1/30. Combination of transileocolic vein obliteration and balloon-occluded retrograde transvenous obliteration is effective for ruptured duodenal varices.Duodenal varices are a rare site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report a 65-year-old woman who presented with hematemesis and melena. She was admitted to our department because of prolonged shock, despite having received transfusion of a large volume of blood. Upper gastrointestinal endoscopy revealed nodular varices with active bleeding in the second portion of the duodenum. Endoscopic injection sclerotherapy (EIS) was performed using a tissue adhesive agent, alpha-cyanoacrylate monomer, with only temporary benefit. However, anemia continued to progress after the procedure. Therefore, we combined transileocolic vein obliteration (TIO) with balloon-occluded retrograde transvenous obliteration (B-RIO), using 5% ethanolamine oleate with iopamidol to obliterate the varices. Complete hemostasis was achieved without complications. Neither recurrence of varices nor further bleeding has occurred for over 3 years. We conclude that combined TIO and B-RTO, which can obstruct both the feeding and the draining vessels of duodenal varices to retain the sclerosing agent completely in the varices, is a safe and effective hemostatic measure for ruptured duodenal varices, when EIS has failed to accomplish complete hemostasis.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
2/30. Fatal rupture of a sacrococcygeal teratoma during delivery.We report the case of premature infant born at 32 weeks' gestation with a sacrococcygeal teratoma diagnosed in utero. During delivery by cesarean section, profound bleeding due to rupture of the teratoma occurred. Despite volume expansion with saline, albumin, and whole blood, a satisfactory peripheral perfusion of the infant was only briefly achieved. Surgical intervention to stop the bleeding was unsuccessful. resuscitation of the infant was discontinued after 55 minutes. The relevant literature is discussed, and suggestions for the management of infants with sacrococcygeal teratomas are made.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
3/30. Lower abdominal phlegmon due to spontaneous rupture of an ileal neobladder.A case is presented of spontaneous rupture of an ileal orthotopic neobladder due to a large residual urine volume. The present case is the 13th such case reported; however, this case is the first to show lower abdominal phlegmon and in which the perforation site was detected using computed tomography scanning. The indications for neobladder should be considered with great care. If spontaneous rupture is suspected, an early diagnosis of the perforation site and a measure of the extravasation volume using computed tomography are necessary. Appropriate treatment should include laparotomy.- - - - - - - - - - ranking = 2keywords = volume (Clic here for more details about this article) |
4/30. A case of hepatocellular carcinoma rupturing after angiography.We report a case of primary hepatocellular carcinoma (referred to as hepatocellular carcinoma below) apparently rupturing after angiography. The patient was a 62-year-old male who was admitted for the treatment of hepatocellular carcinoma. ultrasonography (US) and computed tomography (CT) on admission showed a tumor occupying the entire left lobe of the liver and partly protruding outside the liver and a tumor embolus in the portal vein. We performed preoperative angiography, after which fever and abdominal discomfort appeared. Two days after the angiography, abdominal pain and a rapid increase in the size of the abdominal tumor were noted. US also revealed an unquestionable increase in the size of the tumor, leading to a diagnosis of intratumoral hemorrhage due to the rupture of hepatocellular carcinoma. Since child classification A, clinical stage I and ICG 11.7% indicated an adequate functional reserve of the liver, we performed an emergency operation. laparotomy revealed that the tumor occupied almost the entire left lobe of the liver, partly protruded outside it, and was bleeding from part of its anterior surface. The volume of intra-abdominal hemorrhage was about 100 ml. A portal tumor embolus was present in the portal vein from the horizontal part to the trunk. We performed resection of the left and caudate lobes of the liver with removal of the portal tumor embolus. The resected specimens showed a hemorrhage in and around the tumor. We speculated that in a hepatocellular carcinoma that involves the surface of the liver and is complicated by tumor embolism of the portal vein, angiography could trigger the rupture of the carcinoma.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
5/30. Spontaneous rupture of the right hemidiaphragm after video-assisted lung volume reduction operation.lung volume reduction operation is an important therapeutic option in patients with advanced emphysema. We report a case of spontaneous rupture of the right diaphragm after a video-assisted thoracoscopic surgical procedure for emphysema. The pathophysiology of this complication is also discussed, along with practical points for perioperative management of emphysematous patients.- - - - - - - - - - ranking = 5keywords = volume (Clic here for more details about this article) |
