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1.
Fertil Steril ; 112(6): 1190-1192, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31843096

RESUMO

OBJECTIVE: To describe the clinical characteristics and laparoscopic findings of a very uncommon presentation of a patient with endometriosis. DESIGN: Video presentation of case report (Canadian Task Force classification III). (The institutional review board of the Hospital Naval Pedro Mallo, Buenos Aires, Argentina, has ruled that approval was not required for the publication of this case report.) SETTING: Hospital. PATIENT(S): Thirty-two-year-old woman with endometriosis presenting with hemorrhagic ascites. INTERVENTION(S): We demonstrate the laparoscopic appearance of the peritoneal organs in the presence of massive hemoperitoneum and encapsulating peritonitis and also describe the diagnosis and management options of an uncommon clinical presentation of endometriosis. The patient is a 32-year-old woman, gravida 0, who presented with abdominal pain and ascites. Initially, she underwent exploratory laparotomy with drainage of 5 liters of ascites and excision of endometrial peritoneal implants. She then presented 4 months later with sudden worsening abdominal pain and distention, weight gain, bloating, and shortness of breath. A diagnostic laparoscopy was performed with the findings of over 10 liters of dark hemoperitoneum and diffuse pelviperitonitis with loose necrotic, easy to remove, dense peritoneal tissue. Patient was started on triptorelin acetate with great response. MAIN OUTCOME MEASURE(S): Resolution of the symptomatology secondary to hemorrhagic peritonitis. RESULT(S): Clinical improvement of symptomatology of a patient with endometriosis and hemorrhagic ascites. CONCLUSION(S): Endometriosis can have different clinical presentations. Endometriosis should be a differential diagnosis in women of reproductive age presenting with massive hemorrhagic ascites. Hemorrhagic ascites, considered an exceedingly rare clinical course of endometriosis, represents a challenge to the surgeon who is unfamiliar with this condition. Bilateral oophorectomy is the definitive treatment, but conservative therapy is indicated for women of childbearing age. Diagnostic laparoscopy with drainage of hemoperitoneum is a feasible option to obtain a pathology-confirmed diagnosis in patients presenting with hemoperitoneum secondary to pelvic endometriosis. Awareness of this condition will prevent unnecessary aggressive resection, as is commonly performed when the condition is confused with ovarian cancer.


Assuntos
Endometriose/complicações , Hemoperitônio/etiologia , Fibrose Peritoneal/etiologia , Adulto , Endometriose/diagnóstico por imagem , Endometriose/cirurgia , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/cirurgia , Humanos , Laparoscopia , Fibrose Peritoneal/diagnóstico por imagem , Fibrose Peritoneal/cirurgia , Recidiva , Resultado do Tratamento , Pamoato de Triptorrelina/uso terapêutico
2.
Pan Afr Med J ; 34: 45, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762912

RESUMO

Hemocholecyst is defined as a hemorrhage into the gallbladder. It is a rare complication of anticoagulant therapies which can progress to spontaneous rupture of the gallbladder with hemorrhagic shock. We report the case of a 75-year old hypertensive, dyslipidemic man with hypertensive heart disease initially hospitalized for left hemiplegia. The patient received antiplatelet and anticoagulant therapy with low molecular weight heparin (LMWH) as prevention strategy. After 5 days of treatment the patient developed hemocholecyst and hemoperitoneum, confirmed by angio-abdominal computerized tomography scan in emergency assessment. The patient underwent cholecystectomy, hemostasis of the gallbladder fossa and evacuation of the hemoperitoneum.


Assuntos
Anticoagulantes/efeitos adversos , Colecistectomia/métodos , Doenças da Vesícula Biliar/diagnóstico por imagem , Hemoperitônio/diagnóstico por imagem , Idoso , Anticoagulantes/administração & dosagem , Doenças da Vesícula Biliar/induzido quimicamente , Doenças da Vesícula Biliar/terapia , Hemoperitônio/induzido quimicamente , Hemoperitônio/terapia , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Masculino , Ruptura Espontânea , Tomografia Computadorizada por Raios X
3.
Am J Case Rep ; 20: 1492-1496, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597909

RESUMO

BACKGROUND First described in 1863 by French surgeon Victor-Auguste-François Morel-Lavallee, the Morel-Lavallee lesion (MLL) is a closed traumatic soft-tissue degloving injury. These lesions most commonly occur following motor vehicle collisions (MVCs). The pathophysiology stems from a shearing force that causes separation of the soft tissue from the fascia underneath, which disrupts the vasculature and lymphatic vessels that perforate between the tissue layers. Timely diagnosis and treatment are imperative, as a delayed diagnosis can lead to complications. However, at present there is no universally accepted treatment algorithm. CASE REPORT A 60-year-old morbidly obese woman presented after being involved in an MVC. She complained of abdominal tenderness in the right lower quadrant, with no evidence of peritonitis. Cross-sectional imaging revealed hemoperitoneum and a traumatic posterior abdominal wall/lumbar hernia on the right, with multiple contusions in the subcutaneous abdomen. The patient was taken to the operating room and underwent an exploratory laparotomy that revealed a large abdominal Morel-Lavallee lesion (MLL) along with a traumatic abdominal wall hernia (TAWH). There was also a mesenteric avulsion injury with an associated ileocecal injury. The patient underwent resection of the involved bowel, with primary anastomosis, debridement of the abdominal wall degloving injury, and expectant management for the hernia defect. She recovered from the injuries and was doing well when followed up in the clinic, with follow-up to repair the hernia in the near future. CONCLUSIONS More research is needed to provide surgeons with evidence-based standardized therapies for dealing with these rare pathologies to ensure optimal patient outcomes.


Assuntos
Traumatismos Abdominais/etiologia , Acidentes de Trânsito , Desenluvamentos Cutâneos/etiologia , Hérnia Ventral/etiologia , Traumatismos Abdominais/diagnóstico por imagem , Desenluvamentos Cutâneos/diagnóstico por imagem , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hérnia Ventral/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Tomografia Computadorizada por Raios X
4.
Korean J Parasitol ; 57(4): 405-409, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31533407

RESUMO

In malaria, splenic rupture is a serious complication potentially leading to death. Subcapsular hemorrhage of spleen is thought to be an impending sign of splenic rupture; however, the characteristics of subcapsular hemorrhage are not well known. We report 3 cases of subcapsular hemorrhage of the spleen in vivax malaria, with varying degrees of severity. Case 1 showed subcapsular hemorrhage without splenic rupture, was treated by antimalarial drug without any procedure. The healing process of the patient's spleen was monitored through 6 computed tomography follow-up examinations, over 118 days. Case 2 presented subcapsular hemorrhage with splenic rupture, treated only with an antimalarial drug. Case 3 showed subcapsular hemorrhage with splenic rupture and hypotension, treated using splenic artery embolization. They all recovered from subcapsular hemorrhage without any other complications. These 3 cases reveal the process of subcapsular hemorrhage leading to rupture and a potentially fatal outcome. The treatment plan of subcapsular hemorrhage should be determined carefully considering the vital signs, changes in hemoglobin, and bleeding tendency.


Assuntos
Hemorragia/etiologia , Malária Vivax/complicações , Esplenopatias/etiologia , Adulto , Angiografia , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemorragia/diagnóstico por imagem , Humanos , Masculino , Baço/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X
5.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31527205

RESUMO

Simple hepatic cysts are usually asymptomatic but can rarely result in life-threatening complications such as haemoperitoneum secondary to rupture. A 70-year-old woman with known simple hepatic cyst presented with acute chest pain and dyspnoea. The initial diagnosis was pulmonary embolism, and anticoagulation was commenced. However, she subsequently collapsed with haemodynamic instability. CT revealed a large hepatic cyst haematoma with rupture into the peritoneal cavity. The patient underwent emergency laparotomy, haemostasis and partial deroofing of the cyst. Retrospective review of CT scans suggested that the bleed had begun on presentation but was exacerbated by anticoagulation. To our knowledge, this is the first report of haemorrhagic hepatic cyst associated with acute anticoagulation. We discuss several important clinical lessons including cyst rupture as a possible cause of chest pain, the need for careful review of imaging and the choice of anticoagulation in patients with known simple hepatic cyst.


