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1.
Sultan Qaboos Univ Med J ; 24(1): 135-138, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38434469

RESUMO

Choriocarcinoma (CC) is a malignant neoplasm of the trophoblastic tissue, with a potential to metastasise to distant organs. Limited case of gestational CC develops after a long latent period. We report a 52-year-old postmenopausal woman who developed metastatic choriocarcinoma presumably of gestational origin, 8 years after the last pregnancy and 2 years after the last menstrual period. The patient was brought to the emergency room of a tertiary care centre in Muscat, Oman, in 2022 and was diagnosed with CC metastatic to the brain, spleen, lung and the kidney. The ß-human chorionic gonadotrophin level was found to be raised (1,292,867 mIU/mL). The International Federation of Gynecologic Oncology risk score was calculated to be 14 (very high risk). The patient was initially treated with whole-brain radiotherapy and splenic artery embolisation because of a hemoperitoneum. Afterwards the patient received systemic treatment using the standard EMA/CO regimen till complete serological remission.


Assuntos
Coriocarcinoma , Embolização Terapêutica , Gravidez , Humanos , Feminino , Pessoa de Meia-Idade , Pós-Menopausa , Coriocarcinoma/diagnóstico , Serviço Hospitalar de Emergência , Hemoperitônio
2.
BMJ Case Rep ; 17(3)2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38442968

RESUMO

Spontaneous haemoperitoneum in pregnancy (SHiP) related to endometriosis is a rare and life-threatening complication. We report a case of a patient presenting to our department with major haemoperitoneum at 23+3 weeks of gestation due to a large rectovaginal endometriotic nodule. The patient required a midline laparotomy to evacuate 1 L of haemoperitoneum and achieve haemostasis. A large rectovaginal nodule was seen bleeding and was packed with haemostatic material and a large swab. After 24 hours, the swab was removed and haemostasis was confirmed. The patient was monitored very closely by a multidisciplinary team and the pregnancy was allowed to continue to try and achieve a better outcome for the baby and at 28 weeks of gestation, a girl was delivered in good condition via caesarean section.


Assuntos
Endometriose , Hemostáticos , Feminino , Humanos , Gravidez , Cesárea , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/cirurgia , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Laparotomia , Recém-Nascido
3.
Vet Med Sci ; 10(2): e1391, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38403981

RESUMO

A 2-year-old spayed female Siberian Husky was presented with a history of acute onset lethargy, collapse, haematochezia and vomiting. The patient was severely tachycardic and hypotensive. Point-of-care ultrasound revealed gallbladder wall thickening and peritoneal effusion consistent with haemorrhage on subsequent abdominocentesis. Despite attempted medical stabilization over the course of several hours, including blood products and multiple autotransfusions, the patient progressed to cardiopulmonary arrest. The dog was successfully resuscitated but was subsequently euthanized. Necropsy revealed a severe, acute hemoperitoneum secondary to rupture of the left lateral liver lobe. A tear in the hepatic capsule was identified along with a large hematoma. A single adult nematode, consistent with Dirofilaria immitis, was found in a pulmonary vessel in the right caudal lung lobe. The remaining necropsy findings were supportive of the clinical diagnosis of anaphylaxis. This report details a case, with necropsy findings, supporting a diagnosis of anaphylaxis and severe, refractory hemoperitoneum resulting from hepatic rupture. Acute hepatic rupture should be considered in cases of anaphylaxis-related hemoperitoneum.


