Loop electrosurgical excision procedure (LEEP) is commonly performed for the management of cervical intraepithelial neoplasia. Although LEEP is considered to be a relatively simple procedure, several unexpected complications have been reported in the literature. Herein, we report a case of hemoperitoneum caused by uterine perforation following LEEP. Blood collection in pelvic cavity and two small defects of the uterus were confirmed by diagnostic laparoscopy. The defects were sutured and the patient recovered well after the operation.
Cervical Intraepithelial Neoplasia ; Conization ; Hemoperitoneum ; Humans ; Laparoscopy ; Uterine Perforation ; Uterus

A 37-year-old male visited the hospital with multiple trauma after traffic accident. Fractures of ribs, left femur, and right humerus and spleen rupture with hemoperitoneum were founded on image studies. He was moved to operation room and general anesthesia was performed for splenectomy. During the operation, excessive high peak inspiratory pressure was observed. After abdominal closure, hypoxia, hypercapnia, and respiratory acidosis were worsened. Veno-venous extracorporeal membrane oxygenation (ECMO) was initiated after the operation. Status of the patient were improved after the application of ECMO. The patient was discharged without significant complication. Despite of several limitations in applying ECMO to patients with abdominal compartment syndrome (ACS) and multiple trauma, severe pulmonary dysfunction in ACS patients may be rescued without open abdomen treatment.
Abdomen ; Accidents, Traffic ; Acidosis, Respiratory ; Adult ; Anesthesia, General ; Anoxia ; Extracorporeal Membrane Oxygenation* ; Femur ; Hemoperitoneum ; Humans ; Humerus ; Hypercapnia ; Intra-Abdominal Hypertension ; Male ; Multiple Trauma ; Respiratory Distress Syndrome, Adult ; Ribs ; Rupture ; Spleen ; Splenectomy

OBJECTIVE: The most common cause of hemorrhage after paracentesis is direct needle puncture of the inferior epigastric artery (IEA). This study examined the relationship between the amount of the ascites and the location of the IEA in liver cirrhosis. METHODS: Abdominal computed tomography (CT) examinations of patients with liver cirrhosis were reviewed retrospectively and divided into two groups according to the amount of ascites. The distances between the midline and the IEAs of both sides were measured at the umbilicus, McBurney's point, anterior superior iliac spine, and mid-inguinal level. Branching of the IEAs, abdominal wall and mesenteric varices in the abdomen below the umbilicus level were recorded. RESULTS: A total of 120 abdominal CTs were reviewed. The distances from the midline to the IEA in the large ascites group were longer than those in the small ascites group at the level of the right McBurney's point (44.5±14.6 mm vs. 39.6±11.8 mm, P=0.043) and left McBurney's point (48.6±15.3 mm vs. 43.3±11.5 mm, P=0.035). The incidence of abdominal wall varices was higher in the large ascites group (21.7% vs. 5.0%, P=0.014). CONCLUSION: In patients with liver cirrhosis, the large amount of ascites might be associated with lateralizing the location of the IEA. Moreover, it may be necessary to confirm the blood vessels in the abdominal wall and mesentery near the puncture site by bedside ultrasound before the paracentesis.
Abdomen ; Abdominal Wall ; Ascites ; Blood Vessels ; Epigastric Arteries ; Hemoperitoneum ; Hemorrhage ; Humans ; Incidence ; Liver Cirrhosis ; Liver ; Mesentery ; Needles ; Paracentesis ; Punctures ; Retrospective Studies ; Spine ; Tomography, X-Ray Computed ; Ultrasonography ; Umbilicus ; Varicose Veins