Assuntos
Anticoagulantes/efeitos adversos , Hemoperitônio/etiologia , Ruptura Espontânea/induzido quimicamente , Idoso , Dor no Peito , Cistos/diagnóstico por imagem , Cistos/cirurgia , Diagnóstico Diferencial , Dispneia , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/cirurgia , Humanos , Hepatopatias/diagnóstico por imagem , Hepatopatias/cirurgia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia
6.
BMJ Case Rep ; 12(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302618

RESUMO

Colonoscopy is a common procedure that gastroenterologists perform on a daily basis. It is considered a low-risk outpatient procedure and patients can be discharged on the same day after the procedure. Colonoscopy has become more feasible with the increasing application of standard screening for colon cancer and diagnostic procedures for large intestinal disease. There are reported possible risk factors of splenic rupture during the procedure. However, splenic injury after colonoscopy is considered a rare complication and less than 100 cases have been reported in international literature. Interestingly, this is the first case report demonstrating systemic lupus erythematosus (SLE) as a possible risk factor leading to splenic rupture post-colonoscopy. Failure to recognise this possibility even in its rarity can lead to life-threatening complications. We present a case of an acute splenic rupture with massive intraperitoneal bleeding after colonoscopy in a patient with SLE.


Assuntos
Colonoscopia/efeitos adversos , Lúpus Eritematoso Sistêmico/complicações , Ruptura Esplênica/etiologia , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Esplenectomia , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/cirurgia
7.
Clin Imaging ; 58: 1-4, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31207444

RESUMO

Major bleeding, typically due to laceration of abdominal wall arteries or venous varices, is a rare but serious complication of paracentesis. We report a case of major bleeding post paracentesis to evidence that a sequence of 1) customized post processing of computed tomographic angiography data for periprocedural guidance, followed by 2) transcatheter cyanoacrylate glue embolotherapy, is the optimal treatment of this complication.


Assuntos
Hemoperitônio/diagnóstico por imagem , Paracentese/efeitos adversos , Testes Imediatos , Idoso , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Embolização Terapêutica/métodos , Hemoperitônio/etiologia , Hemoperitônio/terapia , Humanos , Doença Iatrogênica , Masculino
8.
Forensic Sci Med Pathol ; 15(4): 658-662, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31228009

RESUMO

Placenta percreta is the abnormal invasion of the placenta through the myometrium and serosa of the uterus. It is the most invasive of the placenta accreta spectrum followed by placenta increta. This paper presents a case of a maternal and fetal death in the second trimester due to rupture of the uterus at the site of placenta percreta in a C-section scar. Postmortem MRI showed a large hemoperitoneum and thinning of the anterolateral uterine wall. Internal examination revealed two liters of blood in the abdomen and rupture of the anterolateral uterine wall at the site of placenta percreta in a previous C-section scar. Placenta percreta is a rare complication of pregnancy, however, it is becoming more common with the increasing rate of C-section, the most common and significant risk factor.


Assuntos
Cicatriz/patologia , Morte Fetal/etiologia , Placenta Acreta/patologia , Ruptura Uterina/patologia , Adulto , Cesárea , Evolução Fatal , Feminino , Hemoperitônio/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Gravidez , Segundo Trimestre da Gravidez
10.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015234

RESUMO

Splenic laceration and rupture are common phenomena among patients in a traumatic setting, especially in blunt trauma. Much more unusual, however, is splenic injury without a known insult. Several case reports and studies have been written about spontaneous splenic injury in patients with viral, haematological or malignant processes. Recently, we encountered a patient with a spontaneous splenic rupture and no preceding trauma apart from semielective cardioversion. Operative decision-making was complicated by the fact that he required systemic anticoagulation for atrial fibrillation. He eventually underwent splenectomy and made an uneventful recovery.


