Spontaneous rupture of colon cancer, combined with psoas abscess formation, is rare. A 44-year-old male visited for back pain and left buttock mass. Abdominal computed tomography and magnetic resonance image revealed a large abscess in the left psoas muscle and in the left lower quadrant area. Ten days after incision and drainage, a skin defect around the left anterior superior iliac spine remained. A local flap was performed using a superficial skin graft. Ten days after the stitches had been removed, fecal discharge was observed around the anterior superior iliac spine at the flap site. An operation was performed by a general surgeon who had diagnosed this as a case of enterocutaneous fistula. Operative findings included a ruptured tumor mass in the descending colon, which was connected to a retroperitoneal abscess. Pathologic report findings determined adenocarcinoma of the resected colon. Herein, we report a case of psoas abscess resulting from perforating colon cancer.
Adult ; Colonic Neoplasms/*complications ; Humans ; Male ; Psoas Abscess/*etiology ; Rupture, Spontaneous/complications ; Streptococcal Infections/*etiology

PURPOSE: A spontaneous rupture is a rare but life-threatening complication in patients with a hepatocellular carcinoma (HCC). Whether this condition has any influence on the subsequent outcome following a resection is unclear. Therefore, the long-term results of liver resection were compared in patients with and without a tumor rupture. METHOD: This retrospective study was conducted on 17 patients with a spontaneous rupture of an HCC out of 256 with an HCC who underwent hepatic resection. RESULTS: Reduced hemoglobin and albumin, as well as increased leukocytosis, a poor Child Class, large tumor and portal vein tumor thrombosis were more frequent clinical findings in patients with a ruptured HCC. The postoperative complication and extrahepatic recurrence rates were similar between the two groups. The 1- and 3- year survival rates in the 17 patients with a ruptured HCC were 41.2 and 17.7%, respectively, while these were 80.3 and 48.3%, respectively, in the 239 patients without a rupture. However, when these patients were compared exclusively with the 8 patients with a corresponding AJCC/UICC 6th ed. TNM stage IIIB disease without a rupture (50 and 0%, respectively), no significant difference was found in the overall survival rates between the groups. CONCLUSION: The surgical outcomes of stage matched patients with and without a ruptured HCC were similar.
Carcinoma, Hepatocellular* ; Child ; Humans ; Leukocytosis ; Liver ; Portal Vein ; Postoperative Complications ; Prognosis* ; Recurrence ; Retrospective Studies ; Rupture ; Rupture, Spontaneous ; Survival Rate ; Thrombosis

A rare case of bilateral third cranial nerve palsy due to a ruptured anterior communicating artery aneurysm is presented. A 68-yr-old woman was semicomatose with bilaterally fixed dilated pupil, abducted eyes, and ptosis. A computed tomography demonstrated extensive hemorrhage spreading around the both Sylvian and interhemisheric fissure without focal mass effect. Intracranial pressure via extraventricular drainage before surgery was 15-50 mmHg. Three months later, brain MRI showed infarction of left posterior cerebral artery territory and lacuna infarction of the pons. Eleven months after aneurysm repair, nerve palsy improved slowly and recovered partially. The patient communicated well with simple words. The author reviewed and discussed the possible mechanism of this rare neuro-ophthalmological manifestation in view of a false localizing sign.
Rupture, Spontaneous ; Oculomotor Nerve Diseases/*etiology ; Magnetic Resonance Imaging ; Intracranial Aneurysm/*complications/surgery ; Humans ; Female ; Aged

Rupture of the colon caused by high pressure compressed air is a rare, unique and traumatic intra-abdominal injury. As the use of compressed air in industrial work has increased, so has the risk of associated pneumatic injuries from its improper use. Recently we experienced a case of pneumatic rupture of the sigmoid colon accompanied by tension pneumoperitoneum, which caused respiratory distress. The patient's respiration was very rapid with the rate of 44 breaths per minute. On arterial blood gas analysis, pH was 7.40, pO2 68 mmHg, pCO2 44 mmHg, and SaO2 90%. Chest X-ray film showed marked pneumoperitoneum and an elevated diaphragm. The respiratory distress was severe and required immediate relief by emergency decompression peritoneocentesis before surgical intervention consisting of the serosal tear repair, colonic rupture colostomy and abdominal cavity irrigation. A follow up operation 2 months later for colostomy repair completed the patient's recovery.
Adult ; Case Report ; Colonic Diseases/etiology* ; Human ; Male ; Pneumoperitoneum/complications* ; Pressure ; Rupture, Spontaneous

BACKGROUND/AIMS: Spontaneous esophageal rupture is a life-threatening injury because of delay in diagnosis and rapid progression to septic condition. But acceptable standard treatment strategy has not been established yet. This may be due to its low incidence and lack of published literature. In this study, we evaluated the proper treatment strategy as to decide when and how to manage spontaneous esophageal rupture by analyzing our experiences. METHODS: Eleven patients who were diagnosed as spontaneous esophageal perforation in Dongsan Medical Center from 1993 to 2003 were analyzed. Patients were divided into survival and death group. Clinical manifestations, rupture site and size, treatment methods and complications were compared. RESULTS: All patients were male and alcoholics. Six patients had survived and five patients died. Age, sites and sizes of ruptures, operation methods were not different in both groups. Before operation, septic condition was present in all patients of death group and more common than survival group (p=0.015). Survival group showed shorter time interval from rupture to initial treatment (p=0.021) and to operation (p=0.019). CONCLUSIONS: Early diagnosis and initial aggressive treatments such as nothing per oral, pleural and mediastinal drainage are important factor for better prognosis. If possible, early operation such as primary repair must be done. Although any difference according to types of operation method was not found in this study, further study with larger groups seems to be necessary.
Adult ; Alcoholism/complications ; English Abstract ; Esophageal Diseases/complications/diagnosis/*surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Rupture, Spontaneous

Most patients with strabismus are in good health. However, the incidence of strabismus is high in patients with central nervous system dysfunction and musculoskeletal abnormalities. Authors report one case of intracerebral hematoma due to bleeding from an intracranial arteriovenous malformation after a surgical correction of strabismus under general endotracheal anesthesia. The initial operation and postoperative course of this case were uneventful except for several episodes of nausea and vomiting, continuing hours after the operation. Twenty-four hours after the operation, the patient showed a stuporous mental state and right-sided hemiplegia. A brain C-T scan and carotid angiography revealed an intracerebral hematoma with small-sized vascular abnormalities in the frontoparietal region on the left side. Following an emergency evacuation of the hematoma and removal of the malformed vessels, the patient showed progressive improvement.
Cerebral Hemorrhage/etiology* ; Child ; Female ; Hematoma/etiology* ; Human ; Intracranial Arteriovenous Malformations/complications ; Postoperative Complications* ; Rupture, Spontaneous ; Strabismus/surgery*

Spontaneous rupture of the rectosigmoid colon and herniation of the small intestine through the rupture site and eventual evisceration through the anus is a very rare event. In the literature, only 42 cases have been reported. The majority of them occurred in patients with rectal prolapse and one case was reported in association with a third-degree uterine prolapse. We experienced an 81-year-old female patient with rectal prolapse and second-degree uterine prolapse complicated by spontaneous perforation of the rectosigmoid colon and anal evisceration of the small intestine. Segmental resection of the nonviable small intestine, primary repair of the ruptured rectosigmoid colon, and sigmoid loop colostomy were performed, and the patient recovered well. In our patient, both rectal and uterine prolapses cooperatively damaged the anterior wall of the rectosigmoid colon and resulted in perforation. So, rectal and uterine prolapses should be treated before the complication develops. In this patient, uterine prolapse should be treated because of the recurrence of this rare episode.
Aged ; Aged, 80 and over ; Case Report ; Colonic Diseases/etiology* ; Female ; Human ; Rectal Prolapse/complications* ; Rupture, Spontaneous ; Uterine Prolapse/complications*

Spontaneous splenic rupture (SSR) in a patient undergoing hemodialysis has been described as an extremely rare and potentially fatal complication. We report here spontaneous splenic rupture in a 52-year-old woman undergoing regular hemodialysis for end-stage renal disease (ESRD). She complained of colicky abdominal pain in the left upper quadrant area and dizziness when she assumed an upright posture. Her vital signs revealed low blood pressure and tachycardia, which was suggestive of hypovolemic shock. Abdomen CT scan showed splenic hematoma and hemoperitoneum. However, she had no history of any event triggering the splenic rupture. An exploratory laparotomy showed a ruptured spleen and an emergency splenectomy was performed. We suggest that spontaneous spleen rupture may be attributed to uremic coagulopathy and heparin-induced coagulopathy.
Female ; Humans ; Kidney Failure, Chronic/*complications ; Middle Aged ; *Renal Dialysis ; Rupture, Spontaneous ; Spleen/*pathology ; Splenic Diseases/*complications/*pathology

Adult ; Cesarean Section ; Female ; Fetal Distress ; Hemangioma, Cavernous ; Humans ; Liver Neoplasms ; Obstetric Labor Complications ; Pregnancy ; Pregnancy, Multiple ; Rupture, Spontaneous

Spontaneous perforation of the common bile duct (CBD) is a rare event in adults. Most cases of CBD perforation are iatrogenic after invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy. We report a case of an 81-year-old woman who presented with severe right upper abdominal pain, fever, and chills. Abdominal CT showed multiple gallbladder and CBD stones and loculated fluid collection in the inferoposterior portion of the stomach. ERCP showed the leakage of contrast media into the peritoneal cavity from the CBD. We performed endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to decompress the CBD instead of emergent surgical intervention. One week later, cholangiography via ENBD tube revealed that there was no more leakage of the contrast media from the CBD. We performed cholecystectomy, removal of the CBD stones after exploration of the CBD, and T tube insertion. The perforated site of the CBD was closed and there was no more fluid collection in the inferoposterior portion of the stomach. Medical treatment including endoscopic procedures was useful for healing of the perforated CBD.
Aged, 80 and over ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis/*complications ; Choledocholithiasis ; Common Bile Duct Diseases/*etiology ; Female ; Humans ; Rupture, Spontaneous