Severe Intra-abdominal Bleeding Research Articles

Maternal Complications After Laser Surgery for Twin-to-Twin Transfusion Syndrome, a Cohort Study.

To assess maternal complications after fetoscopic laser surgery (FLS) for the twin-to-twin transfusion syndrome (TTTS). All consecutive cases treated with FLS for TTTS between 2008 and 2021 at the Leiden University Medical Center (LUMC) were included. We allocated complications in three timeframes: "Admission for laser surgery," "pregnancy after laser," and "delivery and third stage of labor." Maternal complications were graded according to the Maternal and Fetal Adverse Event Terminology (MFAET) and for intra-abdominal hemorrhage, the Common Terminology Criteria for Adverse Events (CTCAE). In the study period, 637 mothers were treated for TTTS with FLS. There were 1559 occurrences of maternal complications. The rate of severe maternal complications (grade 3 or 4) was 8.0%. Severe complications consisted of six cases of severe intra-abdominal hemorrhage, nine cases of severe hemorrhage in pregnancy, one with severe chorioamnionitis, 10 with severe preeclampsia/HELLP syndrome, and 25 with a severe postpartum hemorrhage. Even though it is the gold standard for treating TTTS, FLS comes at a risk to the mother which should not be neglected. And even though not all complications have serious consequences to the mother, the severe maternal complication rate of 8.0% should be added to the inherent risks for the fetus, and should be discussed with patients eligible for surgery in order to make an informed decision on treatment options.

Sarcopenia As a Determinant Prognostic Factor After Surgery Among Patients with Colorectal Cancer.

Surgery for colorectal cancer (CRC) is not risk-free; therefore, preoperative evaluation must be done to predict and prevent surgical complications. Sarcopenia, a loss of muscle mass and function, was shown to be associated with surgical complications. Our study evaluates the effects of sarcopenia on short-term patient outcomes after CRC resection. Our retrospective study included patients with histologically proven CRC between 2018 and 2020 who underwent surgical resection. Skeletal muscle mass (cm2) was evaluated on a preoperative CT scan at the level of L3 vertebrae then standardized using stature (m2) to obtain the skeletal mass index (SMI) (cm2/m2). Patients received proper adjuvant care if needed and were followed up 90 days post surgery. Descriptive statistics were presented in percentage for categorical variables and in mean for continuous variables. Multivariate was made by linear regression. 113 patients were included, and 15% were sarcopenic. A statistically non-significant association was found between sarcopenia and severe complications (grade III-IV) (23.53% in sarcopenic vs. 9.38% non-sarcopenic, p=0.02, multivariate p=0.675). Sarcopenia was not associated with anastomotic leakage, infectious complications, or ileus or intra-abdominal bleeding (p>0.05). In literature, some studies showed an association between sarcopenia and postoperative complications while others showed no relationship between the two. Most studies used SMI. A non-statistically significant association was found between sarcopenia and postoperative complications in CRC patients. Sarcopenia does not predict postoperative severe complications, anastomotic leakage, infectious complications, or ileus or intra-abdominal bleeding. Emergent surgeries and age >60 years were associated with more postoperative complications.

Hepatocellular adenomas with severe intra-abdominal bleeding, related to an underlying coagulation disorder: a case report

BackgroundHepatocellular adenoma is a rare benign liver tumor. Typically, hepatocellular adenomas are solitary and are found in young women who use estrogen-containing contraceptives. The occurrence of multiple hepatocellular adenoma has been linked to higher body mass index, and as the prevalence of overweight increases, multiple hepatocellular adenomas are seen more often. An hepatocellular adenoma does not always necessitate treatment, as they can regress under conservative strategies. In incidental cases, an adenoma presents owing to bleeding, which is mostly self-limiting. If it is not, embolization of hepatic involved vessels is indicated.Case presentationIn this case report, we discuss a 42-year old Caucasian woman with multiple hepatocellular bleeds, treated by multiple endovascular procedures. After the first embolization of an adenoma in the right liver lobe, a second bleed occurred in the left lobe, necessitating additional endovascular intervention. During admittance, treatment was complicated by pulmonary embolism and a pneumonia. During follow-up, our patient was diagnosed with antiphospholipid syndrome.ConclusionHepatocellular adenoma is a rare diagnosis that requires centralized expertise. This particular case illustrates the complexity of treatment strategies for associated intra-abdominal bleeding and possible complications. Although liver adenoma is often an incidental finding, it can also result in significant morbidity. Centralization of treatment leads to expertise in managing complex treatment strategies.