Assuntos
Anafilaxia , Doenças do Cão , Hepatopatias , Humanos , Cães , Feminino , Animais , Hemoperitônio/etiologia , Hemoperitônio/veterinária , Hemoperitônio/diagnóstico , Anafilaxia/diagnóstico , Anafilaxia/veterinária , Anafilaxia/complicações , Hepatopatias/veterinária , Doenças do Cão/diagnóstico
4.
BMJ Case Rep ; 17(1)2024 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-38286579

RESUMO

An adolescent female presented with an acute abdomen and elevated beta-human chorionic gonadotropin levels and underwent a laparoscopy for a suspected ruptured ectopic pregnancy. Intraoperatively, a ruptured haemorrhagic corpus luteal cyst and tissues suggestive of products of conception were noted in the same ovary. Histology confirmed an ovarian ectopic pregnancy. Haemorrhagic ovarian cysts, and ectopic pregnancies, can cause acute pelvic pain in women of childbearing age. Their similar clinical signs and symptoms pose a diagnostic dilemma for any gynaecologist. Ruptured corpus luteal cysts, as well as ruptured ovarian ectopic pregnancies, should be considered rare but differential diagnoses in women presenting with acute abdominal pain, an adnexal mass and ultrasound features of haemoperitoneum. The mainstay of treatment is a diagnostic laparoscopy, which is a safe and feasible management strategy without compromising patient safety or ovarian function in the long run.


Assuntos
Abdome Agudo , Cistos , Cistos Ovarianos , Gravidez Ectópica , Gravidez Ovariana , Gravidez , Adolescente , Feminino , Humanos , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Ruptura Espontânea/complicações , Ruptura Espontânea/cirurgia , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/cirurgia , Cistos Ovarianos/complicações , Cistos Ovarianos/cirurgia , Cistos Ovarianos/diagnóstico , Ruptura/complicações , Abdome Agudo/etiologia , Cistos/complicações
5.
BMJ Case Rep ; 17(1)2024 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-38296502

RESUMO

This is a case of a spontaneous haemoperitoneum occurring in the second trimester of pregnancy which was managed with interventional radiology to avoid laparotomy and its potential consequences. We aim to raise awareness of this condition in pregnancy because the perinatal mortality rate is as high as 36%. Spontaneous haemoperitoneum in pregnancy (SHiP) has frequently been associated with vascular rupture from pre-existing endometriosis. Most cases of SHiP have been managed with laparotomy. However, transcatheter embolisation can impart lifesaving alternatives to more invasive interventions when caring for pregnant patients. More judicious use of imaging procedures may also help improve diagnostic and therapeutic pathways with SHiP. We recommend that high-risk pregnancies are managed in level IV regional perinatal healthcare centres, when possible, where subspecialists and alternative measures of management exist.


Assuntos
Endometriose , Complicações na Gravidez , Gravidez , Feminino , Humanos , Segundo Trimestre da Gravidez , Complicações na Gravidez/etiologia , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemoperitônio/terapia , Endometriose/complicações , Gravidez de Alto Risco
6.
J Pak Med Assoc ; 74(1): 165-168, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38219192

RESUMO

Endometriosis presenting as ascites is a rare entity, and is more so in women of Asian ethnicity. Less than a hundred cases have been reported worldwide. Majority of patients present with abdominal dist ension and pa in, drai ning massive blood stained serosanguineous fluid. This hinders future fertility prospects of these women. O va rian suppression has been employed as a successful treatment, followed by definitive surgical treatment, such as bilateral salpingo -ooph orectomy, to end the possibility of recurrences, which are otherwise always possible. We present the case of a woman of reproductive age, seeking fertility treatment, who had a more subtle presentation of moderate, but relapsing ascites of un known origin in the past two years. Diagnostic laparoscopy and histopathology of the pe ritoneal deposits suggested endometriosis. Her ovarian func tion was s uppressed, and sh e is curre nt ly underway of a ssisted re produ ction for achieving a pregnancy.


Assuntos
Ascite , Endometriose , Humanos , Gravidez , Feminino , Ascite/diagnóstico , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/cirurgia , Hemoperitônio , Abdome , Ovário , Recidiva
7.
BMC Emerg Med ; 24(1): 7, 2024 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-38185679

