11/29. Haemoperitoneum secondary to spontaneous rupture of hepatocellular carcinoma: CT diagnosis.In Western countries, haemoperitoneum following rupture of hepatocellular carcinoma (HCC) is unusual. Three patients are presented in whom massive intraperitoneal haemorrhage secondary to spontaneous rupture of HCC was diagnosed by computed tomography (CT). CT demonstrated a peripheral hepatic tumour and free intraperitoneal fluid with areas of high-attenuation, representing acute blood-clot, close to the tumour in every case. In our opinion, CT is a valuable imaging modality in the diagnosis of ruptured HCC.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
12/29. Haemoperitoneum due to rupture of an ovarian endometrioid cyst as a first symptom of acute leukaemia.We report the case of a 23-year-old woman admitted for a haemoperitoneum secondary to the rupture of an ovarian endometrioid cyst. Preoperative investigations revealed the diagnosis of acute myeloid leukaemia of M3 type complicated by severe thrombocytopenia. The patient eventually died of intracerebral haemorrhage. The rarity of acute abdomen by bleeding as the first sign of acute leukaemia is emphasized.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
13/29. A rare cause of intra-abdominal haemorrhage: spontaneous rupture of the splenic vein.Spontaneous rupture of the splenic vein is rare, and is associated with high mortality. Few cases have been documented, associated with pregnancy, with hepatic cirrhosis and diseases predisposing to portal hypertension. We report a rare case with no evident symptoms or signs of liver deficiency, which was manifested with sudden massive intraperitoneal haemorrhage. An urgent laparotomy was performed and a tear of the splenic vein which was massively bleeding was found. The patient underwent urgent splenectomy and a biopsy of the liver was taken. The patient had an uneventful postoperative course. The histological examination documented the presence of micro-nodular liver cirrhosis. rupture of the splenic vein is a rare condition, which should be considered in the differential diagnosis of intra-abdominal haemorrhage in a cirrhotic patient and in pregnant women. Control of haemorrhage and ligation of the splenic vein with urgent splenectomy is the appropriate treatment.- - - - - - - - - - ranking = 7keywords = haemorrhage (Clic here for more details about this article) |
14/29. Massive haemoperitoneum complicating metastasis in the liver.The rare phenomenon of gross intra-abdominal bleeding due to hepatic metastasis was seen in a young male who a short time before had undergone orchiectomy because of embryonal cell carcinoma. Following laparotomy, 4 liters of fresh blood were drained from the peritoneal cavity and the left lobe of the liver, containing a single large metastasis, was removed. It is stressed that when no other cause of such haemorrhage can be found in a patient known to have had malignancy, the possibility of bleeding from a metastasis should be considered and appropriate measures taken.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
15/29. Renal cell carcinoma presenting as spontaneous retroperitoneal haemorrhage.On the basis of a spontaneous retroperitoneal haematoma in a 55-year-old female patient the diagnostic and therapeutical problems of such an emergency situation will be discussed. Due to the high incidence of malignant tumours as the bleeding source, radical surgery becomes the necessary treatment, which may be needlessly burdened by high operative risk in the acute phase. For that reason the mode of treatment chosen in this particular case was immediate embolization subsequent to arteriography along with consecutive extracapsular nephrectomy and removal of the haematoma.- - - - - - - - - - ranking = 4keywords = haemorrhage (Clic here for more details about this article) |
16/29. Ruptured aneurysm of the omentum. Case report.A 61-year-old man was operated on for a ruptured aneurysm located on the free margin of the omentum. Such patients should have preoperative arteriography as the source of the haemorrhage can be difficult to find at operation.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
17/29. Relative bradycardia: a sign of acute intraperitoneal bleeding.Acute intraperitoneal bleeding with hypotension may be accompanied by a relatively normal pulse rate instead of the tachycardia usually produced by blood loss. Four cases of intraperitoneal bleeding of diverse, though pelvic, origin, are described. In each patient, symptomatic hypotension occurred with a pulse rate less than 80 per minute, thereby initially confusing the diagnosis of internal bleeding. The hypotension and relative bradycardia responded to atropine followed by fluid replacement. Response to atropine implies that the reflex that produces bradycardia is mediated by the parasympathetic nervous system. It is concluded that relative bradycardia occurring with intraperitoneal haemorrhage may be the cause of both diagnostic difficulty and disproportionately severe hypotension.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
18/29. Fatal intraperitoneal haemorrhage of hepatic origin.Eight cases of fatal haemoperitoneum due to liver bleeding are reported. Two followed trauma (liver biopsy and cholecystectomy). The remaining six were spontaneous, 5 being due to malignant liver disease. The sixth case due to polycystic liver disease appears to be unique. The aetiology and importance of spontaneous hepatic bleeding is discussed.- - - - - - - - - - ranking = 4keywords = haemorrhage (Clic here for more details about this article) |
19/29. Fatal retroperitoneal haemorrhage complicating anticoagulant therapy.Eight cases are reported of extensive retroperitoneal haemorrhage in patients receiving anticoagulant therapy who subsequently died and underwent postmortem examination. No patient had an obvious source of bleeding, and in 5 cases no other cause for death was apparent. Three patients had had vascular surgical procedures: the other 5 were given anticoagulants for suspected venous thrombo-embolism. Six cases presented as unexpected circulatory collapse with rapid demise. Four patients had in addition gastro-intestinal bleeding of varying degree, with no obvious source. This acute massive type of retroperitoneal bleeding contrasts with the commoner presentations of pain, swelling, bruising and compression neuropathy: a high index of suspicion and urgent treatment are required if mortality is to be reduced.- - - - - - - - - - ranking = 5keywords = haemorrhage (Clic here for more details about this article) |
20/29. Detection of occult abdominal trauma in patients with severe head injuries.Among 109 consecutive victims of severe head injury, intra-abdominal injury could not be excluded in 87. These patients were considered to be at risk from occult intra-abdominal haemorrhage. 60 patients underwent diagnostic peritoneal lavage. 10 of these had a positive lavage, correctly indicating intra-abdominal haemorrhage. In each case a lesion requiring surgical repair was identified. 49 patients had a negative lavage, and only 1 of these patients subsequently showed signs of a missed intra-abdominal lesion. 13 patients had low systolic blood-pressure (< 90 mm Hg) on admission, and 4 of these had positive lavage. Of 47 patients with systolic blood-pressure of 90 mm Hg or greater on admission, 6 had positive lavage. 15 patients were deeply comatose with no eye-opening or verbal response and an extensor or no motor response to painful stimuli. 6 of these had positive peritoneal lavage. We conclude that diagnostic peritoneal lavage should form an integral part of the evaluation of comatose patients with head injury, particularly those whose level of consciousness is most depressed, whether or not clinical signs of shock, abdominal injury, or occult haemorrhage are present.- - - - - - - - - - ranking = 3keywords = haemorrhage (Clic here for more details about this article) |
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