Successful curative treatment for a ruptured pancreatic acinar cell carcinoma by radical resection following modified FOLFIRINOX: a case report and literature review.

Pancreatic acinar cell carcinoma (PACC) is a rare pancreatic tumor type, and ruptured pancreatic tumors are rarer. Computed tomography (CT) in a 48-year-old man incidentally revealed a raptured pancreatic tail tumor. The patient was treated conservatively because he was asymptomatic, and his general condition was stable. After a detailed examination, the pancreatic tumor was diagnosed as raptured PACC. Considering the potential infiltration of tumor cells into the hematoma within the omental sac, our decision is to initiate chemotherapy as the primary course of action. A liquid biopsy was performed, and comprehensive genomic profiling of circulating tumor DNA showed a tumor BRCA2 mutation. Chemotherapy with modified FOLFIRINOX (mFFX) was selected as the first treatment. After seven courses of mFFX, the primary tumor diminished remarkably. At this time, the radical resection was performed via distal pancreatectomy with simultaneous resection of the gastric wall and colon, which had adhered strongly to the tumor. Histopathological examination revealed that the tumor had shrunk to less than 5% of its original size due to chemotherapy (Grade 3 of Evans Classification). Devising treatment strategies for ruptured pancreatic malignant tumors is challenging due to the worsening general condition caused by severe abdominal symptoms and intra-abdominal bleeding. In this context, this case-report documents a rare instance of raptured PACC with a tumor BRCA2 mutation that underwent radical resection following mFFX treatment.

Severe Intra-Abdominal Hemorrhage Caused by Invasion of Chorionic Villi into the Myometrium Resulting from Undetected Uterine Perforation

Severe Intra-Abdominal Hemorrhage Caused by Invasion of Chorionic Villi into the Myometrium Resulting from Undetected Uterine Perforation

S3145 Severe Transplantation-Mediated Alloimmune Thrombocytopenia After Liver Transplant Treated Successfully With Efgartigimod

Introduction: Transplantation-mediated alloimmune thrombocytopenia (TMAT) is a rare form of passenger lymphocyte syndrome in which lymphocytes from the donor organ produce antibodies against recipient platelets resulting in thrombocytopenia. We describe a novel treatment of TMAT with efgartigimod, a human IgG1 Fc antibody fragment, in a patient with severe, refractory thrombocytopenia following liver transplantation. Case Description/Methods: A 70-year-old man with cirrhosis secondary to non-alcoholic steatohepatitis complicated by hepatocellular carcinoma underwent deceased donor orthotopic liver transplantation. He required emergent retransplantation on post-operative day 7 for acute hepatic artery thrombosis. Seven days after retransplantation, the patient developed severe thrombocytopenia with platelets <1 × 109/L. He responded poorly to platelet transfusion, and two days later developed severe intra-abdominal bleeding requiring exploratory laparotomy. No active bleeding was found, and splenectomy was performed. Testing for heparin induced thrombocytopenia was negative, and the working diagnoses were post transfusion purpura and idiopathic thrombocytopenic purpura. Over the next 8 weeks, the patient had persistent, severe thrombocytopenia despite platelet transfusions and treatment with intravenous immunoglobulin, plasmapheresis, rituximab, romiplostim, and eltrombopag. Notably, two patients who received lung and kidney transplants from the same donor also developed severe thrombocytopenia. Ultimately, testing revealed the presence of serum antibodies to human platelet antigen (HPA) 1a. Genetic testing revealed the genotypes HPA 1a/1b and HPA 1b/1b in the patient and donor respectively, consistent with a mismatch and TMAT. The patient received weekly efgartigimod for 4 doses, and after his third infusion developed sustained improvement in platelets to >100 × 109/L without need for transfusion. Discussion: TMAT is a rare disorder after solid organ transplantation that can lead to severe thrombocytopenia with life threatening bleeding and even death. Although TMAT generally resolves a few months after transplantation as donor lymphocytes are cleared from the circulation, initial management is challenging. Efgartigimod is a novel treatment approved by the food and drug administration for myasthenia gravis that leads to degradation of IgG by binding to the neonatal Fc receptor and should be considered for severe TMAT.