RESUMO

INTRODUCTION: Focused assessment with sonography for trauma helps detect abdominal free fluid. Prehospital ultrasound scanning is also important because the early diagnosis of hemoperitoneum may reduce the time to definitive treatment in the hospital. This study investigated whether prehospital ultrasound scanning can help detect abdominal free fluid. MATERIALS AND METHODS: In this systematic review, relevant databases were searched for studies investigating prehospital ultrasound examinations for abdominal free fluid in trauma patients. The prehospital ultrasound results were compared with computed tomography, surgery, or hospital ultrasound examination data. The pooled sensitivity and specificity values were analyzed using forest plots. The overall predictive power was calculated by the summary receiver operating characteristic curve. The quality of the included studies was assessed using the quality assessment of diagnostic accuracy studies tool. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was performed to assess the certainty of evidence. RESULT: This meta-analysis comprised six studies that included 1356 patients. The pooled sensitivity and specificity values were 0.596 (95% confidence interval [CI] = 0.345-0.822) and 0.970 (95% CI = 0.953-0.983), respectively. The pooled area under the summary receiver operating characteristic curve was 0.998. The quality assessment tool showed favorable results. In the GRADE analysis, the quality of evidence was very low for sensitivity and high for specificity when prehospital ultrasound was used for hemoperitoneum diagnosis. CONCLUSION: The specificity of abdominal free fluid detection using prehospital ultrasound examinations in trauma patients was very high.


Assuntos
Serviços Médicos de Emergência , Hemoperitônio , Humanos , Hemoperitônio/diagnóstico por imagem , Abdome/diagnóstico por imagem , Ultrassonografia , Bases de Dados Factuais
8.
Toxicon ; 237: 107350, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38016581

RESUMO

Snakebites are frequent in tropical countries. Brazil has an average of 27,000 cases per year, with a fatality rate of 0.5%, and the Bothrops genus is the most common causative agent, accounting for about 70-90% of the accidents. This report describes a case of human envenomation by a juvenile Bothrops jararaca snake in São Paulo, Brazil, in a 71 years-old man, previously healthy. He presented a life-threatening envenomation, which developed to severe hypotension, acute kidney injury and extensive peritoneal hemorrhage. The hemoperitoneum was diagnosed due to persistent hypotension associated with anemia, pain and gastrointestinal complaints. Abdominal Computed Tomography scans showed a moderate to large amount of presumable hematic material inside the abdominal cavity, predominantly in the perihepatic and perisplenic spaces. The intra-abdominal hemorrhage was not surgically addressed, and the patient was discharged 5 days after hospitalization, with the progressive absorption of the hemoperitoneum. Systemic bleeding is one of the complications and main causes of death in Bothrops envenomations. Acute peritoneal hemorrhage is one of these serious complications that must be carefully addressed since its management must take into account the risk of bleeding caused by toxins that affect hemostasis. The case described highlights the importance of early diagnosis and adequate management of this potentially fatal complication in snakebites.


Assuntos
Bothrops , Venenos de Crotalídeos , Hipotensão , Mordeduras de Serpentes , Masculino , Animais , Humanos , Idoso , Mordeduras de Serpentes/complicações , Hemoperitônio/complicações , Brasil , Antivenenos
9.
Artigo em Inglês | MEDLINE | ID: mdl-37961036

