Colonoscopy is a safe procedure performed routinely worldwide. Splenic rupture is a rare complication of colonoscopy with several reported cases since 1974. We report the first case of a complication in the Republic of Korea. The literature on this rare complication is also reviewed here, with focus on the analysis of risk, diagnosis, and treatment. A 77-year-old patient receiving oral aspirin underwent colonoscopy with polypectomy. After 24 hours, the patient experienced dizziness and hypotension. Colonoscopy was performed to exclude intestinal bleeding, which could be diagnosed with hemoperitoneum. A computed tomography scan showed copious abdominal free blood and a splenic rupture. An urgent splenectomy was performed, which was the recognized procedure of choice. Physicians should have greater awareness of the possibility of splenic rupture following colonoscopy in order to avoid delay of diagnosis and treatment for this life-threatening complication.
Aged ; Colonoscopy/*adverse effects ; Hemoperitoneum/diagnosis ; Hemorrhage ; Humans ; Male ; Splenectomy ; Splenic Rupture/*diagnosis/etiology/surgery ; Tomography, X-Ray Computed

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

BACKGROUNDIntraperitoneal hemorrhage is one of the most common complications of radiofrequency (RF) ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal hemorrhage occurred during or after percutaneous RF ablation of hepatic tumors.

METHODSThree hundred and fifty-six patients with hepatic tumors have been treated at 592 procedures of ultrasound guided RF ablation. Intraperitoneal hemorrhage occurred in 5 patients (0.8%). The reasons and management of intraperitoneal hemorrhage in these 5 cases were retrospectively analyzed.

RESULTSTwo patients with liver metastasis and one hepatocellular carcinoma (HCC) patient suffered from hemorrhage during the RF treatment. Two patients with recurrent HCC after surgery developed hemorrhage 20 minutes or 4 hours after RF treatment. One case of hemorrhage was due to the inappropriate electrode positioning induced liver laceration while treating a 1 cm liver metastasis near the liver capsule. One was due to the injury of a small vessel by the RF needle in another liver metastasis patient. Three cases were due to tumor rupture with two cases induced by cough or position change after treating large protruding HCC lesions. Four (80%) of the 5 cases of hemorrhage were rapidly identified by ultrasound. The causes and sites of bleeding during the RF treatment in three cases were confirmed through ultrasound, which were successfully treated using RF coagulation to achieve hemostasis of the bleeding site. Two patients with post-ablation hemorrhage recovered in one hour and 24 hours, respectively after given blood transfusion and other conservative measures. No surgical intervention was required. Two patients died of wide spread metastasis 23 - 36 months afterwards and the other three patients have lived for 18 - 25 months to date.

CONCLUSIONSIt is important to perform close monitoring during and after RF ablation in order to identify intraperitoneal hemorrhage in time. RF ablation of the bleeding sites was a simple and effective management when the bleeding site could be confirmed by ultrasound. The hemorrhage due to the rupture of large and protruding liver tumors could be serious and should be considered as contraindication for RF treatment.

Adult ; Aged ; Catheter Ablation ; adverse effects ; Female ; Hemoperitoneum ; diagnosis ; etiology ; therapy ; Humans ; Liver Neoplasms ; surgery ; Male ; Middle Aged

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*

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

A case of a 23 year-old man who, thanks to his parietal pericardium, scarred by previous open heart surgery, survived traumatic ventricular free wall and coronary artery rupture, without surgical repair, is reported. He was injured in a traffic accident and transferred to our hospital immediately. On arrival, he was hypotensive, with blood pressure of 53/25 mmHg. Because hemoperitoneum was suspected, an emergency exploratory laparotomy was performed. After surgery, his blood pressure stabilized, but electrocardiography showed abnormal findings that had not existed before the traffic accident. To find the probable cause of the electrocardiographic changes, echocardiography was performed, which showed a right ventricular free wall and right coronary artery ruptures. Nevertheless, he survived, without surgery, due to the thickened and adhered pericardium around the rupture site, which presumably resulted from the prior open heart surgery. Since discharged, he has remained well for nine months, with no further events.
Accidents, Traffic ; Blood Pressure ; Cicatrix ; Coronary Vessels* ; Echocardiography ; Electrocardiography ; Emergencies ; Heart Rupture ; Heart* ; Hemoperitoneum ; Humans ; Laparotomy ; Pericardium ; Rupture* ; Thoracic Surgery* ; Young Adult