P-762 Intraabdominal Hemorrhage Following Ultrasound-guided Transvaginal Oocyte Retrieval: Retrospective Analysis of 25 Cases

Abstract Study question Intraabdominal hemorrhage is a rare but serious complication following (oocyte pick up, OPU), it is very important for clinicians to know the risk factors. Summary answer Intraabdominal hemorrhage is mild in most cases, laparoscopy or laparotomy is the most effective approach to stop bleeding quickly in severe intraabdominal hemorrhage cases. What is known already During the OPU procedure, intraabdominal hemorrhage is not visible without the assistance of ultrasound, even minor bleeding, if persists, may lead to life-threatening consequences. Previous publications had limited sample size and the analysis of serial cases was scarce, most studies focused on severe hemorrhage that necessitated surgical interventions and somehow neglected those with mild hemorrhage. The reported incidence of severe intraabdominal hemorrhage varied from 0.06% to 0.27%, while 0.08%-0.1% of patients required surgery. Study design, size, duration Retrospective study, 25 cases that underwent post-OPU intraabdominal hemorrhage and required hospitalization in our center since 2003 to January 2021. Participants/materials, setting, methods Patients underwent intraabdominal hemorrhage following OPU in a University-affiliated center needed to be hospitalized. We aimed to discuss the clinical characteristics, risk factors, and precautionary measures of intraabdominal hemorrhage following OPU procedures. Main results and the role of chance The incidence of intraabdominal hemorrhage following OPU procedures was 0.044%. In all 25 cases, 17 received conservative treatment while emergency surgical exploration was performed to stop bleeding quickly for the remaining patients. Primary symptoms included the following: abdominal distention and/or pain, chest distress, dizziness, syncope, tenesmus, palpitations, etc.48% and 92% of patients had obvious symptoms within the first hour and 12 hours following OPU, respectively. Pelvic hematoma and/or effusion were found under ultrasonic scan in all but three patients. Overall, the reduction in hemoglobin(ΔHb) and hematocrit (ΔHct) were 26.50±13.32 g/L and 7.70%±3.66%, respectively. The mean interval between OPU and surgical procedure was 29.88±18.80 hours. And the main intra-operative findings were laceration and/or active bleeding on the ovary and satisfied hemostasis was achieved through suture or electrocoagulation. The blood aspirated during the procedure was 1 563±548 ml on average. Before they got discharged, these patients stayed at hospital for 5.04 days on average. In addition, our data shows that intraabdominal hemorrhage following OPU does not affect the final pregnancy outcomes, the cumulative live birth rate per woman was 48% (12/25). Limitations, reasons for caution This study is limited by its retrospective nature. In addition, patients who underwent mild hemorrhage and received effective therapy in an outpatient clinic rather than hospitalization or elsewhere were not included, which might lead to underestimation of the incidence concerned. Wider implications of the findings Intraabdominal hemorrhage is a rare but serious complication following OPU, which might be life-threatening. Nonetheless, hemorrhage is mild in most cases and conservative treatment is the first-line choice. Laparoscopy or laparotomy is the most effective approach to stop bleeding quickly in severe intraabdominal hemorrhage cases. Trial registration number not applicable

Risk factors of relaparotomy for intra-abdominal hemorrhage after cesarean delivery

