperitoneum in Patients on Anticoagulation with Ruptured Hemorrhagic Ovarian Cyst: A Report of Two Cases and Review of Literature

Successful Conservative Management of Massive Hemoperitoneum in Patients on Anticoagulation with Ruptured Hemorrhagic Ovarian Cyst: A Report of Two Cases and Review of Literature

Corpus luteal cyst rupture presenting as massive spontaneous hemoperitoneum in women with dengue infection: A case series

Corpus luteal cyst rupture presents with acute pain abdomen, hemoperitoneum and features of shock. The condition clinically closely mimics acute rupture ectopic pregnancy but has negative urine pregnancy test. Massive hemoperitoneum requires urgent surgical exploration and achievement of hemostasis. Here is a case series describing 3 cases of corpus luteal cyst rupture in patients with diagnosed dengue fever presenting with features of acute abdomen with or without shock at emergency. All were managed surgically, did well in postoperative period, had transfusions of blood and blood products and finally discharged in satisfactory condition. The objective of this series is to highlight the importance of this condition as a differential diagnosis in patients with acute abdomen which is not much described in medical literature.

Successful pregnancy outcome via in-vitro fertilization and laparoscopic resection of non-communicating rudimentary horn pregnancy containing early pregnancy: a case report

BackgroundNon-communicating rudimentary horn pregnancy (NCRHP) lead to life-threatening condition for both mother and fetus. Early diagnosis of NCRHP and laparoscopic resection is important to prevent catastrophic conditions. However, delayed diagnosis until the second or third trimester makes it difficult to accurately diagnose between NCRHP and bicornuate uterine pregnancy, as both conditions present uterine rupture and massive hemoperitoneum. Furthermore, these rare cases are challenging in pregnancy trials and associated with adverse outcomes in subsequent pregnancies.Case presentationA 31-year-old gravida 1 para 0 Korean woman visited our infertility center with a confirmed positive urine pregnancy test after timed intercourse. Before she was scheduled to have timed intercourse, a unicornuate uterus with a non-communicating right uterine horn was suspected based on an ultrasound scan and hysterosalpingography during the initial infertility workup. A gestational sac was observed in the right non-communicating rudimentary horn at 5 weeks of gestation. Serum beta-human chorionic gonadotropin (b-hCG) level was 2052.0mIU/mL. An elective laparoscopic resection of the right rudimentary horn containing a gestational sac, along with ipsilateral salpingectomy, was performed with no adverse event. After 3-month of recovery period and three cycles of conceptional trials involving timed intercourse and intrauterine insemination, in-vitro fertilization (IVF) was performed using the antagonist protocol, and successful pregnancy was confirmed. The patient had been hospitalized from 21 + 6 weeks to 35 + 6 weeks of gestation, underwent cerclage placement and tocolytics with corticosteroid treatment. She delivered an early-term male baby by cesarean section.ConclusionIn this rare case, the successful pregnancy achieved through IVF following the appropriate management of NCRHP under laparoscopy underscores the critical importance of early diagnosis and intervention in cases of NCRHP. Timely identification and management of NCRHP are vital to prevent the occurrence of catastrophic conditions and to enhance the prognosis of a successful pregnancy through assisted reproductive technology (ART). Therefore, a high index of suspicion for NCRHP is important and employs a range of diagnostic modalities.

Cavernous haemangioma and mid trimester pregnancy loss leading to severe haemorrhage and hysterectomy: a case report and review of literature.

Cavernous haemangiomas are benign vascular tumours that are known to occasionally involve the female genital tract, including the uterus. They are often underdiagnosed during pregnancy, although they can also lead to severe postpartum or antepartum haemorrhage. Describe our case of an uncommon second-trimester pregnancy loss in a woman with a diffuse cavernous haemangioma of the uterus and cervix and review the wider literature. The review was conducted using MEDLINE, Scopus and PubMed electronic databases from beginning of the database to May 2023, using the following keywords: arteriovenous malformation; cavernous haemangioma/hemangioma; uterine neoplasms; pregnancy complications; abnormal vaginal bleeding. Description of the characteristics of cavernous haemangioma during pregnancy as well as diagnostic criteria and treatment options. Twenty publications were included in the review, which included English-language case reports over a period from 1959 to 2022. No pathognomonic symptoms for cavernous haemangioma of the uterus in a pregnant woman were noted. Complications including massive secondary postpartum haemorrhage, haemoperitoneum, and severe thrombocytopenia with anaemia after delivery were reported. Diagnosis and management during pregnancy can be challenging and requires considerable attention, with a multidisciplinary approach including gynaecologists, radiologists, and pathologists to avoid major complications. An additional case of diffuse cavernous haemangioma of the uterus and cervix is described, that adds to the little existing literature.