OBJECTIVE: To explore the characteristics of abdominal penetrating injuries with exploratory laparotomy, as well as to summarize the key points of injury degree, and to supply reasonable reference for the practice and criterion modification in forensic clinical medicine identification. METHODS Fifty-seven cases which were all abdominal penetrating injuries with exploratory laparotomy from July 1990 to February 2011 were retrospectively analyzed including the instrument causing trauma, amount of the hemoperitoneum, the organs of the injury, conclusion of the forensic indentification, and so on. RESULTS There was some correlation between the organ injury patterns, volume of hemoperitoneum and identification conclusion for the abdominal penetrating injury cases with exploratory laparotomy. CONCLUSION The intra-abdominal injury has important effect for the injury degree of the abdominal penetrating injury cases with exploratory laparotomy and should be considered in the practice and criterion modification of these kinds of cases.
Abdominal Injuries/surgery* ; Adolescent ; Adult ; Expert Testimony/standards* ; Female ; Forensic Medicine/standards* ; Hemoperitoneum/pathology* ; Humans ; Injury Severity Score ; Laparotomy/methods* ; Male ; Middle Aged ; Retrospective Studies ; Wounds, Penetrating/surgery* ; Wounds, Stab/surgery* ; Young Adult

PURPOSE: To evaluate the radiological findings and clinical courses of the complications arising after nonbiliary laparoscopic gastrointestinal surgery (NLGS). MATERIALS AND METHODS: We retrospectively reviewed the clinical records of 131 patients who underwent NL-GS (83 cases involving colorectal surgery, 18 splenectomies, 14 appendectomies, ten adrenalectomies, three lumbar sympathectomies, two Duhamel 's operation, and one peptic ulcer perforation repair) over a four-year period. Among these 131 patients, the findings of fifteen in whom postoperative complications were confirmed were analysed. The radiologic examinations these patients underwent included CT (n = 8), barium enema and fistulography (n = 4), ultrasonography (n = 3), ascending venography of the lower legs (n = 2), and penile Doppler sonography (n = 1). We evaluated the radiologic findings and clinical courses of early (within 2 weeks) and late (after 2 weeks) postoperative complications. RESULTS: Sixteen cases of postoperative complications developed in fifteen patients ; in 14 (17%) after colorectal surgery and in one (6%) after splenectomy. Eleven of the sixteen cases (69%) involved early complications, consisting of an abscess in three, ischemic colitis in two, hemoperitoneum in one, perforation of the colon in one, pancreatitis in one, recto-vaginal fistula in one, deep vein thrombosis after colorectal surgery in one, and abscess after splenectomy in one. The remaining five cases (31%) involved late complications which developed after colorectal surgery, comprising anastomosic site stricture in two, abdominal wall (trocar site) metas-tasis in one, colo-cutaneous fistula in one, and impotence in one. Among the 16 cases involving postoperative complications, recto-vaginal fistula, colon perforation, and abdominal wall metastasis were treated by surgery, while the other thirteen cases were treated conservatively. CONCLUSION: Various postoperative complications develop after NLGS, with a higher rate of these being noted in cases involving colorectal surgery than in other cases.
Abdominal Wall ; Abscess ; Adrenalectomy ; Appendectomy ; Barium ; Colitis, Ischemic ; Colon ; Colorectal Surgery ; Constriction, Pathologic ; Enema ; Erectile Dysfunction ; Fistula ; Hemoperitoneum ; Humans ; Laparoscopy ; Leg ; Male ; Neoplasm Metastasis ; Pancreatitis ; Peptic Ulcer Perforation ; Phlebography ; Postoperative Complications ; Retrospective Studies ; Splenectomy ; Sympathectomy ; Ultrasonography ; Venous Thrombosis

OBJECTIVETo compare clinically relevant postoperative complications after open, laparoscopic, and robotic gastrectomy for gastric cancer.

METHODSClinical data of patients with gastric cancer who underwent gastrectomy between January 1, 2014 and October 1, 2016 at Chinese People's Liberation Army General Hospital were analyzed retrospectively. All the patients were diagnosed by upper endoscopy and confirmed by biopsy without distant metastasis. They were confirmed with R0 resection by postoperative pathology. Patients with incomplete data were excluded. The complications among open group, laparoscopic group and robotic group were compared. The continuous variables were analyzed by one-way ANOVA, and categorical variables were analyzed by χtest or Fisher exact test.