Objectivethe main objective was to identify risk factors of relaparotomy for intra-abdominal hemorrhage (IAH) after cesarean delivery. The secondary objectives were to identify clinical warning signs associated with IAH: heart rate>120/min, systolic blood pressure<90 mmHg, scar bleeding, unconsciousness or abdominal pain with visual analog pain scale > 7 or use of category 3 analgesic medications, in the post-anesthesia care unit and in the post-partum unit. Study designa case-control study (1:2 ratio), in two academic tertiary perinatal centers during 2008−2017. Postpartum laparotomies performed for another indication were excluded. The cases were women who underwent relaparotomy for IAH. A control group comprised women who had an uncomplicated cesarean delivery before and after each case. Results19,007 women had a cesarean delivery during the study period and among them 52 relaparotomies (0.27 %) for IAH were performed. 48 cases were compared to 96 controls. In multivariate analysis, the existence of a preeclampsia (aOR = 2.8, 95 % IC 1.1−7.4), urgent cesarean (aOR = 3.2, 95 % IC 1.1−9.6), surgical difficulties during initial cesarean (aOR = 9.0, 95 % IC 2.8−23.8), and estimated blood loss > 500 mL during initial cesarean (aOR = 7.4, 95 % IC 2.4−22.5) were independently associated with IAH. Tachycardia > 120/min was the most discriminating factor associated with the occurrence of relaparotomy for IAH (84 %). In the absence of tachycardia, hypotension < 90 mmHg was the second most discriminant factor for IAH (73 %). Conclusionpreeclampsia, urgent cesarean, surgical difficulties and blood loss > 500 mL during initial cesarean were independently associated with an increased risk of relaparotomy for IAH. Tachycardia and/or hypotension were discriminant-warning signs for severe IAH.

A Review of "Predicting the Need to Pack Early for Severe Intra-abdominal Hemorrhage" (1996).

A Review of "Predicting the Need to Pack Early for Severe Intra-abdominal Hemorrhage" (1996).

Perioperative outcomes of robotic pancreaticoduodenectomy: a single surgeon's experience with 55 consecutive cases.

Robotic pancreaticoduodenectomy (RPD) has been increasingly performed for patients with periampullary tumours and tumours in the pancreatic head. This method offers several technical advantages compared to open and laparoscopic surgeries. However, the surgical results often vary depending on the experience of different pancreatic centres. A retrospective study of our first 55 cases of RPD from August 2016 to April 2020 was conducted to evaluate the perioperative outcomes of RPD and to summarize the operative experiences in a single intuition. Benign and malignant tumours in the pancreatic head or periampullary tumours without obvious vascular and adjacent organ invasion were included in this study. Perioperative characteristics and postoperative complications of the enrolled patients were retrospectively collected. The first 17 cases were robot-assisted laparoscopic pancreaticoduodenectomy (RA-LPD) and the remaining 38 patients underwent total RPD. The RA-LPD group had a remarkably longer operative time than the total RPD group (415.3±89.2 vs. 362.4±75.6 min, P=0.047). The incidences of biliary leakage, chyle leakage, DGE, intra-abdominal infection and intra-abdominal haemorrhage were 3.6%, 0.0%, 5.5%, 9.1% and 5.5%, respectively. Two patients underwent relaparotomy due to severe intra-abdominal haemorrhage. The median length of hospital stay was 14 (11 to 19) days. There were no deaths during the perioperative period. RPD is a technically feasible procedure for selected patients with periampullary tumours and tumours in the pancreatic head in experienced hands.

A 23-Year-Old Man with SARS-CoV-2 Infection Who Presented with Auditory Hallucinations and Imaging Findings of Cytotoxic Lesions of the Corpus Callosum (CLOCC)

