1/6. hemoperitoneum due to a ruptured gastric stromal tumor.BACKGROUND/AIMS: gastrointestinal stromal tumors form a group of uncommon neoplasms originated from pluripotential mesenchymal cells. Many patients are asymptomatic and the tumor is discovered during an abdominal operation. Massive intraperitoneal bleeding is an exceptional complication associated with high mortality rates. Our aim is to report a case of a gastric stromal tumor in an 83-year-old patient presenting with intraperitoneal hemorrhage and hypovolemic shock, successfully operated. methods: Emergency laparotomy showed a hemoperitoneum caused by rupture of a large exogastric tumor attached to the greater curvature. Total gastrectomy and esophagojejunostomy was performed. RESULTS: Histological examination revealed proliferation of spindle-shaped cells but immunocytochemistry failed to identify specific markers of smooth muscle and neural cells. diagnosis of a gastric stromal tumor was made. Postoperative evolution was uncomplicated. CONCLUSION: Gastric stromal tumor is a relatively rare neoplasm of mesenchymal origin whose nature and prognosis is unclear.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/6. A novel approach to the treatment of gunshot injuries to the sacrum.Two patients (a 17-year-old male and a 19-year-old female) sustained single gunshot wounds to the abdomen. Given the nature of their wounds and presumed peritoneal penetration they were taken urgently to the operating room for exploratory laparotomy. Both patients sustained multiple intra-abdominal injuries including gastric and small and large bowel perforations. Given the extensive nature of these injuries both patients required bowel resections. Upon further exploration they were both noted to have significant bleeding from the bony aspect of their sacrum. A surgical hemostat (CoStasis; Cohesion Technologies, Inc., Palo Alto, CA) (4.5-9.0 cm3) was directly applied to the injured area of the sacrum in both cases after standard surgical hemostatic techniques were unsuccessful. After application no further attempts of hemostatic control by standard methods were attempted. In both cases the sacral bleeding ceased without any further surgical intervention. Postoperatively neither patient rebled from the sacral injuries. Penetrating injuries to the sacrum can be life threatening and difficult to control with standard surgical hemostatic techniques. CoStasis, a new surgical hemostat, was effective in obtaining immediate and definitive hemostatic control. Future prospective trials on the use of CoStasis in trauma patients are warranted.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
3/6. laparoscopy in the emergency setting.laparoscopy has been available for 90 years and was actively undertaken by the gynecologists. Today the vast majority of gynecological procedures are performed by this route. Despite the efforts of a few enthusiastic surgeons, the general surgical community did not incorporate laparoscopy into their armamentarium until the advent of laparoscopic cholecystectomy. However, this endoscopic technique has much to contribute, especially in the setting of emergency care. It is of value in formulating a treatment algorithm and in avoiding unnecessary laparotomy in both blunt and penetrating trauma. laparoscopy helps to define the nature of obscure abdominal diagnoses, avoids unnecessary appendectomy, and provides the window of opportunity for surgery in mesenteric ischemia due to either arterial or venous thrombosis or embolus. It is also of value in patients with pain or fever of unknown origin, displaced gastrostomy or dialysis tubes, and in the rare patient with gastrointestinal bleeding where other diagnostic modalities have been unable to yield the diagnosis. In this article the instrumentation and techniques will be outlined and the role of laparoscopy in each of the above situations will be detailed. As with all surgical procedures, it is vital that the surgeon be well-trained and knowledgeable about the correct use of the technique, its possible pitfalls and how to avoid them, as well as knowing the contraindications.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/6. Spontaneous rupture and hemorrhage of hepatic focal nodular hyperplasia in lobus caudatus.In general, focal nodular hyperplasia lesions of the liver have a benign natural course; the majority of cases remain asymptomatic and complications are rare. We report a case of spontaneous rupture and hemorrhage of focal nodular hyperplasia, which is extremely rare in the literature. A 35-year-old woman was admitted with severe upper abdominal pain and unstable hemodynamic status. No major abdominal trauma was noted. radiology findings suggested a diffuse hemoperitoneum. Emergent surgical exploration showed a hemoperitoneum due to the rupture of a hepatic mass lesion in segment I. Suture of the rupture was undertaken with success. After this lifesaving emergent surgery, further investigations, including ultrasound, contrast-enhanced computed tomography, and magnetic resonance imaging, were undertaken, and a 5.7 x 9.8 x 6.4-cm focal nodular hyperplasia lesion was identified in segment I. Two weeks after the first surgical hemostasis, surgical removal of segment I, including the mass, was performed. The postoperative course was uneventful. Pathological evaluation confirmed the nature of focal nodular hyperplasia. The patient remains asymptomatic without evidence of recurrence 3 years and 6 months after surgery. To our knowledge, this is the firstcase of spontaneous rupture and hemorrhage of focal nodular hyperplasia that needed two consecutive surgical operations.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/6. Spontaneous intra-abdominal hemorrhage in hemophilia.Intra-abdominal hemorrhage in patients with hemophilia is uncommon but represents a major cause of death in hemophiliacs. The manifestations are protean and may mimic other intra-abdominal processes. We present seven episodes of hemophilic intra-abdominal hemorrhage in which the initial diagnoses were incorrect in five of the seven cases. The mean time from seeking medical assistance to correct diagnoses was two days (range, zero to five days). Computed tomography proved useful, particularly when the diagnosis was uncertain or needed to be differentiated from other possibilities, such as aneurysm, tumor, or abscess. Delay in diagnosis and diagnostic and therapeutic misadventures can be minimized only by a knowledge of the nature of such hemorrhage.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/6. Postcoital hemoperitoneum without identifiable bleeding source: a case report.Spontaneous intra-abdominal bleeding has been called abdominal apoplexy. It has been so named because its nature and spontaneity closely resemble those of its more common cerebral counterpart. The bleeding source commonly came from a ruptured branch of celiac axis or superior mesenteric artery. Rarely, hemoperitoneum occurs spontaneously post coitus without evident vaginal injury. There were only twelve cases reported in the medical literature to date. Nearly, all of them showed injury of pelvic organs including round or broad ligaments, ovarian cysts or adhesion bands. A case of massive hemoperitoneum after coitus, with no definite bleeding source, is reported.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |