Bowel obstruction: signs indicating the need for urgent surgery.

Bowel obstruction is common in emergency departments. Obstruction is more common in the small bowel than in the large bowel. The most common cause is postsurgical adhesions. Nowadays, bowel obstruction is diagnosed with multidetector computed tomography (MDCT). MDCT studies for suspected bowel obstruction should focus on four points that need to be mentioned in the report: confirming the obstruction, determining whether there is a single transition point or whether the obstruction is found in a closed loop, establishing the cause of the obstruction, and seeking signs of complications. Identifying signs of ischemia is important in the management of the patient because it enables patients at higher risk of poor outcomes after conservation treatment who could benefit from early surgical intervention to avoid greater morbidity and mortality associated with strangulation and ischemia of the obstructed bowel loop.

[Selective intra-arterial embolization in spontaneous rupture of hepatocarcinoma]. / Embolización selectiva intraarterial en ruptura espontánea de hepatocarcinoma.

We present the case of a patient with no previous history of liver disease, who required urgent medical care due to dizziness and hypotension. A diagnosis of hemoperitoneum was made by means of ultrasound and fine needle aspiration. The hemoperitoneum source was the spontaneous rupture of a liver tumor whose CT axial scan appearance was suggestive of hepatocarcinoma. The hemorrhage was controlled using intraarterial selective embolization. The rupture of a hepatocarcinoma is a surgical emergency with high mortality. Its early detection using an adequate diagnostic sequence, allows the surgeon to establish a therapeutic procedure as soon possible. Selective intraarterial embolization with alcohol has proved to be an effective procedure in the management of this kind of hemorrhage with a minimum surgical preparation, and allows further surgical interventions. Nevertheless mortality is still high due to the severity of the clinical entity.