Patient: Male, 23-year-oldFinal Diagnosis: Cytokine release syndrome • disseminated intravascular coagulation • multiple organ failureSymptoms: Auditory hallucinations • fever • headache • restlessness • suicidal thoughtsMedication: —Clinical Procedure: —Specialty: Infectious Diseases • NeurologyObjective:Unusual clinical courseBackground:Cytotoxic lesions of the corpus callosum (CLOCC) is a rare clinical and radiological syndrome that has been associated with various infectious etiologies. CLOCC are among the recently described neurological associations with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with coronavirus disease 2019 (COVID-19). We report a case of CLOCC in a man with SARS-CoV-2 infection who presented with auditory hallucinations and rapidly developed systemic inflammatory response syndrome (SIRS).Case Report:A 23-year-old man with no past medical and psychiatric history presented with auditory hallucinations, restlessness, and suicidal ideations. A nasopharyngeal swab specimen tested using real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay was positive for SARS-CoV-2. A brain MRI revealed an isolated oval-shaped lesion in the splenium of the corpus callosum, with hyperintense signal on diffusion-weighted imaging (DWI) and hypointense on apparent diffusion coefficient (ADC) maps, suggestive of CLOCC. After a dramatic hospital course associated with multiple organ dysfunction syndrome (MODS) and severe intra-abdominal and cerebral bleeding, he developed cardiac arrest and died on hospital day 15.Conclusions:This case highlights the need for increased vigilance for the atypical manifestations of SARS-CoV-2 infection. In addition, it suggests that CLOCC can be considered as a differential diagnosis by clinicians in patients with SARS-CoV-2 infection who present with unexplained neurological and neuropsychiatric symptoms, leading to poor outcome.

A Case of Shock Associated with Mesenteric Injury and Severe Intraabdominal Hemorrhage Resulting from an Unusual Sexual Practice

A Case of Shock Associated with Mesenteric Injury and Severe Intraabdominal Hemorrhage Resulting from an Unusual Sexual Practice

Thinking outside the “box”: severe intra-abdominal bleeding due to liver injury post CPR

Thinking outside the “box”: severe intra-abdominal bleeding due to liver injury post CPR

Thinking Outside the "Box": Severe Intra-Abdominal Bleeding Due to Liver Injury Post CPR

35-year-old woman with a past psychiatric history and alcohol abuse was found unresponsive on the bathroom floor by her boyfriend. EMS was called, and chest compressions were commenced by the boyfriend while awaiting EMS arrival. EMS found the patient to be in PEA and continued CPR on scene and during transport. ROSC was achieved while en route to the hospital. On arrival to the ED she was initially normotensive but quickly decompensated requiring aggressive fluid resuscitation and vasopressors. FAST was performed by ED staff, revealing hemoperitoneum.

Percutaneous Endoscopic Necrosectomy (PEN) Combined with Percutaneous Catheter Drainage (PCD) and Irrigation for the Treatment of Clinically Relevant Pancreatic Fistula after Pancreatoduodenectomy

Purpose: This study aimed to evaluate the efficacy of percutaneous endoscopic necrosectomy (PEN) combined with percutaneous catheter drainage (PCD) and irrigation versus PCD for the treatment of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD). Materials and Methods: A total of 34 consecutive patients who suffered from CR-POPF after PD were enrolled in this retrospective cohort study. 12 patients received PEN combined with PCD and irrigation, and 22 patients received PCD. The complications and outcomes of the treatments were compared. Results: No patients suffered from severe PCD- or PEN-related complications. Compared with those treated with PCD, the patients treated with PEN combined with PCD and irrigation had a lower incidence of postoperative delayed severe intraabdominal hemorrhage (31.8% vs. 0%; p = 0.04). During the follow-up period, no patients in either group suffered from collection recurrence or external pancreatic fistula requiring surgical intervention.Conclusions: PEN combined with PCD and irrigation was safe and effective for reducing postoperative delayed severe intraabdominal hemorrhage in patients with CR-POPF after PD.