OBJECTIVE: Focused assessment with sonography for trauma (FAST) is used routinely for evaluating patients with major trauma. After a primary survey, the existence of hemoperitoneum or hemopericardium must be searched using FAST. Traditionally, hemopericardium can be assessed through the subcostal approach with the curved probe for the abdomen. On the other hand, satisfactory images (four chamber view) are difficult to obtain with this approach. METHODS: This was a prospective, single-center pilot study of an academic tertiary medical center. When FAST is performed on the patients, traditional FAST (subcostal approach with the curved probe) is generally conducted. During a FAST examination, the time consumed, numeric rating scale (NRS) for pain, and success rate of satisfactory images are recorded. After the traditional FAST was used, we used the curved probe like echo probe. The curved probe was positioned beside the left nipple with the probe marker opposite-sided (modified FAST) like the parasternal long-axis view of echocardiography. Finally, the existence of hemopericardium is confirmed using an echo probe. In this study, the consumed time, NRS, and success rate of satisfactory images were compared. RESULTS: The consumed time was shorter (57.4 vs. 71.2 seconds, P<0.001) and the pain score was lower (0.1 vs. 1.8, P<0.001) with the modified FAST compared to the traditional FAST. Satisfactory images were obtained in 23 cases (51%) with traditional FAST, whereas satisfactory images were obtained in 37 cases (82%) using modified FAST. CONCLUSION: Mvodified FAST is more accurate for the detection of hemopericardium than traditional FAST. The pain is less severe and the time consumed is shorter.
Abdomen ; Advanced Trauma Life Support Care ; Echocardiography ; Hand ; Hemoperitoneum ; Humans ; Nipples ; Pericardial Effusion ; Pilot Projects ; Prospective Studies ; Ultrasonography

Hepatic haemangioma is a congenital vascular malformation, considered the most common benign mesenchymal hepatic tumour. Spontaneous or traumatic rupture is the most severe complication. In case of rupture, surgical resection and enucleation, as a single therapy or after trans-arterial embolization are considered the treatments of choice. We report a case of spontaneous rupture of a hepatic haemangioma with massive hemoperitoneum successfully treated by percutaneous hepatic trans-arterial embolization and pelvic drainage alone.
Drainage ; Hemangioma ; Hemoperitoneum ; Liver ; Radiology, Interventional ; Rupture ; Rupture, Spontaneous ; Vascular Malformations

PURPOSE: To describe the experience of patients over a 7-year period who have had open abdomen (OA) surgery, at a tertiary university hospital.METHODS: The medical records of 59 patients, who were managed with OA after a laparotomy between March 2009 and December 2015, were reviewed retrospectively. The data collected included demographics, indication for OA, abdominal closure methods, abdominal closure rate, the intensive care unit stay duration, mechanical ventilation duration, hospital stay duration, and complications.RESULTS: Forty-seven patients (37 males, 78.7%) with a mean age of 52.2 ± 16.7 years were reviewed in the study. The indications for OA were traumatic intra-abdominal bleeding in 23 patients (48.9%), non-traumatic bowel perforation in 10 (21.3%), non-traumatic bleeding in 7 (14.9%), and bowel infarction in 6 (12.8%). The abdominal wall was closed in 38 patients (80.9%). Primary closures and fascial closure using an artificial mesh were performed on 21 (44.7%) and 12 patients (25.5%), respectively. The median number of dressing changes was 0 (interquartile range 0 – 1). The median duration of the intensive care unit and hospital stays were 12.0 and 32.0 days, respectively. The median interval to abdominal closure was 4 days (interquartile range 2 – 10.3 days). Twenty-seven patients developed complications, including uncontrolled sepsis (21.3%), entero-atmospheric fistula (19.1%), ventral hernia (8.5%), bleeding (4.3%), and lateralization (4.3%). The mortality rate was 44.7% with sepsis being the main cause of death (61.9%).CONCLUSION: Traumatic intra-abdominal bleeding was a common indication for OA. Primary closure was performed in most patients, and frequent complications resulted in poor patient outcomes.
Abdomen ; Abdominal Wall ; Abdominal Wound Closure Techniques ; Bandages ; Cause of Death ; Demography ; Fistula ; Hemoperitoneum ; Hemorrhage ; Hernia, Ventral ; Humans ; Infarction ; Intensive Care Units ; Intra-Abdominal Hypertension ; Intraabdominal Infections ; Laparotomy ; Length of Stay ; Male ; Medical Records ; Mortality ; Respiration, Artificial ; Retrospective Studies ; Sepsis