RESULTSA total of 1 791 patients (1 320 males and 471 females) were included in the study, aged from 17 to 98 (59.0±11.6) years, comprising 922 open, 673 laparoscopic and 196 robotic gastrectomies. There were no significant differences among three groups in baseline data (gender, age, BMI, comorbidity, radiochemotherapy) and some of operative or postoperative data (blood transfusion, number of lymph node dissection, combined organ resection, resection site, N stage, postoperative hospital stay). The blood loss in laparoscopic and robotic groups was significantly lower than that in open group[(185.7±139.6) ml and (194.0±187.6) ml vs. (348.2±408.5) ml, F=59.924, P=0.000]. The postoperative complication occurred in 197 of 1 791(11.0%) patients. The Clavien-Dindo II(, III(a, III(b, IIII(a, and IIIII( complications were 5.5%, 4.0%, 1.2%, 0.1%, and 0.2% respectively. The anastomotic leakage (2.4%), intestinal obstruction(1.3%) and pulmonary infection(1.2%) were the three most common complications, followed by wound infection(0.8%), cardiovascular disease(0.7%), anastomotic bleeding (0.7%), delayed gastric emptying (0.6%), duodenal stump fistula(0.5%), intraperitoneal hemorrhage (0.5%), pancreatic fistula (0.3%), intra-abdominal infection(0.2%), chylous leakage (0.1%) and other complications(1.7%). There were no significant differences among three groups as the complication rates of open, laparoscopic and robotic gastrectomy were 10.6%(98/922), 10.8%(73/673) and 13.3%(26/196) respectively (χ=1.173, P=0.566). But anastomotic leakage occurred more common after laparoscopic and robotic gastrectomy compared to open gastrectomy [3.1%(21/673) and 5.1%(10/196) vs. 1.3%(12/922), χ=12.345, P=0.002]. The rate of cardiocerebral vascular diseases was higher in open group[1.3%(12/922) vs. 0.1%(1/673) and 0, χ=8.786, P=0.012]. And the rate of anastomotic bleeding was higher in robotic group [2.0%(4/196) vs. open 0.4%(4/922) and laparoscopic 0.6%(4/673), χ=6.365, P=0.041]. In view of Clavien-Dindo classification, III(a complications occurred more common in laparoscopic group [5.5%(37/673) vs. open 3.3%(30/922) and robotic 2.6%(5/196), χ=6.308, P=0.043] and III(b complications occurred more common in robotic group [3.1%(6/196) vs. open 1.1%(10/922) and laparoscopic 0.7%(5/673), χ=7.167, P=0.028].

CONCLUSIONSMorbidities of postoperative complications are comparable among open, laparoscopic and robotic gastrectomy for gastric cancer. However, in consideration of the high difficulty of anastomosis, the minimally invasive surgery should be performed by more experienced surgeons.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomotic Leak ; epidemiology ; etiology ; Blood Loss, Surgical ; statistics & numerical data ; Cerebrovascular Disorders ; epidemiology ; etiology ; Chylous Ascites ; epidemiology ; etiology ; Comorbidity ; Comparative Effectiveness Research ; Duodenal Diseases ; epidemiology ; etiology ; Female ; Gastrectomy ; adverse effects ; methods ; Gastrointestinal Hemorrhage ; epidemiology ; etiology ; Gastroparesis ; epidemiology ; etiology ; Gastroscopy ; Hemoperitoneum ; epidemiology ; etiology ; Humans ; Intestinal Fistula ; epidemiology ; etiology ; Intraabdominal Infections ; epidemiology ; etiology ; Laparoscopy ; adverse effects ; Length of Stay ; Lymph Node Excision ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; etiology ; Postoperative Hemorrhage ; epidemiology ; etiology ; Postoperative Period ; Respiratory Tract Infections ; epidemiology ; etiology ; Retrospective Studies ; Risk Assessment ; Robotic Surgical Procedures ; adverse effects ; Stomach Neoplasms ; surgery ; Surgical Wound Infection ; epidemiology ; etiology