6/30. survival following free rupture of left ventricular aneurysm: report of a case.A 50-year-old man sustained free rupture of the left ventricle four weeks following a massive anterior myocardial infarction. The rupture occurred at the junction between a bulging left ventricular aneurysm that was not yet fibrotic and normal myocardium without evidence of fresh myocardial infarction. Accurate preoperative diagnosis aided by echocardiography and right heart catheterization made possible a planned surgical approach. Postoperative support with intraaortic balloon pumping appeared to be beneficial in maintaining statisfactory cardiac function until an adequate stroke volume could be reestablished, presumably by an increase in left ventricular volume.- - - - - - - - - - ranking = 2keywords = volume (Clic here for more details about this article) |
7/30. Hemorrhagic corpus luteum cyst torsion in term pregnancy: a case report.hemoperitoneum during pregnancy resulting from spontaneous rupture of adnexal torsion is a rare cause of fetal and maternal death. Presenting symptoms include severe abdominal pain, followed rapidly by maternal shock and fetal distress. It is hard to localize the adnexae in advanced pregnancy. Here, we present a case of spontaneous rupture of hemorrhagic corpus luteum cyst torsion that had not been previously diagnosed by ultrasound during term pregnancy. The patient was sent to our emergency room for sudden onset of severe low abdominal pain. Treatment consists of maintenance of adequate circulating intravascular volume and rapid surgical intervention. Preoperative diagnosis of adnexal torsion during term pregnancy is very difficult, although it is always identified during surgery.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
8/30. Successful delivery after hepatic rupture in previous pre-eclamptic pregnancy.Rupture of the liver in the course of pre-eclamptic pregnancy is a rare but life-threatening event. Controversiality exists with regard to the treatment modality. A case is presented of a pre-eclamptic multiparous woman with liver rupture and intra-abdominal bleeding immediately after delivery of a stillborn infant, who was successfully treated by correction of intravascular volume with blood transfusions without surgical intervention. The index pregnancy was succeeded by an uneventful pregnancy and delivery. This is the first case report of a conservatively managed liver rupture with an uneventful course of the next pregnancy. Conservative treatment should consist of correction of hypovolemia and clotting disorders, while surgical approach should be reserved for patients who cannot be stabilized hemodynamically.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
9/30. A case report: change in fetal heart rate pattern on spontaneous uterine rupture at 35 weeks gestation after laparoscopically assisted myomectomy.A 31-year-old nulligravid woman who underwent laparoscopically assisted myomectomy 5 months before becoming pregnant suffered uterine rupture at 35 weeks gestation. A 50 g intramuscular myomatous node had been removed laparoscopically. Early signs of rupture included sudden onset of severe abdominal tenderness and frequent uterine contractions despite reassuring FHR tracing. Variable deceleration was observed as late as 7.5 hours after onset. Emergency cesarean section was performed due to increasing severity of tenderness, revealing complete uterine rupture at the fundus site without extrusion of the fetus or placenta. A male neonate (2,860 g) was delivered without asphyxia and an apgar score of 8. Total volume of hemorrhage was approximately 50 ml. The ruptured uterine wall was repaired by suturing in 2 layers. The present case indicates that sudden onset of abdominal tenderness in pregnant women with a history of laparoscopic myomectomy may suggest uterine rupture even in the presence of reassuring FHR. This is a rare case, as non-reassuring FHR patterns generally appear in the late stages of uterine rupture.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
10/30. Rupture of urachal diverticulum in radiation cystitis and neurogenic bladder dysfunction after radical hysterectomy.We experienced a rare case of the rupture of the urachal diverticulum in radiation cystitis and neurogenic bladder after radical hysterectomy. A 61-year-old woman presented with severe lower abdominal pain and urinary retention. Abdominal computed tomography revealed that the urachal remnant contained a large volume of urine that leaked to subcutaneous tissue. We excised the urachal diverticulum and bladder together and created a continent urinary diversion using transverse colon. Nine months after the operation, the patient could manage clean intermittent self-catheterization 6 times a day through her umbilical stoma without any urinary complications.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
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