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ABSTRACT Introduction: hepatocellular adenoma - AHC - is a rare benign neoplasm of the liver more prevalent in women at reproductive age and its main complication is hemorrhage. In the literature, case series addressing this complication are limited. Methods: between 2010 and 2022, 12 cases of bleeding AHC were attended in a high-complexity university hospital in southern Brazil, whose medical records were retrospectively evaluated. Results: all patients were female, with a mean age of 32 years and a BMI of 33kg/m2. The use of oral contraceptives was identified in half of the sample and also half of the patients had a single lesion. The mean diameter of the largest lesion was 9.60cm and the largest lesion was responsible for bleeding in all cases. The presence of hemoperitoneum was documented in 33% of the patients and their age was significantly higher than the patients who did not have hemoperitoneum - 38 vs 30 years, respectively. Surgical resection of the bleeding lesion was performed in 50% of the patients and the median number of days between bleeding and resection was 27 days. In only one case, embolization was used. The relation between ingrowth of the lesions and the time, in months, was not obtained in this study. Conclusion: it is concluded that the bleeding AHC of the present series shows epidemiological agreement with the literature and may suggest that older patients trend to have hemoperitoneum more frequently, a fact that should be investigated in further studies.
RESUMO Introdução: o Adenoma Hepatocelular - AHC - é uma neoplasia benigna rara do fígado associada a mulheres com idade reprodutiva. Sua principal complicação é o sangramento,mas as séries de casos direcionadas a esta intercorrência são limitadas. Métodos: entre os anos de 2010 e 2022 foram registrados 12 casos de AHC sangrante em um hospital universitário de alta complexidade no sul do Brasil, cujos prontuários foram retrospectivamente avaliados. Resultados: todos os pacientes eram do sexo feminino, com média de idade de 32 anos e de IMC de 33kg/m2. O uso de anticoncepcionais foi identificado em metade da amostra e também metade das pacientes apresentava lesão única. O diâmetro médio da maior lesão foi de 9,60cm e a maior lesão foi responsável pelo sangramento em todos os casos. Hemoperitôneo foi documentado em 33% das pacientes e a idade destas foi significativamente maior do que as pacientes que não apresentaram hemoperitôneo - 38 vs 30 anos, respectivamente. A ressecção cirúrgica da lesão sangrante foi realizada em 50% das pacientes e a mediana de dias entre o sangramento e a ressecção foi de 27 dias. Em apenas um caso foi lançado mão da embolização da lesão. Não se demonstrou correlação entre a taxa de redução das lesões e o passar dos meses, nos casos em que foi adotado tratamento conservador. Conclusão: conclui-se que aos AHC sangrantes da presente série apresentam concordância epidemiológica com a literatura e pode sugerir que as pacientes com maior idade tendem a apresentar hemoperitôneo mais frequentemente, fato que deve ser investigado em maiores estudos.
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Objective:To explore the risk factors of abdominal hemorrhage (AH) in patients with severe acute pancreatitis (SAP) and its impact on outcome.Methods:The clinical data of 231 SAP patients admitted to Diagnosis and Treatment Center for SAP of Guizhou Province from January 1, 2015 to December 31, 2019 were retrospectively analyzed. These patients were divided into AH group and non-AH group. The general information, etiology, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, organ failure, complications, interventions, bleeding time, bleeding site and outcome were compared between the two groups. Binary multivariate Logistic regression analysis was used to explore the risk factors of AH in SAP patients and whether the time and location of AH were risk factors affecting the outcome.Results:A total of 231 patients were enrolled in the analysis, including 198 patients without AH and 33 with AH (14.3%). There was no significant difference in gender, age or etiology between the two groups. The scores of APACHE Ⅱ and SOFA in AH group were significantly higher than those in non-AH group [APACHE Ⅱ score: 18 (12, 24) vs. 13 (9, 19), SOFA score: 9 (5, 15) vs. 5 (4, 11), both P < 0.01]. The incidences of acute kidney injury (AKI), gastrointestinal dysfunction, coagulation disorders, necrotic infection, pseudocyst and gastrointestinal fistula in AH group were significantly higher than those in non-AH group (66.7% vs. 47.0%, 36.4% vs. 7.1%, 18.2% vs. 6.6%, 66.7% vs. 9.1%, 66.7% vs. 34.3%, 9.1% vs. 1.5%, all P < 0.05). The proportions of requiring