RESUMO

OBJECTIVE: To evaluate the association of admission total plasma protein (TPP) and the administration of red blood cell transfusions in dogs with diagnosed hemoabdomen. To secondarily evaluate additional point-of-care parameters associated with red blood cell transfusion administration. DESIGN: Retrospective study between 2009 and 2019. SETTING: University veterinary teaching hospital. ANIMALS: Ninety dogs admitted to a university veterinary teaching hospital after a diagnosis of traumatic or nontraumatic hemoabdomen (NTH). MEASUREMENTS AND MAIN RESULTS: Medical records were retrospectively reviewed; signalment, point-of-care diagnostics, and transfusion administration information was recorded. A total of 47 dogs (traumatic hemoabdomen 11/26; NTH 36/64) received packed red blood cell transfusions. For each 1 g/dL unit decrease in TPP, dogs had an increased odds ratio (OR) of 2.14 (95% confidence interval [CI]: 1.44-3.40, P < 0.001) of receiving a red blood cell transfusion. Dogs diagnosed with NTH were more likely to receive a red blood cell transfusion than dogs with a traumatic hemoabdomen (OR: 2.78, 95% CI: 1.11-7.141, P = 0.03). Lower PCV values (OR: 1.08, 95% CI: 1.04-1.12, P < 0.001), bicarbonate values (OR: 1.3, 95% CI: 1.09-1.56, P = 0.003), and base excess (OR: 1.27, 95% CI: 1.1-1.49, P = 0.003) were associated with a higher likelihood of red blood cell transfusion. Additionally, higher lactate (OR: 1.35, 95% CI: 1.16-1.63, P < 0.001) and Acute Patient Physiologic and Laboratory Evaluation (APPLE)fast scores (OR: 1.10, 95% CI: 1.04-1.17, P < 0.001) were associated with increased red blood cell transfusion administration. CONCLUSIONS: Low admission TPP, independent of low PCV, was associated with red blood cell transfusions regardless of underlying cause. For each 1 g/dL unit decrease in TPP on presentation, dogs were approximately 2 times more likely to receive a red blood cell transfusion during hospitalization. Other factors that were associated with increased transfusion administration included presenting PCV, PCV/TPP ratio, bicarbonate, base excess, lactate, and APPLEfast scores.


Assuntos
Doenças do Cão , Transfusão de Eritrócitos , Humanos , Cães , Animais , Transfusão de Eritrócitos/veterinária , Estudos Retrospectivos , Bicarbonatos , Hospitais Veterinários , Hospitais de Ensino , Hemoperitônio/complicações , Hemoperitônio/veterinária , Hospitalização , Lactatos , Proteínas Sanguíneas , Doenças do Cão/diagnóstico , Doenças do Cão/terapia
11.
BMJ Case Rep ; 16(12)2023 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-38056929

RESUMO

Arteriovenous malformations (AVMs) are vascular anomalies composed of a tangle of abnormal vessels in which one or more feeding arteries are directly connected to one or more draining veins via a nidus with no intervening capillary bed. The adnexa are particularly rare sites for the formation of such malformations. Here, we present the case of a middle-aged woman who presented with spontaneous massive haemoperitoneum occurring as a result of a ruptured adnexal AVM. The diagnosis was suspected on transabdominal sonography and confirmed on CT angiography. The patient was shifted to the interventional radiology suite for an urgent angioembolisation following which she improved haemodynamically and her symptoms resolved. The case highlights the fact that although exceedingly rare, gonadal AVMs are an important cause of spontaneous intraperitoneal bleeding. Diagnostic and interventional radiology play an important role in the early and accurate diagnosis of this entity, and angioembolisation can be lifesaving in such patients.


Assuntos
Anexos Uterinos , Malformações Arteriovenosas , Embolização Terapêutica , Hemoperitônio , Feminino , Humanos , Pessoa de Meia-Idade , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemoperitônio/terapia , Anexos Uterinos/irrigação sanguínea
12.
J Radiol Case Rep ; 17(8): 38-48, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38090638

RESUMO

An 18-year-old male developed a huge liver abscess with severe anemia over the course of 2 weeks. Abdominal contrast enhanced computed tomography showed ruptured huge liver abscess in the right liver lobe with signs of active hemorrhage (contrast extravasation). Serology examination confirmed amoeba as the suspected pathogen of cause. Angiography was performed followed by transcatheter arterial embolization to localize and control the hemorrhage. Embolization using a combination of polyvinyl alcohol and gelfoam successfully controlled the active hemorrhage. Exploratory laparotomy was performed to evacuate and debride the huge abscess. Metronidazole was given and showed good results. Huge liver abscess size is a predictor of conservative management failure and requires a gradual step-up intervention. The purpose of this paper is to explain the importance of imaging in detecting liver abscess and active hemorrhage along with the role of interventional radiology in this case.