Primary omental pregnancy after in vitro fertilization complicated by hemoperitoneum—how to manage it laparoscopically

To report an uncommon case of primary OP treated laparoscopically. Ectopic pregnancy (EP) is the leading cause of maternal mortality during the first trimester and the incidence increases with assisted reproductive techniques, occurring in approximately 1.5%-2.1% of patients undergoing invitro fertilization.1 Omental pregnancy (OP) is an extremely rare form of EP accounting for less than 1% of all EPs. OP can be classified as primary or secondary on the basis of Studdiford's criteria2. The preoperative diagnosis of OP is complex and usually occur in acute circumstances during a throughout intraoperative evaluation of the abdomen.3-5 A delayed diagnosis poses a serious threat to the survival of the patient; therefore, it is important to remark that EP can exist in unusual locations and prompt surgical intervention may be necessary. A step-by-step narrated video of a rare clinical case and description of the surgical procedure. Tertiary Level Academic Hospital "IRCCS Azienda Ospedaliero - Universitaria di Bologna" Bologna, Italy. A 36-year-old woman was referred to our emergency room because of acute abdominal pain and nausea for 2 hours with no signs of hemodynamic instability. The patient also complained that poor vaginal bleeding appeared during the last 24 hours. The patient has undergone a cycle of invitro fertilization with an elective single frozen embryo transfer of a blastocyst on day 5, 2 months before. She had no relevant clinical or surgical history. Diffuse abdominal tenderness and a painful uterus at mobilization were appreciated at clinical examination. A massive hemoperitoneum was diagnosed using transvaginal-transabdominal ultrasound, and no uterine or adnexal lesions were identified. The β-human chronic gonadotropin level was 43.861 mIU/mL, and the hemoglobin value was 10.5 g/dL. On suspicion of a ruptured EP, after detailed counseling and the acquisition of informed consent, a laparoscopic exploration was planned. First, the hemoperitoneum was evacuated to allow visualization of the abdominal cavity. At pelvic inspection, no EP was found. Throughout the exploration of the abdominal cavity, a 4-cm bluish cystic mass of friable consistency was detected infiltrating the omentum and the mesentery. According to Studdiford's criteria, the diagnosis of a primary OP was established. A careful and complete excision of the ectopic implant was performed with an ultrasonic system and required a considerable hemostatic effort using bipolar energy, endoscopic clips, and mechanical compression. The postoperative course was uneventful. The β-human chronic gonadotropin levels gradually decreased to negative values within 29 days after surgery. Omental ectopic pregnancy can be successfully managed with a laparoscopic approach even in an emergency setting. Omental pregnancy can easily be overlooked, even by skilled surgeons, during laparoscopic exploration. It is mandatory that all peritoneal surfaces and the omentum be carefully inspected during surgery in patients without other signs of pelvic EP.We confirm that the patient included in this video gave consent for publication of the video and posting of the video online, including on social media, the journal website, scientific literature websites, and other applicable sites.

Conservative Management of Splenic Injury in Blunt Abdominal Trauma: A Single Center Experience.

Road traffic accidents are the greatest cause of death worldwide. Most intra-abdominal injuries caused by blunt abdominal trauma have been treated surgically for a very long period. Over the past few decades, conservative care has gained in popularity and effectiveness as a treatment choice for blunt abdominal trauma. To determine the efficacy of conservative management in patients suffering from splenic injury in blunt abdominal trauma. The study included 62 cases of blunt abdominal trauma treated non-operatively in the general surgery department of the Hayatabad Medical Complex Peshawar between June 2021 and December 2022. Minimal hemoperitoneum was observed in 47 (75.8%) cases, moderate hemoperitoneum was noted in 11 (17.7%) cases, and 4 (6.4%) patients didn't have free fluid in the abdomen. There was no massive hemoperitoneum among the study patients. No major complications were observed during the study period. Only 7 (11.3%) cases develop minimal pleural effusion while 2 (3.2%) patients developed splenic abscess. Mortality was observed in only 1 (1.6%) case. Conservative management is a safe and efficient strategy and should be considered as a first line of treatment for all hemodynamically stable patients who suffered blunt splenic injury.

