Thrombocytopenia is included in the classification criteria for systemic lupus erythematosus (SLE). However, severe thrombocytopenia causing spontaneous bleeding is rare. Here, we describe a 22-year-old woman who presented with spontaneous hemoperitoneum as the first manifestation of SLE. Laboratory findings compatible with SLE included positive antinuclear antibody and a false-positive venereal disease research laboratory. Symptoms suggesting the disease were not prominent early after admission, but headache and seizures that developed on the 3rd day of admission led to the diagnosis of SLE. The brain magnetic resonance imaging and angiography findings were compatible with the neuropsychiatric manifestations of SLE. High-dose steroid and monthly intravenous cyclophosphamide pulse therapy were effective at improving the headache and seizure, as well as the hemoperitoneum.
Adult ; Female ; Hemoperitoneum/*etiology ; Humans ; Lupus Erythematosus, Systemic/*complications ; Thrombocytopenia/etiology

The experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis (SAP) by transcatheter arterial embolization was summarized. The clinical data of 19 SAP patients complicated with intra-abdominal bleeding in our hospital from Jan. 2000 to Jan. 2003 were analyzed retrospectively and the therapeutic outcome of TAE was evaluated statistically. The results showed that the short-term successful rate of hemostasis by TAE was 89.5% (17/19), the incidence of re-bleeding after TAE was 36.8% (7/19) and the successful rate of hemostatis by second TAE was 71.4% (5/7). It was concluded that the intra-abdominal bleeding in SAP was mainly caused by the rupture of erosive/infected pseudoaneurysm. Mostly, the broken vessels were splenic artery and gastroduodenal artery; In terms of emergence hemostatis, TAE is the most effective method. Surgical hemostasis is necessary if hemostasis by TAE is failed or re-bleeding occurs after TAE.
Aneurysm, False/diagnosis ; Aneurysm, False/etiology ; Aneurysm, False/therapy ; *Embolization, Therapeutic/methods ; Hemoperitoneum/diagnosis ; Hemoperitoneum/etiology ; Hemoperitoneum/*therapy ; Pancreatic Pseudocyst/diagnosis ; Pancreatic Pseudocyst/etiology ; Pancreatic Pseudocyst/therapy ; Pancreatitis, Acute Necrotizing/*complications ; Pancreatitis, Acute Necrotizing/therapy ; Retrospective Studies

When primary injuries caused by penetrating violence and secondary injuries by faulty medical procedures are both present, it is important to distinguish "avoidable" from "unavoidable" secondary injuries. The primary and "unavoidable" secondary injuries rather than the secondary "avoidable" injuries should be included as evidence for assessment of the degree and grade the injuries. The basic principles to assess blood accumulation after injury have been stated in the seventy-two clause of "The Assessment Criterion of Severe Human Body Injury". However, it dose not distinguish abdominal blood accumulation caused by primary penetrating wounds from that resulted from secondary medical procedures. An amendment to the clause might be necessary.
Abdominal Injuries/complications* ; Expert Testimony/standards* ; Female ; Forensic Medicine/standards* ; Hemoperitoneum/surgery* ; Humans ; Injury Severity Score ; Male ; Wounds, Penetrating/complications*

The stomach is the most frequent site of gastrointestinal stromal tumor (GIST). The common clinical manifestation of GIST are melena and hematochezia caused by gastointestinal bleeding. However, hemoperitoneum due to GIST rupture is a very rare condition. We describe a 33-year-old man with gastric GIST causing hemoperitoneum. A preoperative CT scan demonstrated large amount of fluid collection and extraluminal mass lesion in gastric antral area. He underwent an emergent laparotomy. The antral mass was polypoid shaped and showed ruptured focus. We performed a distal gastrectomy. The tumor was revealed as GIST with intermediate malignant risk by pathologic examination. The patient had an uneventful postoperative course and remains well.
Adult ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors/complications/*diagnosis/surgery ; Hemoperitoneum/*diagnosis/etiology ; Humans ; Male ; Tomography, X-Ray Computed

Adult ; Crohn Disease ; complications ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; etiology ; Hemoperitoneum ; diagnosis ; etiology ; Humans ; Wounds, Nonpenetrating ; diagnosis ; etiology

