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.

Acute mesenteric ischaemia, a highly lethal disease with a devastating outcome.

BACKGROUND: Acute mesenteric ischaemia remains a serious condition requiring emergency, surgical management. The mortality rate still remains high, due to the unspecific and delayed diagnosis and ranges from 59% to 100%. Purpose of our study is to present our experience in the management of the disease. PATIENTS AND METHODS: This is a retrospective study of 61 patients treated surgically for acute mesenteric ischaemia, between 1988 and 2004. All patients underwent a laparotomy. 75% of the patients were operated within the first 24 hours and the rest within 48 hours. RESULTS: Superior mesenteric artery embolism occurred in 36 (59%), thrombosis in 21 (34%) and superior mesenteric vein thrombosis in 4 (7%) cases. In 49 (80%) cases, embolectomy or thrombectomy of the superior mesenteric artery with resection of the necrotic segment of the bowel was performed. Twelve cases (20%) were considered inoperable because of massive bowel necrosis. According to our study mortality and morbidity rate amounts to 75% and 80% respectively. No significant difference in the mortality rate between patients with embolism (75%) and thrombosis (76%) was found. However a significant increase of mortality rate was observed when the surgical intervention became afterwards the first 24-hour period. (72% versus 87%). Patients who underwent embolectomy or thrombectomy with bowel resection presented an improved survival rate compared with patients that underwent only bowel resection. (p = 0.019) CONCLUSIONS: Acute mesenteric ischaemia has the characteristics of a highly lethal condition and only early recognition and appropriate treatment can reduce the potential for a devastating outcome. The reduction of time interval from the beginning of symptoms up to the treatment remains the main critical important factor.

Coexistence of primary adrenal hydatid cyst and arterial hypertension: report of a case and review of the literature.

Adrenal gland has been considered as an atypical localization of Echinococcus Granulosus and the reported incidence is 0.5%. We report a rare case of coexistence of primary adrenal hydatid cyst and arterial hypertension. The patient underwent surgical excision of the adrenal gland with a slight improvement of blood pressure's regulation, requiring antihypertensive medication postoperatively. Till today, two cases of coexistence of primary adrenal hydatid cyst and arterial hypertension have been reported in the literature. However there is not clear and acceptable explanation about the relation and the involved pathogenetic mechanism. Resection of the cyst with conservation of the gland remains the optimal procedure. In case of haemorrhage or failure to perform a cystectomy, ablation of the entire adrenal gland including the cyst should be performed.

Thromboendarterectomy of the right common iliac artery in a patient with Marfan's syndrome and restoration with a new technique.

Marfan's syndrome is a rare hereditary disease of connective tissue, the surgical interest of which is in its propensity to the development of arterial aneurysms. We describe the case of a 40-year-old male who was admitted to our hospital because of thrombosis of the right common iliac artery and who was treated with a new technique: thromboendarterectomy of the right common iliac artery and covering of the artery with a synthetic graft, in order to avoid the risk of developing an aneurysm of the endarterectomised iliac artery. This is a new technique, here described for the first time in the international literature.