Assuntos
Embolização Terapêutica , Abscesso Hepático Amebiano , Masculino , Humanos , Adolescente , Abscesso Hepático Amebiano/cirurgia , Ruptura Espontânea , Hemoperitônio , Embolização Terapêutica/métodos , Angiografia
13.
Medicine (Baltimore) ; 102(51): e36753, 2023 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-38134099

RESUMO

To summarize the clinical characteristics and explore the risk factors for miscarriage of a viable intrauterine pregnancy following surgical intervention in patients with heterotopic pregnancy (HP). A total of 106 women diagnosed with HP that underwent surgical intervention in the Women's Hospital School of Medicine Zhejiang University between January 2014 and December 2021 were included in this retrospective study. They were divided into a miscarriage group (n = 13) and an ongoing pregnancy group (n = 93) according to the outcomes of the HP within 2 weeks after surgery. Data regarding clinical characteristics, surgical conditions, postoperative recovery, and complications were collected and compared between the groups. Logistic multivariate analysis was performed to explore the risk factors for miscarriage in patients with HP within 2 weeks of surgical intervention. Among the 106 women with HP, 80 had tubal HP, 8 had cornual HP, and 18 had interstitial HP. Eighty-seven (82.1%) patients developed clinical symptoms that manifested primarily as abnormal vaginal bleeding and/or abdominal pain, whereas 19 (17.9%) patients had no clinical symptoms. The mean gestational age on the day of surgery was 7.2 weeks (inter-quartile range, 6.4-8.3). The miscarriage rate within 2 weeks of surgical intervention was 12.3% in patients with HP. Compared to the ongoing pregnancy group, the miscarriage group had a higher body mass index, earlier gestational age at treatment, and higher volume of hemoperitoneum (P < .05 for all). Logistic multivariate analysis indicated that the women with a hemoperitoneum volume > 200 mL had significantly higher risk of miscarriage after adjusting covariates [OR (odds ratio) = 5.285, 95% CI (confidence interval) (1.152-24.238), P < .05]. Hemoperitoneum volume was independently associated with miscarriage of viable intrauterine pregnancies in patients with HP within 2 weeks of surgical intervention.


Assuntos
Aborto Espontâneo , Gravidez Heterotópica , Gravidez , Humanos , Feminino , Recém-Nascido , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Gravidez Heterotópica/epidemiologia , Gravidez Heterotópica/cirurgia , Gravidez Heterotópica/diagnóstico , Estudos Retrospectivos , Hemoperitônio , Fatores de Risco
14.
BMC Res Notes ; 16(1): 300, 2023 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-37908004

RESUMO

OBJECTIVE: To report the outcomes and complications associated with prophylactic incisional gastropexy performed in dog breeds at risk for GDV. RESULTS: Seven hundred and sixty-six dogs underwent prophylactic incisional gastropexy of which 61 were electively performed at the time of castration or spay and 705 were adjunctively performed at the time of emergency abdominal surgery. All dogs had short-term follow-up, and 446 dogs (58.2%) had additional follow-up with a median long-term follow-up time of 876 days (range 58-4450). Only 3 dogs (0.4%) had a direct complication associated with the gastropexy site including hemorrhage causing hemoabdomen (2) and infection with partial dehiscence (1). No dogs with long-term follow-up experienced gastric dilatation (GD), gastric dilatation volvulus (GDV), or persistent GI signs following gastropexy. Results of this study found that complications directly associated with prophylactic gastropexy were rare and limited to hemorrhage causing hemoabdomen and infection with partial dehiscence. Transient postoperative GI signs may occur. Gastropexy malpositioning and bowel entrapment were not encountered. There was no occurrence of GD or GDV.


Assuntos
Doenças do Cão , Dilatação Gástrica , Gastropexia , Volvo Gástrico , Cães , Animais , Dilatação Gástrica/etiologia , Dilatação Gástrica/prevenção & controle , Dilatação Gástrica/cirurgia , Gastropexia/efeitos adversos , Gastropexia/métodos , Gastropexia/veterinária , Doenças do Cão/cirurgia , Volvo Gástrico/etiologia , Volvo Gástrico/cirurgia , Volvo Gástrico/veterinária , Hemoperitônio
15.
BMJ Case Rep ; 16(11)2023 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-37977832

RESUMO

Transvaginal ultrasound-guided oocyte retrieval is the gold-standard technique for oocyte retrieval that has few associated procedural and post-procedural complications. Rarely, severe complications can occur including haemoperitoneum, for which the incidence reported in the literature is approximately 0.08-0.22%. In this report, we present the case of a nulliparous woman in her late 30s who presented to the hospital with severe abdominal pain following transvaginal ultrasound-guided oocyte retrieval and was found to have extensive haemoperitoneum attributed to ovarian rupture.