Atraumatic splenic rupture (ASR) in a patient undergoing peritoneal dialysis (PD) is uncommon, but can be life-threatening. According to recent systematic reviews, the major causes of ASR are 1) neoplastic (30.3%), 2) infectious (27.3%), 3) non-infectious inflammatory (20.0%), 4) iatrogenic (9.2%), 5) mechanical (6.8%), and 6) idiopathic (6.4%). It is diagnosed by imaging studies, most commonly ultrasonography and computed tomography (CT). Due to its rarity, the early diagnosis of ASR is difficult, and no standard treatment has been described. Here, we report a case of idiopathic ASR in a patient undergoing PD. The diagnosis was established by abdominal CT scan, and splenectomy was performed. Thus, hemoperitoneum in a PD patient should raise suspicion of ASR. Early diagnosis and appropriate treatment will lead to a better outcome.
Diagnosis ; Early Diagnosis ; Hemoperitoneum ; Humans ; Peritoneal Dialysis ; Splenectomy ; Splenic Rupture ; Tomography, X-Ray Computed ; Ultrasonography

A 55-year-old man was admitted to the trauma center after a car accident. Cardiac tamponade, traumatic aortic injury, and hemoperitoneum were diagnosed by ultrasonography. The trauma surgeon, cardiac surgeon, and interventional radiologist discussed the prioritization of interventions. Multi-detector computed tomography was carried out first to determine the severity and extent of the injuries, followed by exploratory sternotomy to repair a left auricle rupture. A damage control laparotomy was then performed to control mesenteric bleeding. Lastly, a descending thoracic aorta injury was treated by endovascular stenting. These procedures were performed in the hybrid-angio room. The patient was discharged on postoperative day 135, without complications.
Aorta ; Aorta, Thoracic ; Cardiac Tamponade ; Heart ; Hemoperitoneum ; Hemorrhage ; Humans ; Laparotomy ; Middle Aged ; Resuscitation ; Rupture ; Shock ; Stents ; Sternotomy ; Trauma Centers ; Ultrasonography

Intraperitoneal metastatic hepatocellular carcinoma (HCC) is uncommon. Although rare, it can spontaneously rupture and cause hemoperitoneum similar to primary HCC in the liver. We present a case of intraperitoneal metastatic HCC that had spontaneously ruptured and appeared as an irregularly margined hemorrhagic mass with T1 high and T2 dark signal intensities on magnetic resonance imaging. Ruptured HCC is a life-threatening emergency with high mortality rate. Spontaneously ruptured intraperitoneal metastatic HCC should be considered if a patient with a history of HCC presents with acute abdomen, although rare.
Abdomen, Acute ; Carcinoma, Hepatocellular ; Emergencies ; Hemoperitoneum ; Humans ; Liver ; Magnetic Resonance Imaging ; Mortality ; Neoplasm Seeding ; Rupture ; Rupture, Spontaneous

We reported a case of secondary abdominal pregnancy with placental implantation into the fallopian tube, diagnosed at 16 weeks, in a woman admitted to the emergency room complaining of syncopal attacks. The best approach would be termination of the pregnancy, taking into consideration the high risk to the mother and the low possibility of alive and healthy birth. We had to perform an urgent surgical intervention due to the fact that the patient was in a clinically unstable condition, which was related to hemoperitoneum. If placental implantation is on abdominal organs or vessel the best approach would be to ligate the cord and to leave placenta in situ. Taking into consideration the place of placental implant, the removal of the fallopian tube with the placenta was the safest approach in this case. The best and most acceptable form of treatment would be individualized in case of rare form of ectopic pregnancy.
Emergency Service, Hospital ; Fallopian Tubes ; Female ; Hemoperitoneum ; Humans ; Laparotomy ; Mothers ; Parturition ; Placenta ; Pregnancy ; Pregnancy, Abdominal ; Pregnancy, Ectopic ; Ultrasonography