Spontaneous omental bleeding: a case report and literature review

BackgroundSpontaneous rupture of omental vessels is an infrequent medical condition possibly causing severe intra-abdominal hemorrhage. Omental bleeding results from trauma associated injury and irritation, neoplasia, arterial aneurysm rupture, and anticoagulant treatment. Idiopathic omental bleeding rarely causes acute abdominal bleeding which has been reported to occur in previous studies. Here we reported a case with idiopathic omental hemorrhage due to vascular malformation. A systematic review of literature is provided.Case presentationA 58-year-old Han Chinese man arrived at the emergency department with left upper quadrant abdominal pain for 1 day. He had no significant previous medical history. There was no history of fever, vomiting, nausea, or anorexia. He was a non-smoker and did not consume alcohol. On physical examination, blood pressure was 118/72 mmHg, for a temperature of 37.7 °C; heart and respiratory rates of 130 per/min and 20 per/min were obtained, respectively. Abdomen assessment showed only mild tenderness in the left upper quadrant. Complete blood count (CBC) showed white cell and platelet counts of 16.69 × 103/L and 196 × 103/L, respectively. The haemoglobin value was 13.5 g/L at admission. Abdominal Computer Tomography (CT) was performed that showed peritoneal fluid appeared around the liver. Fresh blood was confirmed in the abdominocentesis. A hemoperitoneum was confirmed by abdominal enhanced CT, which presented a structural disorder in the left upper abdomen. The subject immediately underwent exploratory laparotomy. A massive hemoperitoneum originating from omental vessels was observed. The omental were partially removed. There was no evidence of malignancy or aneurysm upon palpation. Pathological assessment of the extracted tissue pointed to vascular malformation. The patient subsequently had an uneventful recovery; hospital discharge occurred at 7 days post-operation.Previous reports assessing idiopathic omental bleeding were systematically reviewed, summarizing published cases. A total of 12 hits were found in PubMed for idiopathic omental bleeding.ConclusionIdiopathic omental bleeding is a rare condition that requires emergency treatment. Treatment strategies include surgical intervention and transcatheter arterial embolization (TAE). The surgical option is suitable in subjects with persistent hypotension and those with unconfirmed diagnosis.

A metastatic invasive mole arising from iatrogenic uterus perforation

BackgroundInvasive mole derives from hydatidiform mole, but its pathogenesis remains unknown. Invasive mole arising from iatrogenic uterine perforation has not been reported yet.Case presentationA reproductive woman was admitted because she suffered form severe abdominal pain and acute intra-abdominal hemorrhage after suction evacuation due to misdiagnosis as inevitable abortion. The patient underwent hysteroscopy and laparoscopy, by which an iatrogenic uterine perforation and omentum and pelvic peritoneum metastases were confirmed. All lesions were removed and the final pathological diagnosis was metastatic invasive mole. The patient underwent post-operative chemotherapy with methotrexate and presented a good prognosis.ConclusionInvasive mole arising form iatrogenic uterine perforation displays an unusual metastatic manner other than general invasive moles. The prevention of uterine perforation should be emphasized during suction evacuation for mole pregnancy.

Protein-Losing Hypertrophic Gastropathy, Menetrierʼs Disease, Successfully Managed With Long-Acting Octreotide