Assuntos
Flutter Atrial/diagnóstico , Cardioversão Elétrica/efeitos adversos , Ruptura Esplênica/etiologia , Idoso , Flutter Atrial/diagnóstico por imagem , Flutter Atrial/fisiopatologia , Flutter Atrial/terapia , Diagnóstico Diferencial , Ecocardiografia Transesofagiana/métodos , Hemoperitônio/diagnóstico por imagem , Humanos , Masculino , Baço/diagnóstico por imagem , Baço/lesões , Esplenectomia/métodos , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
11.
Rev. cuba. cir ; 58(1): e634, ene.-mar. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1093153

RESUMO

RESUMEN El tumor estromal gastrointestinal es el tumor mesenquimático más frecuente y se caracteriza por la expresión de un receptor de factor de crecimiento tirosina kinasa, CD117 c-KIT/CD 117. Se diferencia del resto de los tumores mesenquimáticos en que no expresa esta proteína. Alrededor del 70 - 80 por ciento de estos tumores son benignos, la mayoría se localizan en estómago e intestino delgado (> 90 por ciento). Los tumores estromal gastrointestinal malignos son generalmente de gran tamaño (> 5 cm), con índice mitótico alto y pueden dar metástasis a hígado y peritoneo. El tratamiento es la resección quirúrgica. Presentamos una paciente con 65 años de edad que acudió al cuerpo de guardia por sufrir caída de sus pies y quejarse de dolor abdominal. Como datos positivos al examen físico se constató palidez cutáneo mucosa y los complementarios de urgencia. El ultrasonido y la tomografía axial computarizada informaron líquido libre en cavidad con cifras de hemoglobina en 6,4 g/L. La punción abdominal constató sangre roja que no coagulaba. Se realizó laparotomía exploratoria encontrando hemoperitoneo y gran tumoración en cara anterior del antro gástrico, con otra pequeña en la porción alta del cuerpo; se realizó resección local con bordes libres de tumor y se suturaron los bordes gástricos. El resultado de la biopsia informó tumor del estroma gastrointestinal de células fusiformes con bajo índice mitótico, que midió 13 x 8 x 8 cm, con marcada angiogénesis y zonas de calcificación(AU)


ABSTRACT Gastrointestinal stromal tumor is the most frequent mesenchymal tumor and is characterized by expression of a tyrosine kinase growth factor receptor, CD117 c-KIT/CD 117. It is different to the rest of mesenchymal tumors in that it does not express this protein. About 70-80 percent of these tumors are benign. The majority are located in the stomach and small intestine (more than 90 percent). Malignant gastrointestinal stromal tumors are usually large (over 5 cm in size), with a high mitotic index, and can metastasize to the liver and peritoneum. The treatment is surgical resection. We present a 65-year-old patient who came to the emergency room due to having fallen on her own feet and complaining of abdominal pain. As positive data to the physical examination, mucous and skin whitening and the emergency complement tests were analyzed. Ultrasound and CT scan reported free fluid in cavity with hemoglobin values at 6.4 g/L. The abdominal puncture showed red blood that did not clot. The exploratory laparotomy showed a hemoperitoneum and a large tumor in the anterior face of the gastric antrum, with a small one in the upper portion of the body; local resection with tumor-free borders was performed and the gastric borders were sutured. The result of the biopsy reported a spindle cell gastrointestinal stromal tumor with a low mitotic index, measuring 13x8x8 cm, with marked angiogenesis and areas of calcification(AU)


