BACKGROUND: Hemophilia A and hemophilia B are characterized by prolongation of bleeding and hemorrhages in the joints and soft tissues. There is no ultimate treatment, if patients did not properly manage who can lead to chronic disease and lifelong disabilities. Many patients with hemophilia continue to seek medical attention, for several reasons in the emergency department (ED). In this retrospective study, we examined the overall ED use by patients with hemophilia in a single center, particularly in order to examine visits related to clinical characteristics.METHODS: There were 210 patients with hemophilia for a 16-year period. Among them, 96 patients visited the ED. We evaluated the history, laboratory findings, image study, clinical course.RESULTS: There are 170 hemophilia A, 40 hemophilia B. Bleeding is the most common reason for ED visits. Bleeding site is joint, intracranial, muscle, subcutaneous, gastrointestinal in regular sequence. Life threatening bleeding was reported 23 episodes of Intracranial hemorrhage (ICH), 12 episodes of gastrointestinal hemorrhage, 6 episodes of iliopsoas bleeding and 2 episodes of pulmonary hemorrhage. In the case of ICH, seizure is usual symptom. In the case of gastrointestinal bleeding, hematochezia is the common symptom. In the case of iliopsoas bleeding, lower extremity pain and edema, limitation of motion are common symptoms.CONCLUSION: In order to minimize complications, we must perform fast, accurate judgement and treatment when the patients with hemophilia visit ED.
Chronic Disease ; Edema ; Emergencies ; Gastrointestinal Hemorrhage ; Hemophilia A ; Hemophilia B ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Joints ; Lower Extremity ; Muscles ; Overall ; Retrospective Studies ; Seizures

Acute pancreatitis is one of the main causes of intra-abdominal hypertension (IAH). IAH contributes to multiple physiologic alterations and leads to the development of abdominal compartment syndrome (ACS) that induces multiorgan failure. We report a case of ACS in a patient with severe acute pancreatitis. A 44-year-old man who was admitted in a drunk state was found to have severe acute pancreatitis. During management with fluid resuscitation in an intensive care unit, drowsy mentality, respiratory acidosis, shock requiring inotropes, and oliguria developed in the patient, with his abdomen tensely distended. With a presumptive diagnosis of ACS, abdominal decompression through percutaneous catheter drainage was performed immediately. The intraperitoneal pressure measured with a drainage catheter was 31 mm Hg. After abdominal decompression, the multiorgan failure was reversed. We present a case of ACS managed with percutaneous catheter decompression.
Abdomen ; Acidosis, Respiratory ; Adult ; Catheters* ; Decompression ; Diagnosis ; Drainage* ; Humans ; Intensive Care Units ; Intra-Abdominal Hypertension* ; Lower Body Negative Pressure ; Oliguria ; Pancreatitis* ; Resuscitation ; Shock ; Transcutaneous Electric Nerve Stimulation

Most infants with repaired gastroschisis develop normally and remain in good health. About 10% of patients with gastroschisis have other malformations. We report a case of choledocholithiasis and intestinal malrotation in an adolescent with repaired gastroschisis. A 17-year-old girl presented with fever, jaundice, and abdominal pain. She had undergone an operation to repair gastroschisis at birth. Physical examination revealed icteric sclera, a tight abdominal wall, and a longitudinal surgical scar at the midline. An abdominal computed tomography scan revealed a round calcifying lesion near the pancreas and a midline-positioned liver and gallbladder. Absence of the retroperitoneal duodenum and the anterior and left-sided position of the superior mesenteric vein compared with the superior mesenteric artery were observed. Results of abarium examination revealed intestinal malrotation. Endoscopic retrograde cholangiopancreatography revealed diffuse dilatation of the biliary trees and a malpositioned gallbladder. A single stone was removed by using a basket. The clinical symptoms improved after the patient underwent endoscopic retrograde cholangiopancreatography.
Abdominal Pain ; Abdominal Wall ; Adolescent* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis* ; Cicatrix ; Dilatation ; Duodenum ; Female ; Fever ; Gallbladder ; Gastroschisis* ; Humans ; Infant ; Jaundice ; Liver ; Mesenteric Artery, Superior ; Mesenteric Veins ; Pancreas ; Parturition ; Physical Examination ; Sclera

Portal hypertension can lead to development of new veins, called collateral vessels in the esophagus, stomach, abdominal wall, rectum and so on. In particular, collateral vessels located in other site than the gastroesophageal region are defined as ectopic varices. These varices are fragile and can rupture easily, resulting in a large amount of blood loss that may become serious and occasionally result in death. We experienced a case of massive rectal variceal bleeding after cross-clamping of the inferior vena cava and hepatic portal vein during the living donor liver transplantation in patients who had no history of rectal variceal bleeding. Our case suggests that acute intraoperative hemorrhage from an ectopic varix should be a consideration before liver transplantation.
Abdominal Wall ; Esophageal and Gastric Varices* ; Esophagus ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Transplantation* ; Liver* ; Living Donors ; Portal Vein ; Rectum ; Rupture ; Stomach ; Varicose Veins ; Veins ; Vena Cava, Inferior

Glycoprotein IIb/IIIa antagonists are well established for their effectiveness in improving clinical outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention. Acute profound thrombocytopenia is a rare complication of abciximab. We present a case which was managed successfully for the rare complication of acute profound thrombocytopenia after using abciximab and an intra-aortic balloon pump for the treatment of a no-reflow phenomenon and consecutive cardiogenic shock during primary percutaneous coronary intervention.
Acute Coronary Syndrome ; Antibodies, Monoclonal ; Humans ; Immunoglobulin Fab Fragments ; Myocardial Infarction ; No-Reflow Phenomenon ; Percutaneous Coronary Intervention ; Shock, Cardiogenic ; Thrombocytopenia

BACKGROUND/AIMS: Ischemic colitis has a clinical spectrum ranging from mild reversible colitis to an acute fulminant course. Early and accurate diagnosis is therefore mandatory for a good clinical outcome. The aim of this study is to evaluate the efficacy and safety of a colonoscopy and histological examination with biopsy in the early and accurate diagnosis of ischemic colitis. METHODS: We investigated the clinical characteristics and endoscopic findings with the histopathology of 89 cases of ischemic colitis from October 2002 to August 2012 in a tertiary-care hospital. All patients underwent a colonoscopy with biopsy within a few days of the onset of symptoms, and the histological features from the biopsy specimens were reviewed. In addition, the occurrence of complications by colonoscopy with biopsy was evaluated. RESULTS: The mean age of the patients was 65.8+/-12.6 years (male:female, 1:2.2). The major combined disorders were hypertension (51.7%), diabetes (31.5%), and arrhythmia (19.1%). The clinical features usually presented with hematochezia (83.1%), abdominal pain (77.5%), and diarrhea (60.7%). The involved patterns were the left colon (56.2%), right colon (39.3%), and pancolon (4.5%). Based on the main histological features of ischemic colitis, including glandular atrophy (67.4%), hemorrhage (61.8%), capillary thrombi (42.7%), and coagulative necrosis of mucosa (29.2%), 67 of the 89 cases (75.3%) could be confirmed with ischemic colitis. There were no serious complications such as bowel perforation or major bleeding following the colonoscopy with biopsy. CONCLUSIONS: A colonoscopy with biopsy is beneficial and safe for the early and precise diagnosis of ischemic colitis.
Abdominal Pain ; Arrhythmias, Cardiac ; Atrophy ; Biopsy ; Capillaries ; Colitis ; Colitis, Ischemic ; Colon ; Colonoscopy ; Diarrhea ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Hypertension ; Mucous Membrane ; Necrosis