Protein-losing gastro-enteropathies are characterized by excessive loss of protein into the gastrointestinal tract. Ménétrier's disease (MD) is a rare disease characterized by extreme foveolar hyperplasia with glandular atrophy in a patient with gross enlargement of gastric folds or ruggae. Little is understood about the pathogenesis of this disease and treatment has mostly consisted of dietary therapy (low-fat, high-protein, medium-chain triglyceride diet.) This case describes a patient with MD successfully managed with Octreotide until he developed intussusception of a large gastric adenoma which required an emergent gastrectomy. A 52 yo AA male was diagnosed with MD after evaluation of a large gastric mass/thickened fold incidentally noted on imaging. An EGD confirmed thickened and large gastric folds. Gastric biopsies demonstrated dilated hyperplastic foveolar glands with stromal edema making the diagnosis of MD (Figure 1, 2). His course was complicated by several hospitalizations for DVTs treated with anticoagulation, severe intra-abdominal hemorrhage due to a complicated LVP, complicated pancreatic fluid collections, volume over load, and severe symptomatic anemia. Labs revealed a hemoglobin of 2.6 g/dL (MCV 58), ferritin 8 ng/ml, iron of < 5 mcg/dL, and Albumin of 0.9 g/dL. For several weeks his Albumin persistently ranged between 0.9 - 1.3 g/dL. Further evaluation revealed an elevated alpha-1-antitrypsin stool clearance >59 ml/day. He was started on octreotide 100mg BID SQ x6 months and subsequently transitioned to long acting Octreotide 20mg IM q4weeks. His albumin increased from 0.9 g/dL to 2.9 g/dL over the following 12-months. His anemia, microcytosis, and iron deficiency normalized. All of his clinical manifestations of hypoalbuminemia resolved and he regained significant muscle mass. Unfortunately, almost 19-months after making the diagnosis of MD he developed a gastric outlet obstruction due to a large fungating gastric adenoma filling and markedly distending the duodenum necessitating an emergent gastrectomy. He recovered well from surgery and continues to do well upon on follow up. Our case demonstrates the potential role of Octreotide as treatment or bridge to surgery for management of patients with protein losing gastropathies as well as as a gastric outlet obstruction from a gastric adenoma, an uncommon complication of this rare disease.Figure: Endoscopic appearance of the stomach showing mucosa edema and polypoid changes of the gastric fundus and body.Figure: Gastrectomy is performed. A, Grossly, there is hypertrophy of the fundal and body mucosa with sparing of the gastric antral mucosa; B-D, histologically, the body and fundal mucosa shows edematous, mildly inflamed lamina propria with hyperplastic.

Role of ultrasonography in blunt abdominal trauma

Objective The aim of the study was to assess the role of ultrasonography (US) focused assessment with sonography in trauma (FAST) at the time of presentation and ultrasound repeated after 12–24 h in early diagnosis of intra-abdominal injury (IAI) following blunt abdominal trauma (BAT) and for follow-up. Background US was used in patients with IAI. Trauma is the most common cause of mortality. The most common mechanisms resulting in BAT among patients were motor vehicle collisions (73%), motorcycle collisions (7%), auto–pedestrian collisions (6%), and falls (6%). Patients and methods This is a prospective study of 50 patients presented to the Emergency Room of Menoufia University Hospital with BAT who underwent US and FAST examination at the time of presentation and were followed up with US after 12–24 h. Of them, 12 patients were hemodynamically unstable, six patients had severe intra-abdominal hemorrhage and entered the operation theater urgently after FAST examination, and the other six patients entered the ICU for urgent care, FAST findings, and follow-up. US findings were correlated with patients' clinical data. Results US is very useful in the follow-up of patients with minor IAI and it decreases the use of computed tomography. However, ultrasound is operator dependent and could overlook lacerations of solid organs and gastrointestinal injuries. Therefore, contrast-enhanced computed tomography is still considered the gold standard in the evaluation of the exact site and the degree of IAI. Conclusion We concluded that ultrasound is considered the best modality in the initial evaluation of patients with BAT. However, repeated ultrasound in patients of BAT increases the sensitivity of ultrasound for causing intra-abdominal bleeding to 100%.

Acute lymphoblastic congenital leukemia as a cause of perinatal death following massive cerebral hemorrhage

Abstract Background Congenital leukemia is a rare condition and most commonly found in infants with Down syndrome. The occurrence in newborns without a genetically predisposing syndrome is extremely infrequent. Highlights We describe a case of peripartal fetal death at 30 weeks and 4 days of gestation. Emergency cesarean section was performed after a previously uncomplicated pregnancy because of pathologic fetal heart rate tracing and suspected intracranial hemorrhage on ultrasound imaging. Resuscitation of the newborn was unsuccessful and stopped after 30 min, when ultrasound of the fetus confirmed very severe intracranial and intraabdominal bleeding. Autopsy was performed after informed consent and demonstrated evidence of acute lymphoblastic leukemia in the bone marrow, associated with wide spread visceral involvement. Conclusion Perinatal fetal demise due to congenital leukemia is exceedingly rare and can occur unexpectedly in the third term after a normal pregnancy. We here report the clinical and pathologic findings, discuss the pathogenesis of fetal leukemia and its clinical manifestations along with a thorough review of the relevant literature.