Ruptured Subcapsular Liver Hematoma: A Rare Complication of HELLP Syndrome

This case report highlights the rare and life-threatening complication of ruptured subscapular liver hematoma in the setting of hemolysis, elevated liver enzymes, and low platelets syndrome, a complication associated with pre-eclampsia. A 30-year-old pregnant woman at 38 weeks of gestation presented with high blood pressure, exaggerated neurological reflexes, and high levels of albumin in her urine. Her condition deteriorated over time, and liver function tests revealed elevated readings. An emergency cesarean section was performed, during which a large liver tear with active bleeding and rupture of the liver capsule in the right lobe were discovered. An exploratory laparotomy revealed a massive hemoperitoneum with active bleeding, and hepatic packing was performed using three gauzes. Despite this, the patient's liver parameters continued to worsen, and she was transferred to the intensive care unit for further resuscitation. After 72 hours, she underwent a second operation to remove the gauze packing, and hemostasis was successfully achieved without any active bleeding. Early detection of ruptured subcapsular liver hematoma and a coordinated approach involving medical, obstetrical, radiology, and surgical teams can lead to successful treatment of this rare and dangerous complication.

Focal placenta percreta mimicking subserous fibroid presenting as massive reactionary hemorrhage following cesarean delivery: A case report

Background: Reactionary hemorrhage is a severe complication of a cesarean section (CS) that may result from uterine atony, retained placental tissue, or ligature slippage. This case presents a rare cause of reactionary hemorrhage due to focal placenta invasion after CS presenting as hemoperitoneum.
 Case presentation: A 32-year gravida 2 para 1 presented to the outpatient department at 39 gestational weeks. She was scheduled for elective CS and bilateral tubectomy given previous CS and cephalopelvic disproportion. Her antenatal routine ultrasound was unremarkable. Eight hours later, she was scheduled for an emergency relaparotomy for intraabdominal collection. Intraoperatively, there was bleeding from a focal placental invasion at the left cornua with omentum covering the placental mass and massive hemoperitoneum. She was transfused with 4, 4, and 6 units of packed cells, platelets, and fresh frozen plasma, respectively, and was discharged home. 
 Conclusion: Focal placenta percreta may present with hypotension and massive hemorrhage in the postpartum period; therefore, a high index of suspicion is required to detect and prevent complications intrapartum.

Massive Hemoperitoneum after Paracentesis in a Patient with Budd-Chiari Syndrome: Treated with a TIPS after Negative Arteriogram.

Paracenteses are considered safe procedures; however, in patients with portal hypertension, the rapid shifts in intraabdominal pressure can prompt hemorrhage from an ectopic varix. Little literature exists on the appropriate management in this clinical setting. Here, we describe a patient with portal hypertension secondary to Budd-Chiari syndrome, presenting with massive hemoperitoneum following paracentesis. Angiography was performed, without revealing an arterial source of bleeding. Subsequently, transjugular intrahepatic portosystemic shunt placement was performed via a recanalized middle hepatic vein, reducing the patient's portosystemic gradient from 15 to 6 mm Hg. This patient developed no further signs or symptoms of bleeding and remained hemodynamically stable until discharge. Follow-up imaging confirmed patency of her shunt and resolution of her ascites, without the need for future paracentesis. This case highlights that in the absence of arterial extravasation, the possibility of ectopic variceal hemorrhage should be considered, which can be successfully treated with portosystemic shunt creation.

Postmortem Identification of Vascular Ehlers-Danlos Syndrome in a Lung Transplant Recipient.

Postmortem Identification of Vascular Ehlers-Danlos Syndrome in a Lung Transplant Recipient.

