1/53. splenic rupture in a patient with acute myeloid leukemia undergoing peripheral blood stem cell transplantation.splenic rupture is a rare but well-recognized complication of hematological malignancies. Here, we present the case of a 22-year-old woman with the diagnosis of acute myeloid leukemia who was undergoing peripheral blood stem cell transplantation. On day 10 she developed a hypovolemic shock due to rupture of her spleen and went to emergency laparotomy. This is the first report of splenic rupture during peripheral blood stem cell transplantation.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
2/53. Sequential retroperitoneal venous hemorrhage and embolism of an angio-seal puncture closure device complicating iliac artery angioplasty.PURPOSE: To present a case of iatrogenic puncture closure device embolization complicating surgery for retroperitoneal hemorrhage (RPH) secondary to angioplasty-induced common iliac vein trauma. methods AND RESULTS: A 78-year-old woman with rest pain underwent successful kissing balloon dilation of her aortoiliac bifurcation for a calcified ostial stenosis of the left common iliac artery. Hemostatic puncture closure devices (Angio-Seal) were used to secure both femoral punctures. A right-sided retroperitoneal hematoma developed, and during surgical exploration of the right groin, the Angio-Seal device was removed. The only bleeding site found was the external iliac artery puncture and it was repaired. She again became hypovolemic 18 hours later and was returned to surgery, where bilateral groin explorations and laparotomy by the vascular surgical team found a tear in the left common iliac vein. After repair, the patient was stable for 48 hours when the left leg became critically ischemic. angiography detected a new high-grade stenosis in the left profunda femoris artery; embolectomy retrieved a footplate from the left puncture closure device. The patient died 11 days later from multiorgan failure. CONCLUSIONS: RPH should be considered early as an occult cause of hypovolemic shock developing soon after even technically straightforward iliac angioplasty. Interventionists should be aware that using the Angio-Seal device risks acute limb ischemia if footplate embolization occurs.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
3/53. Hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones.We present a patient with complication of huge hepatic subcapsular hematoma after extracorporeal shock wave lithotripsy (ESWL) for pancreatic lithotripsy. The hematoma measured 78-110mm. angiography showed a subcapsular hematoma, rather than a hematoma in the liver. In the arterial phase, the distal end of the small vessel showed spotty opacification similar to microaneurysma, suggesting that it was an injury caused by separation of the liver and its capsule, caused by the shock waves. The portal vein and hepatic vein were normal. After 8 weeks of conservative therapy, the hematoma was gradually absorbed and the patient was discharged. Eight months after the accident, the hematoma had decreased to 40mm in size. After 20 months, it was completely absorbed. The reported rate of renal subcapsular hematoma after ESWL for renal or ureter stones is 0.1%-0.7%. To date, however, only five cases of hepatic subcapsular hematoma after right renal stone disintegration have been reported. This is the first report of hepatic subcapsular hematoma after ESWL for pancreatic stones.- - - - - - - - - - ranking = 6keywords = shock (Clic here for more details about this article) |
4/53. A giant intramural gastric hematoma successfully treated by transcatheter arterial embolization.We describe a case of intramural gastric hematoma with hemorrhagic shock caused by the formation of a large hematoma. Computed tomographic and angiographic examinations confirmed the presence of active bleeding into the hematoma. Transcatheter arterial embolization (TAE) was performed for hemostasis. To our knowledge, although 21 cases of intramural gastric hematoma have been reported in the literature, this is apparently the first case treated by TAE. We conclude that TAE is a safe and effective treatment option for intramural gastric hematoma confirmed to be associated with active bleeding into the hematoma.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
5/53. Spontaneous delayed splenic rupture--case report of a five-year interval between trauma and diagnosis.A 27-year-old white man was admitted in shock with a tender distended abdomen 5 years following significant thoraco-abdominal trauma. Immediately following resuscitation he had an emergency exploratory laparotomy because of his critical condition. At operation 3 liters of old and fresh blood were present intraperitoneally and the spleen was ruptured. The spleen was surrounded by and adherent to the omentum and adjacent viscera. splenectomy was performed and recovery was uneventful. Histologic examination of the spleen confirmed the 5-year interval between injury and rupture. Delayed splenic rupture accounts for 14% of all splenic injuries and has a high mortality. This case represents the longest reported delay between splenic trauma and delayed rupture.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