Assuntos
Doenças Ovarianas , Doenças Urológicas , Feminino , Humanos , Recuperação de Oócitos/efeitos adversos , Recuperação de Oócitos/métodos , Hemoperitônio/etiologia , Hemoperitônio/complicações , Doenças Ovarianas/etiologia , Ultrassonografia/efeitos adversos , Doenças Urológicas/complicações
16.
Hepatol Commun ; 7(11)2023 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-37889553

RESUMO

BACKGROUND: Thromboelastography (TEG) informs the need for blood product transfusions to prevent procedural bleeding complications in patients with cirrhosis. We aimed to evaluate the impact of using a TEG-based transfusion protocol on blood product utilization before paracentesis and the post-paracentesis hemoperitoneum (PPH) incidence. METHODS: We conducted an ambispective analysis of patients with cirrhosis who underwent paracentesis from 2017 to 2021. In May 2019, we enacted a TEG-based transfusion protocol to guide pre-paracentesis blood product use. Patients with platelets < 20,000 or international normalized ratio ≥ 4 underwent TEG and received blood products if r value > 10 min or MA <30 mm. Patients were divided into pre-TEG and post-TEG protocol cohorts based on the date of paracentesis. Pre-paracentesis blood product transfusions in the form of platelets, fresh frozen plasma, and cryoprecipitates were recorded. PPH was defined as a decrease in hemoglobin of ≥1 g and the presence of blood on diagnostic imaging and/or the need for therapeutic intervention. RESULTS: A total of 483 patients underwent 1281 paracenteses. The main etiologies of cirrhosis were alcohol (43%) and NASH (25%), and the mean MELD-sodium was 22±6. Pre-TEG and post-TEG protocol cohort sizes were similar: 253 patients and 607 paracenteses versus 230 patients and 674 paracenteses. After TEG-protocol implementation, blood product transfusions decreased significantly (228 vs. 49 products, p<0.001) with associated cost savings. One patient in each cohort developed PPH. CONCLUSION: Implementation of a pre-paracentesis TEG-based transfusion protocol for patients with cirrhosis successfully resulted in decreased blood product use with no associated increase in incidence of PPH.


Assuntos
Hemoperitônio , Tromboelastografia , Humanos , Tromboelastografia/métodos , Hemoperitônio/etiologia , Hemoperitônio/complicações , Transfusão de Sangue , Cirrose Hepática/complicações , Coeficiente Internacional Normatizado
17.
Open Vet J ; 13(9): 1212-1218, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37842112

RESUMO

Background: Granulosa cell tumors (GCTs) are the most common ovarian tumors in mares. The classical presentation of a GCT is a unilaterally enlarged ovary appearing as a multicystic honeycomb mass. In rare cases, GCTs cause hemoperitoneum as a result of the rapid growth of the tumor. The clinical diagnosis of GCT is usually based on history, rectal examination, ultrasonographic examination, and serum hormone analysis, and surgical removal of the affected ovary is the treatment of choice. The different surgical approaches are based on the dimension of the GCT. Case Description: A 7-year-old mare was referred to the department for horses due to suspicion of a large colon impaction. The mare presented with clinical signs of colic, fever, and signs of hypovolemic shock. Rectal and ultrasonographic examination showed hemoperitoneum and a honey-comb mass within the abdomen, and a GCT as the cause of an acute hemoperitoneum was diagnosed based on the serum level of anti-Müllerian hormone. After stabilization of the mare, the GCT was removed through a ventral midline incision. Because of the enormous dimensions of the GCT, intra-abdominal partial resection of the tumor using a tenotomy knife was necessary to exteriorize the ovarian pedicle. At 3 months follow-up, the mare was ridden for her intended use. Conclusion: This report provides an approach to an uncommon case of a very large and heavy GCT.