CLINICAL STUDY ON CONSERVATIVE MANAGEMENT OF BLUNT SPLENIC INJURY

Background: Spleen is the most common intra-abdominal organ to be injured in blunt abdominal trauma and currently most cases are treated nonoperatively. Aim of this study was to evaluate the efcacy of Non-Operative Management (NOM) of blunt splenic injury and to point out the predictors of failure of NOM. Methods: Over a 12 month period (June 2021- May 2022), 16 hemodynamically stable patients with blunt splenic injury admitted in Department of General Surgery in Silchar Medical College and Hospital were evaluated prospectively. Association of various factors were analysed using SPSS statistical software version 22 to nd out efcacy of NOM as well as to point out predictors of NOM. Results: NOM was successful in 81.3% of patients and 18.8% were converted to operative management (NOM failure). Statistical analysis showed that Systolic BP and Haemoglobin at the time of admission, Number of blood transfused, Injury Severity Score (ISS), USG nding of grade of hemoperitoneum, American Association for Surgery of Trauma (AAST) grade of splenic injury, Duration of hospital stay were signicantly associated with the outcome of NOM success (P value < 0.05). Age, Sex, Mode of injury, Pulse rate at the time of admission had no signicant relation with the outcome. AASTgrade IV splenic injury or higher, Massive hemoperitoneum, ISS > 25, Haemoglobin <8 gm%, Requirement of 4 or more units of blood and New-onset hemodynamic instability were independent predictors of failure of conservative management. Conclusion: Conservative management of blunt splenic injury is safe and effective as long as patients are selected based on strict inclusion/exclusion criteria

Watermelon skiing with a melancholy outcome: massive haemoperitoneum secondary to traumatic rupture of a para-adnexal leiomyoma

A 33-year-old woman sustained blunt abdominal trauma following a watermelon skiing accident in a rural location. She had massive haemoperitoneum and required transfer by helicopter to a level one trauma centre. At laparotomy, the cause of haemoperitoneum was found to be due to traumatic rupture of a para-adnexal leiomyoma. On review of the literature, this is the first reported case of traumatic haemoperitoneum from ruptured para-adnexal leiomyoma, and the first reported trauma associated injury from watermelon skiing.

Acute maternal collapse in pregnancy with ruptured rudimentary horn of unicornuate uterus: A case report

Unicornuate uterus with rudimentary horn occurs due to failure of complete development of one of the Mullerian ducts and incomplete fusion with the contralateral side. It is associated with numerous obstetrics and gynecological problems such as Infertility, Endometriosis, Miscarriages, Malpresentations & Intrauterine growth restriction. Pregnancy in the non-communicating rudimentary horn is extremely rare and usually terminates in rupture during first or second trimester of pregnancy. Pregnancy occurs via transperitoneal migration of sperm or zygote. Variable thickness of rudimentary horn musculature, poor distensibility of myometrium lead to rupture. This complication is usually seen in 2nd trimester resulting in shock and haemoperitoneum. Diagnosis of rudimentary horn pregnancy is difficult and can be missed in ultrasound. It requires a high risk of suspicion. Materials and Methods: We report the case of 24yr primi gravida with 26 weeks of gestation presented with pain abdomen and sudden maternal collapse on arrival, suspected to be intra-abdominal pregnancy in ultrasound and on laparotomy found ruptured rudimentary horn of unicornuate uterus with fetus found intra-abdominally with massive hemoperitoneum. Conclusion: Pregnancies in rudimentary horn of unicornuate uterus are prone to intra uterine growth restriction and rupture in second trimester so a high index of suspicion is required to save this catastrophic event and associated maternal morbidity and mortality. In our opinion, routine excision of rudimentary horn should be undertaken during non-pregnant state laparoscopically. However, those women who refuse should be adequately counseled regarding potential complications and if pregnancy occurs in rudimentary horn, first trimester laparoscopic excision should be done.

Embarazo ectópico cornual. A propósito de un caso

Ectopic pregnancy is defined as a pregnancy that occurs outside the uterine cavity, the most common location being in the ampullary region of the uterine tube. In the literature, the terms interstitial pregnancy and cornual pregnancy are often used synonymously, they represent between 1.1% and 6.3% of ectopic pregnancies in general and correspond to only 2.2% of tubal ectopic pregnancies; its etiology is multifactorial. In gestations greater than 12 weeks, uterine rupture occurs in 20-35% of cases, generating massive hemoperitoneum that could quickly lead to hypovolemic shock, maternal death or permanent sequelae of infertility. For this reason, treatment options will depend on the time of diagnosis and the hemodynamic stability of the patient.