6/53. Blunt abdominal trauma with delayed rupture of splenic haematoma in a haemophiliac patient.A 13-year-old haemophilia A patient presented with pain in the abdomen, 4 days after a blunt abdominal trauma. The computed tomography scan of the abdomen showed a large splenic haematoma. The patient was initially managed with factor viii replacement therapy, but 4 weeks later he had a delayed rupture of the splenic haematoma with haemoperitoneum and shock. An elective splenectomy under factor viii therapy was successfully performed.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
7/53. Spontaneous rupture of the kidney with perirenal hematoma.Spontaneous rupture of the kidney involves either the collecting system or parenchyma, the latter being associated with a subcapsular or perirenal hematoma. A review was made of 78 cases of spontaneous parenchymal rupture with perirenal hematoma, including 4 of our own. One of these cases is the first description of spontaneous rupture of the kidney secondary to renal vein thrombosis. The patients are usually in the fourth decade of life and present with an acute onset of flank pain, a tender mass and commonly symptoms and signs of shock. hematuria is often present and generally urography reveals a mass, distorted collecting system and/or non-visualization of the kidney. Tumors are the most common cause followed by vascular diseases, infection, nephritis and blood dyscrasias. nephrectomy when possible should be performed expeditiously since conservative therapy is uniformly unsuccessful.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
8/53. Epicardial haematoma: rare cause of acute myocardial ischaemia.pericardial effusion and coronary dissection are well known complications of percutaneous transluminal coronary angioplasty (PTCA). We report a rare case of sub-epicardial haematoma after PTCA, leading to local compression and cardiogenic shock. We discuss the successful management of this problem.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
9/53. An unusual case of noncavitary hemorrhage revealed by intravenous contrast-enhanced computed tomography.Peripheral arterial injuries after blunt trauma commonly follow injuries to adjacent soft tissue, organ, and bone. We present here a case of blunt injury to the lumbar artery and the deep iliac circumflex artery in which there was no adjacent bone fracture, but in which hemorrhagic shock and persistent anemia ensued. Intravenous contrast-enhanced computed tomography revealed the site of active bleeding, leading us to perform an angiographic embolization for hemostasis.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
10/53. leiomyosarcoma presenting as a spontaneously ruptured renal tumor-case report.BACKGROUND: Ruptured renal neoplasms can be a catastrophic clinical presentation. angiomyolipoma is the commonest renal tumor which presents in this fashion. Renal sarcomas are rare renal neoplasms. Renal leiomyosarcomas are the most common histological subtype of renal sarcomas, accounting for approximately 50-60% of the reported cases. These tumors are usually peripherally located and appear to arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall. CASE PRESENTATION: A 70 years old male, with hypertension and ischemic disease, developed acute left flank pain. The general physician evaluated this using ultrasound, which showed a solid left renal mass. Two weeks later, he presented in the emergency room in a state of shock with a palpable flank mass. CT scan of the abdomen showed a large heterogeneous mass lesion in the left perinephric space with minimal post contrast enhancement. Per-operatively, large retroperitoneal hematoma was found within Gerota's fascia along with spleen plastered to the upper limit of hematoma. nephrectomy and splenectomy were performed. Postoperative course was uneventful and patient was discharged on the 10th post-operative day. Histopathological evaluation of the specimen showed high-grade leiomyosarcoma CONCLUSIONS: Spontaneous rupture of renal neoplasm is a rare clinical presentation. angiomyolipoma is the commonest cause of spontaneous rupture of the kidney. Presentation of a leimyosarcoma as a ruptured renal neoplasm has not been previously reported in the English literature.- - - - - - - - - - ranking = 1keywords = shock (Clic here for more details about this article) |
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