Assuntos
Tumor de Células da Granulosa , Doenças dos Cavalos , Neoplasias Ovarianas , Animais , Cavalos , Feminino , Tumor de Células da Granulosa/diagnóstico , Tumor de Células da Granulosa/cirurgia , Tumor de Células da Granulosa/veterinária , Hemoperitônio/veterinária , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/cirurgia , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/cirurgia , Neoplasias Ovarianas/veterinária
19.
J Radiol Case Rep ; 17(8): 15-20, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37654899

RESUMO

Traditional Chinese medicine is a popular form of complementary and/or alternative medicine in Southeast Asia, often incorporating acupuncture. Acupuncture involves the insertion of thin needles into varied anatomical points on the body for the relief of a range of symptoms, such as musculoskeletal aches and pains. We present the first reported case of percutaneous liver injury secondary to acupuncture. We aim to familiarize readers with this rare and as-yet unreported case of intra-abdominal injury related to acupuncture, which is commonly practiced in many countries in Eastern and Southeast Asia.


Assuntos
Terapia por Acupuntura , Hemoperitônio , Humanos , Fígado/diagnóstico por imagem , Terapia por Acupuntura/efeitos adversos , Agulhas , Dor
20.
Emerg Med J ; 40(12): 821-825, 2023 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-37673644

RESUMO

BACKGROUND: While the role of Extended Focused Assessment with Sonography in Trauma (eFAST) is well defined in the management of severe blunt trauma, its performance in injuries caused by stab wounds has been poorly assessed. METHODS: Prospective single centre study which included all patients with stab wounds to the thorax or abdomen between December 2016 and December 2018. All patients underwent initial investigation with both eFAST and CT scan, except in cases of haemodynamic or respiratory instability, and in cases with a positive diagnosis by eFAST in which case surgery without CT scan was performed. RESULTS: Of the 200 consecutive patients included, 14 unstable patients underwent surgery immediately after eFAST. In these 14 patients, 9 had cardiac tamponade identified by eFAST and all were confirmed by surgery. In the remaining 186 patients, the median time between eFAST and CT scan was 30 min (IQR 20-49 min). Test characteristics (including 95% CI) for eFAST compared with reference standard of CT scan for detecting pneumothorax were as follows: sensitivity 77% (54%-92%), specificity 93% (90%-97%), positive predictive value (PPV) 60% (49%-83%), negative predictive value (NPV) 97% (93%-99%). Test characteristics (including 95% CI) for eFAST compared with CT scan for detecting haemothorax were as follows: sensitivity 97% (74%-99%), specificity 96% (92%-98%), PPV 83% (63%-93%) and NPV 99% (96%-100%). Finally, test characteristics (including 95% CI) for eFAST compared with CT scan for detecting haemoperitoneum were as follows: sensitivity 75% (35%-97%), specificity 97% (93%-99%), PPV 55% (23%-83%) and NPV 99% (96%-99%). CONCLUSIONS: In patients admitted with stab wounds to the torso, eFAST was not sensitive enough to diagnose pneumothorax and haemoperitoneum, but performed better in the detection of cardiac tamponade and haemothorax than the other injuries. More robust multicentre studies are needed to better define the role of eFAST in this specific population.


Assuntos
Traumatismos Abdominais , Tamponamento Cardíaco , Pneumotórax , Traumatismos Torácicos , Ferimentos não Penetrantes , Ferimentos Perfurantes , Humanos , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Estudos Prospectivos , Hemotórax/etiologia , Hemotórax/complicações , Tamponamento Cardíaco/complicações , Hemoperitônio/etiologia , Hemoperitônio/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/complicações , Sensibilidade e Especificidade , Ultrassonografia , Traumatismos Abdominais/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/complicações , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem
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