Assuntos
Humanos , Masculino , Idoso , Tumores do Estroma Gastrointestinal/patologia , Margens de Excisão , Hemoperitônio/diagnóstico por imagem , Laparotomia/métodos
12.
Med Ultrason ; 21(1): 77-82, 2019 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-30779835

RESUMO

Uterine leiomyomas are common benign uterine tumors but by contrast, their acute complications are very rare. We present an unusual case of 38-year-old woman that came to the emergency department with acute abdominal pain. The ultrasound revealed hemoperitoneum, a uterus with two intramural fibroids and a tender inhomogeneous pelvic mass that seems to connect with the uterus. Computer tomographic (CT) examination raised the suspicion of a degenerated fibroid and hemoperitoneum. Emergency laparotomy was performed: the hemoperitoneum was determined by a degenerated fundal subserosalfibroid. Myomectomy was subsequently carried out. Even though this condition is extremely rare, every clinician has to bear in mind that acute fibroid complications can be a potential cause of acute abdominal pain that requires immediate surgery. The imagistic tools, ultrasound and CT are extremely helpful for the diagnosis.Due to its relative rarity in the second part of the article we have performed a review of the existing literature regarding the acute complications of fibroid torsion.


Assuntos
Hemoperitônio/etiologia , Leiomioma/complicações , Anormalidade Torcional/complicações , Neoplasias Uterinas/complicações , Adulto , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/cirurgia , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Tomografia Computadorizada por Raios X , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/cirurgia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia , Útero/diagnóstico por imagem , Útero/cirurgia
14.
Rev. chil. cir ; 71(1): 70-74, feb. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-985382

RESUMO

Resumen Introducción: La colecistitis hemorrágica es una complicación poco frecuente de la colecistitis aguda con una alta mortalidad. Materiales y Método: Paciente con dolor abdominal en hipocondrio derecho e ictericia. Los exámenes de laboratorio y ultrasonido hepatobiliar mostraron datos sugestivos de colecistitis aguda; durante su estancia hospitalaria presenta deterioro de su estado general, realizándose tomografía computarizada mostrando imágenes sugestivas de colecistitis hemorrágica y hemoperitoneo. Resultados: Laparotomía de urgencia, corroborando los hallazgos tomográficos y resolviéndose satisfactoriamente con la colecistectomía. Discusión: El diagnóstico de colecistitis hemorrágica es difícil ya que sus manifestaciones clínicas de inicio no difieren de la colecistitis aguda, por lo que la sospecha clínica y el adecuado estudio de imagen son importantes para su detección. Conclusión: A pesar que la colecistitis hemorrágica con perforación y hemoperitoneo es una patología muy poco común, de diagnóstico confuso, es importante establecer la realización de una tomografía computarizada abdominal con contraste endovenoso en pacientes con sospecha de colecistitis aguda grave.


Introduction: Hemorrhagic cholecystitis is a rare complication of acute cholecystitis with a high mortality. Materials and Method: Patient with abdominal pain in right hypochondrium and jaundice. Laboratory analyses and hepatobiliary ultrasound suggested acute cholecystitis, however, general worsening during hospital stay was observed and a computed tomography was performed, revealing hemorrhagic cholecystitis and hemoperitoneum. Results: Urgent laparotomy which confirmed tomographic results, successfully solved with cholecystectomy. Discussion: Hemorrhagic cholecystitis diagnosis is difficult as symptoms at the beginning do not differ from acute cholecystitis, then, clinical suspicion and a correct image analysis is crucial for its detection. Conclusion: Although, perforated hemorrhagic cholecystitis with hemoperitoneum is a very rare entity with confused diagnosis, an abdominal computed tomography with intravenous contrast is very important in any patient with severe acute cholecystitis suspicion.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Colecistite/cirurgia , Colecistite/diagnóstico por imagem , Hemorragia/cirurgia , Tomografia Computadorizada por Raios X , Dor Abdominal , Doença Aguda , Hemoperitônio/cirurgia , Hemoperitônio/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Laparotomia/métodos
18.
BMJ Case Rep ; 11(1)2018 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-30567155