Peritoneal pregnancies are classified as primary and secondary. Primary implantation on the peritoneum is extremely rare in extrauterine pregnancy and is a potentially life-threatening variation of ectopic pregnancy within the peritoneal cavity, representing a grave risk to maternal health. Secondary abdominal pregnancies are by far the most common and result from tubal abortion or rupture, or less often, after uterine rupture with subsequent implantation within abdomen. Early diagnosis and appropriate surgical management, regardless of stage of gestation, appear to be important in achieving good results. We report a case of primary peritoneal pregnancy in a 28-year-old woman, who had severe lower abdominal pain one day before laparotomy for a preoperative diagnosis of ectopic pregnancy. The conceptus was implanted on the left uterosacral ligament. A fresh embryo of approximately 8 weeks' gestation was found in the conceptus.
Adult ; Case Report ; Female ; Follow-Up Studies ; Hemoperitoneum/surgery ; Hemoperitoneum/diagnosis ; Hemoperitoneum/complications* ; Human ; Ligaments ; Ovum Implantation ; Peritoneum/pathology ; Pregnancy ; Pregnancy, Abdominal/surgery ; Pregnancy, Abdominal/pathology ; Pregnancy, Abdominal/diagnosis ; Pregnancy, Abdominal/complications* ; Rupture, Spontaneous/surgery ; Rupture, Spontaneous/diagnosis ; Sacrum ; Uterus/pathology

BACKGROUND/AIMS: Spontaneous rupture of hepatocellular carcinoma (HCC) is known as a rare but life- threatening condition because of massive blood loss into the peritoneal cavity. In the countries with high prevalence, the reported incidence of spontaneous rupture and hemorrhage ranged from 10.2% to 14.5% of patients with HCC. This study was aimed to analyze the risk factors for spontaneous rupture and prognosis in the patients with ruptured HCC. METHODS: Among 642 consecutive patients with HCC who had admitted to Gyeongsang National University Hospital from January 1998 to September 2003, spontaneous rupture of HCC occurred in 83 patients (12.9%). The medical records of the 83 patients were reviewed retrospectively, and the clinico-laboratory parameters and radiologic findings were analyzed. RESULTS: Sixty-nine out of the 83 patients were male, the mean age was 57.7 +/- 13.2 years (male, 56.8 +/- 12.9 years; female, 62.3 +/- 13.5 years). Location of tumor, Child-Pugh class and Okuda stage were the risk factors influencing spontaneous rupture of HCC, whereas the TNM stage, presence of portal vein thrombosis, and size of the tumor were not. Among the 83 patients with ruptured HCC, 51 were treated by transarterial embolization (TAE), 31 by supportive measures, and 1 by operation. The median survival time was 3.4 +/- 4.5 months in all patients with ruptured HCC, 4.9 +/- 5.1 in successful TAE, and 2.1 +/- 3.4 in supportive measure groups. CONCLUSIONS: Advanced Child-Pugh class, advanced Okuda stage, and peripheral location were the risk factors for spontaneous rupture of HCC. The prolonged survival could be achieved in patients eligible for successful transarterial embolization rather than supportive measures.
Aged ; Carcinoma, Hepatocellular/*complications/pathology ; English Abstract ; Female ; Hemoperitoneum/etiology ; Humans ; Liver Neoplasms/*complications/pathology ; Male ; Middle Aged ; Prognosis ; Risk Factors ; Rupture, Spontaneous

A case of histiocytic medullary reticulosis with splenic infaraction from a 23-year-old male is presented. Radiologic findings on selective spleen scintigraphy and abdominal CT are described. Selective spleen scintigraphy showed huge, multilobulated spleen with numerous photon-deficient areas in it and peripherally. Abdominal CT showed large peripheral band-like low density and infiltrative lesion in spleen with accompanying intraabdominal lymphadenopathy. Histoligical features were consistent with HMR in spleen and liver specimens.
Adult ; Hemoperitoneum/etiology ; Hepatomegaly/etiology/pathology ; Histiocytic Sarcoma/*complications ; Humans ; Male ; Splenic Infarction/*etiology/radiography/radionuclide imaging ; Splenic Rupture/etiology ; Splenomegaly/etiology/pathology ; Tomography, X-Ray Computed