mechanical ventilation (MV) and surgical intervention in AH group were significantly higher than those in non-AH group (69.7% vs. 43.4, 48.5% vs. 14.6%, both P < 0.01). The length of intensive care unit (ICU) stay and hospital stay in AH group were significantly longer than those in non-AH group [length of ICU stay (days): 13 (8, 19) vs. 7 (3, 16), length of hospital stay: 24 (13, 40) vs. 17 (12, 24), both P < 0.01], and the hospital mortality was significantly higher (60.6% vs. 9.6%, P < 0.01). Multivariate Logistic regression analysis showed that APACHE Ⅱ score [odds ratio ( OR) = 1.157, 95% confidence interval (95% CI) was 1.030-1.299, P = 0.014], infectious necrosis ( OR = 12.211, 95% CI was 4.063-36.697, P < 0.01), pseudocyst ( OR = 3.568, 95% CI was 1.238-10.283, P = 0.019) and requiring MV ( OR = 0.089, 95% CI was 1.354-6.625, P = 0.007) were the risk factors of AH in SAP patients. In 33 AH patients, there was no significant difference in hospital mortality between early hemorrhage (occurred within 2 weeks of onset) and late hemorrhage (occurred 2 weeks after onset) groups [66.7% (8/12) vs. 57.1% (12/21), P > 0.05]. All 4 patients in the unspecified bleeding site group died during hospitalization; half or more patients died in the pseudocyst/abscess bleeding (14 cases), mesenteric/intestinal bleeding (13 cases) and gastric variceal bleeding (2 cases) groups (7 cases, 8 cases and 1 case respectively), and there were significant differences among the groups ( P < 0.05). Multivariate Logistic regression analysis showed that neither bleeding time ( OR = 0.989, 95% CI was 0.951-1.028, P = 0.574) nor bleeding site ( OR = 2.009, 95% CI was 0.822-4.907, P = 0.126) was the risk factor of death in patients with SAP combined with AH. Conclusions:Both early and late bleeding significantly increased the length of hospital stay and mortality of SAP patients. APACHE Ⅱ score, infectious necrosis and pseudocyst were the risk factors of AH in SAP patients. Neither bleeding time nor bleeding site was the risk factors of death in patients with SAP combined with AH. However, it still needed to be confirmed by a large sample clinical study.
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Objective To analyze the clinical efficacy of transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization in the treatment of hepatic artery thrombosis (HAT) after liver transplantation. Methods Clinical data of 9 patients diagnosed with HAT after liver transplantation undergoing transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization were retrospectively analyzed. The incidence of HAT and clinical efficacy of thrombolytic therapy were summarized. The incidence of thrombolysis related complications and clinical prognosis were evaluated. The thrombolytic therapy procedures of typical cases were analyzed. Results HAT was diagnosed at 1-66 d after liver transplantation with a median time of 10 d. The formation site of HAT was found at the anastomosis of the main hepatic artery in 8 cases and at the right branch in 1 case. Upon diagnosis, 9 patients received transcatheter hepatic arterial thrombolysis combined with splenic arterial embolization in emergency. The hepatic artery was open during operation in 4 cases and treated with postoperative thrombolytic therapy with indwelling catheter in 3 cases. The opening time for inwelling catheter was 72-96 h. The total successful rate was 7/9. The thrombolysis related complication of abdominal hemorrhage occurred in 1 case after surgery. Three cases died, including 2 cases of liver failure and infection, and 1 case of biliary ischemia and systemic infection at 70 d after interventional therapy. Conclusions Hepatic arterial thrombolysis combined with splenic arterial embolization is an efficacious treatment for HAT after liver transplantation, which can serve as the optimal therapy for patients who are unable to undergo secondary liver transplantation.
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Spontaneous intra-abdominal hemorrhages are uncommon in hemophilic patients. They can cause complications in patients with severe hemophilia, and are associated with a high mortality rate. To date, there is no guideline for the management of intra-abdominal hemorrhage in patients with hemophilia. Management of intra-abdominal hemorrhage ranges from conservative treatment to emergent embolization or surgery. We describe two children with hemophilia A, who were successfully treated non-operatively by administering coagulation factor concentrates and embolization, and were later discharged from the hospital. We emphasize the role of an active approach in the evaluation and management of intra-abdominal hemorrhage without any surgical intervention.