RESUMO

A 57-year-old man who was hypotensive at induction of anaesthesia was having intermittent episodes of hypotension after an uncomplicated and relatively bloodless open inguinal hernia repair of a large left-sided hernia . His hypotension was responsive to small fluid boluses. He did not show any tachycardia, had no abdominal pain, no signs of bruising or bleeding in his abdomen, flanks, or scrotum. Remained clinically well and alert throughout until being transferred to a tertiary centre. Eventually became haemodynamically unstable approximately 6 hours postoperatively. CT angiogram showed a large haemoperitoneum with active bleeding. Diagnostic laparoscopy revealed an actively bleeding inferior epigastric artery which was stopped. The patient received 2 units of red blood cells and made a full recovery.


Assuntos
Artérias Epigástricas , Hemoperitônio/diagnóstico , Hérnia Inguinal/cirurgia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia
19.
Perit Dial Int ; 38(6): 455-456, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30413637

RESUMO

Hemoperitoneum is a well-recognized complication in female peritoneal dialysis (PD) patients of childbearing age. Bloody effluent is commonly of minor nature, presenting during menstruation or midcycle, resolving after a few rapid exchanges without a need for further intervention. One must remain vigilant, however, and consider a broader differential diagnosis when hemoperitoneum is persistent or severe, as it indicates a serious and potentially life-threatening etiology. We report 2 episodes of hemoperitoneum in a PD patient occurring more than 1.5 years apart, with different underlying etiologies. The more dramatic second episode was due to a ruptured ectopic pregnancy, a condition which had not been reported as a cause of hemoperitoneum in dialysis patients to date and requires a high index of suspicion and prompt surgical intervention.


Assuntos
Hemoperitônio/etiologia , Cistos Ovarianos/diagnóstico por imagem , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Gravidez Ectópica/diagnóstico por imagem , Adulto , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/cirurgia , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Cistos Ovarianos/complicações , Cistos Ovarianos/cirurgia , Diálise Peritoneal Ambulatorial Contínua/métodos , Gravidez , Complicações na Gravidez/terapia , Gravidez Ectópica/cirurgia , Medição de Risco , Ruptura Espontânea/complicações , Ruptura Espontânea/cirurgia , Resultado do Tratamento
20.
Fertil Steril ; 110(5): 925-931.e1, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30316439

RESUMO

OBJECTIVE: To report a case of primary hepatic pregnancy complicated by acute hemoperitoneum that was treated with a laparoscopic approach. DESIGN: Case report and review of the literature. SETTING: Obstetrics and gynecology unit of a university hospital. PATIENT(S): A 37-year-old pregnant woman who presented with vaginal bleeding. INTERVENTION(S): Diagnosis by abdominal ultrasound and computed tomography. MAIN OUTCOME MEASURE(S): Patient recovery after minimally invasive laparoscopic surgery and monitoring. RESULT(S): A hepatic ectopic pregnancy complicated by hemoperitoneum was diagnosed. The hepatic pregnancy was surgically removed via laparoscopy through a retroperitoneal approach, and the patient's human chorionic gonadotropin level was subsequently monitored. The patient's postoperative course was uneventful, and the serum human chorionic gonadotropin level dropped to zero. CONCLUSION(S): Only 39 cases of hepatic pregnancy have been reported in the literature, making it an exceptional category among abdominal pregnancies. Hepatic localization should be ruled out in cases of unknown pregnancy location. Abdominal ultrasound has a key role detecting hepatic localization and excluding other abdominal implantation sites. Laparoscopic surgery represents a feasible approach for the treatment of first trimester hepatic pregnancies.


Assuntos
Laparoscopia/métodos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/cirurgia , Adulto , Feminino , Hemoperitônio/complicações , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/cirurgia , Humanos , Laparoscopia/instrumentação , Gravidez , Resultado do Tratamento
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