OBJECTIVE: Sixteen cases of blunt diaphragmatic injury were clinically reviewed during 10 years from Oct.1987 to Jun.1996 at the Kangdong sacred heart hospital. The age and sex distribution were ranged from 3 to 67-old-years. The most common age range was between third decades to fifth decades in 10 cases(62.50%) and occurred predominantly in male, the sex ratio was 4.3 : 1.(M:F 4.3:1) The modes of blunt diaphragmatic injury were due to motor vehicle accidents(MVA), motor cycle accidents(MCA), fall down(FD) and others. Most common injuries were responsible for MVA. MVA were pedestrian traffic accidents 5 cases (41.7%), driver 4 cases(33.3%) passenger 3 cases(25.0%). In the blunt diaphragmatic injury sites, the left-sided diaphragmatic injury had predominant[left-sided cases 10(62.50%), right-sided cases 6(37.50%)]. Cost common symptoms and signs were chest pain or chest discomfort(81.25%) and dyspnea(68.75%), abdominal tenderness(50.00%), decreased bowel sound and breath sound(50.00%) and others. All of 16 cases in blunt diaphragmatic injury were associated with other injuries. The associated injuries were hemopneumothorax 14(87.50%), hemoperitoneum 7(43.759o), liver injury 7(43.75%), orthopedics fracture 14(87.50%), head injury 5(31.25%) and others. The diagnostic methods were used with simple x-ray, ultrasonogram and computed tomogram. The preoperative diagnosis of blunt diaphragmatic injury were suggested in 10 cases(62.509o) and others were confirmed during operation. The thirteen cases of all of sixteen cases were performed emergency operation within eight hours. The herniated intraabdominal organs through ruptured diaphragm were presented in 10cases(62.5%) [stomach 7 cases(43.75%), spleen 6 cases(37.50%), colon 3 cases(18.75%), liver 3 cases(18.75%), small bowel and omentum 2 cases(12.50%), respectively]. The mean size of blunt diaphragmatic injury were 7.7cm, right-sided mean size were 9cm, left-sided mean size were 6.9cm. The most common site of blunt diaphragm- atic injury were presented in anteromedial site 7 cases(43.75%). Simple chest x-ray revealed abnormal finding [hemothorax 10cases(62.50%), pneumothorax 4cases(25.00%), herniated organ into thorax8 cases(50.00%), diaphragm elevation 3 cases(18.75%) and others]. The postoperative complication were associated in 10 cases(62.50%) out of 16 cases. Common complications were pleural effusion 6 cases(37.50%) and atelectasis 3 cases(18.75%). Injury severity score(ISS) value of 16 cases in the blunt trauma ranged from 10 to 59. It was presented with mean value of ISS(35.5),mean value of ISS survivors(35) and nonsurvivors(55.5). Revised trauma score(RTS) value ranged also from 4 to 12. There were revealed with mean value of RTS(9.7),mean value of RTS survivors(10) and nonsurvivors(6.5). All of the blunt traumatic injury, mortality rate was related to the values of ISS and RTS.
Accidents, Traffic ; Chest Pain ; Colon ; Craniocerebral Trauma ; Diagnosis ; Diaphragm ; Emergencies ; Heart ; Hemoperitoneum ; Hemopneumothorax ; Humans ; Liver ; Male ; Mortality ; Motor Vehicles ; Omentum ; Orthopedics ; Pleural Effusion ; Pneumothorax ; Postoperative Complications ; Pulmonary Atelectasis ; Sex Distribution ; Sex Ratio ; Spleen ; Thorax ; Ultrasonography

Renal transplantation has been considered the optimal therapeutic modality for children afflicted with end-stage renal disease since the capability became available more than three decades ago to prolong the lives of such children. Nowadays, the outcome of renal transplantation was marked improved, due to the development of immunology and new immunosuppressive agent. But the reports on renal transplantation in children were not many. The Severance Hospital of Yonsei University College of Medicine started the renal transplant program in April, 1979. There were 400 transplants from 1979 to August 1989. Among them, there were 13 cases of child age, and the results were summarized & analyzed. 1. The age incidence of recipients was from 8 to 16. Males were 10 cases and females were 3 Cases. 2. Among the primary diseases of recipients, the congenital diseases were 10 cases and the acquired diseases were 8 cases. And 4 cases were received bilateral nephrectomy due to vesicoureteral reflux and severe proteinuria. 3. Among the donors, 6 cases were related and 7 cases were unrelated. Related donors were 1 haplotype mismatch and unrelated, donors were 2 antigen match including DR locus. 4. There were 6 rejections in 13 cases. Among them, acute rejections were 4 cases and chronic rejections were 2 cases. 5. Postoperative complications were found in 6 cases ; peritoneal rupture, hemoperitoneum, urinary tract infection, smallpox, congestive heart failure and sepsis. 6. Among 13 cases, 11 cases of grafts were survived from 3 months to 9 years. The 1 case was expired due to chronic rejection and respiratory infection after postop. 30 months. And the other 1 case was peritoneal dialyzed due to chronic rejection after postop. 6 months. From the results presented here, we think the outcome of renal transplantation in children is good and the indication should be evaluated carefully.
Allergy and Immunology ; Child* ; Female ; Haplotypes ; Heart Failure ; Hemoperitoneum ; Humans ; Incidence ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation* ; Male ; Nephrectomy ; Postoperative Complications ; Proteinuria ; Rupture ; Sepsis ; Smallpox ; Tissue Donors ; Transplantation ; Transplants ; Urinary Tract Infections ; Vesico-Ureteral Reflux