Nonoperative management for major blunt hepatic trauma in a 3-year-old child

Introduction: Based on hemodynamic stability, non-operative management of low- and high-grade liver injury is the first treatment choice over surgical treatment. Small clinics are still preferring primary operative approach instead of nonoperative one. Presentation of the case: We are presenting a case (3-year-old male child) of nonoperative treatment of a grade IV blunt liver trauma (lacero-contusive injury of V, VI and VII segments) with massive hemoperitoneum. The patient was put into a conservative treatment with antibiotics, fluids and ½ unit of blood. The results of Computed Tomography showed significant amounts of perihepatic and periileal fluid between the bowels and in the Douglas pouch, which persisted for five days. Laboratory alterations ​​of Serum Glutamic Pyruvic Transaminase, Serum Glutamic-Oxaloacetic Transaminase, and Total Bilirubin reached their maximum values on third day, persisting in decline until fifth day and returned to normal after tenth day. The hospital stay was 11 days, the length of time necessary for the complete conservatory treatment and full recovery of the trauma. Discussion: More than 80%-90% of liver injuries are managed with nonoperative intervention. Early and late complication can be managed by interventional radiology procedures when it is possible. Success rate of conservative treatment is over 80%. Conclusion: If no other abdominal injuries are evident and patient is hemodynamically stable nonoperative management for major blunt hepatic trauma in children is the best choice of treatment

The impact of the COVID-19 pandemic on ectopic pregnancy presentation and treatment: A retrospective cohort study

ObjectiveWe examined ectopic pregnancy (EP) incidence, presentation and management, before and during the COVID-19 pandemic, and following initiation of vaccination against COVID-19. Study designIn a single-center retrospective cohort study, we compared incidence, presentation and management of EP, between 98 women who presented during the pandemic (March 1 2020 to August 31, 2021), and 94 women diagnosed earlier (March 1 2018 to August 31, 2019). Sub-periods before and after introduction of the vaccination were compared. ResultsAge and parity were similar between the periods. For the pandemic compared to the earlier period, the median gestational age at EP presentation was higher (6.24 ± 1.25 vs. 5.59 ± 1.24, P<0.001), and the proportions were higher of symptomatic women (42.9% vs. 27.7%, p = 0.035) and urgent laparoscopies (42.9% vs. 24.5%, p = 0.038). In a multivariable linear model, women who presented during the pandemic were more likely to undergo an urgent laparoscopy [OR 2.30, 95%CI (1.20–4.41)], P = 0.012. In urgent surgeries performed during the pandemic compared to the earlier period, the proportion of women with a hemoglobin drop >2 gr/dL was greater (60% vs. 30%, p = 0.024). Statistically significant differences were not found in sonographic or laboratory findings, in rupture or massive hemoperitoneum rates, or in the need for blood transfusion in urgent laparoscopy. Outcomes were similar before and after introduction of vaccinations. ConclusionDuring the pandemic, and even after the introduction of vaccination, women with EP were more likely to undergo urgent surgery, and blood loss was greater. This is likely due to delayed diagnosis.

Laparoscopic Repair of Post-Coital Vaginal Perforation Communicating with the Abdominal Cavity

<h3>Study Objective</h3> The objective of this video is to describe an approach to the work-up and surgical management of postcoital vaginal laceration communicating with the abdominal cavity. <h3>Design</h3> N/A. <h3>Setting</h3> An academic tertiary care hospital. <h3>Patients or Participants</h3> The patient is an 18 y/o G0 who presented 12 hours after intercourse with heavy vaginal bleeding, diffuse abdominal pain, and multiple syncopal episodes. Initial exam was notable for hypotension, diffuse abdominal pain with involuntary guarding, and copious vaginal bleeding from the vagina of unclear origin. <h3>Interventions</h3> A bedside FAST scan demonstrated free fluid in Morrison's pouch. CT scan demonstrated multiple foci of air in the pelvis consistent with vaginal perforation. The patient was taken to the OR for laparoscopic repair of a 4cm full-thickness vaginal perforation communicating with the abdominal cavity, where 300cc of hemoperitoneum was evacuated from the abdominal cavity. An air leak test was performed at the end of the case to ensure no injury to the sigmoid colon. <h3>Measurements and Main Results</h3> The patient received was discharged on POD#1 in stable condition. <h3>Conclusion</h3> Vaginal perforation communicating with the abdominal cavity is a rare complication of intercourse that can have a delayed presentation and occur with hemorrhagic shock. FAST scan can be employed at the bedside to rapidly identify massive hemoperitoneum. Though prior case reports have mainly reported an open repair, a laparoscopic approach is a safe and effective method to repair vaginal defects communicating with the abdominal cavity. Finally, given the high rate of traumatic rectovaginal fistula reported in this population, surgeons should consider the use of an intraoperative air-leak test to confirm colorectal integrity after the repair.