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Child , Humans , Blood Coagulation Factors , Hemophilia A , Hemorrhage , MortalityABSTRACT
Spontaneous intra-abdominal hemorrhages are uncommon in hemophilic patients. They can cause complications in patients with severe hemophilia, and are associated with a high mortality rate. To date, there is no guideline for the management of intra-abdominal hemorrhage in patients with hemophilia. Management of intra-abdominal hemorrhage ranges from conservative treatment to emergent embolization or surgery. We describe two children with hemophilia A, who were successfully treated non-operatively by administering coagulation factor concentrates and embolization, and were later discharged from the hospital. We emphasize the role of an active approach in the evaluation and management of intra-abdominal hemorrhage without any surgical intervention.
Subject(s)
Child , Humans , Blood Coagulation Factors , Hemophilia A , Hemorrhage , MortalityABSTRACT
Objective To investigate the cause,prevention and treatment of intra-abdominal hemorrhage after liver transplantation. Methods Clinical data of 82 patients undergoing liver transplantation were retrospectively analyzed. All participants were divided into the intra-abdominal hemorrhage (n =12)and control groups (n =70). Preoperative parameters including age,model for end-stage liver disease (MELD)score,prothrombin time (PT),prothrombin time international normalized ratio (PT-INR),fibrinogen (FIB),activated partial thromboplastin time (APTT),platelet (Plt) were statistically compared between two groups. Intraoperative hemorrhage volume,cold ischemia time of donor liver, anhepatic phase time and operation time were also compared between two groups. Postoperatively,the mortality rate was compared between two groups. Results Among 82 patients,1 2 (1 5%)presented with intra-abdominal hemorrhage and required twice surgical hemostasis. In the intra-abdominal hemorrhage group,4 cases (33%)died,and 8 (1 1%)died in the control group. No statistical significance was documented between two groups (P>0. 05 ). Age,MELD score,PT-INR, FIB,APTT and PLT did not significantly differ between two groups (all P>0. 05 ). Compared with patients in the control group,those in the intra-abdominal hemorrhage group yielded significantly more blood loss intraoperatively,longer operation time and longer cold ischemia time of donor liver (all P<0. 05 ). Anhepatic phase time did not significantly differ between two groups (P>0. 05 ). Conclusions After liver transplantation,intra-abdominal hemorrhage is associated with longer cold ischemia time of donor liver,more intraoperative blood loss and longer operation time. In order to decrease the incidence of postoperative intra-abdominal hemorrhage,coagulation function should be completely corrected prior to surgery and the surgical skills should also be enhanced.
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Se describen 6 casos clínicos de mujeres con embarazo ectópico intersticial de menor incidencia entre las formas de la variedad tubárica, tratadas en el Hospital Ginecoobstétrico Docente "Tamara Bunke Bider" de Santiago de Cuba. Esta entidad clínica ha mostrado un incremento inusual en la población asistida (7,59 %) que resulta, 2,57 veces mayor que la media (2,95 %) del intervalo notificado en la bibliografía médica (1,9-4 %). Se exponen las historias individuales de las pacientes en forma tabulada y, asimismo, los autores ofrecen sus consideraciones a propósito de estas experiencias.
Six case reports of women with interstitial ectopic pregnancy of lower incidence among the forms of tubaric variety treated in "Tamara Bunke Bider" Teaching Gynecological and Obstetrical Hospital from Santiago de Cuba are described. This clinical entity has shown an unusual increase in the assisted population (7.59%), which is 2.57 times higher than the mean (2.95%) of the interval notified in the medical literature (1.9-4%). Tabulated individual medical records of the patients are exposed and, likewise, the authors offer their considerations concerning these experiences.
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OBJECTIVE To determine the prevalence of post-operative infections in patients who underwent damage control laparotomy(DCL) with abdominal packing and to identify the risk factors,mortality and predominant pathogens.METHODS A retrospective study of postoperative infections and microbiology in patients who underwent abdominal packing as an adjunct of DCL to control coagulopathic hemorrhage over a 5 year period(Feb 2002-Feb 2007) were performed.RESULTS A total of 26 patients were studied.Pneumonia/lower respivatory tract infection was the prominant type of infection(57.7%),followed by bacteremia(50.0%),urinary tract infection(15.4%) and wound infection(15.4%).Of the 244 organisms isolated from various sites,the most frequently isolated bacteria were Pseudomonas aeruginosa(27.0%),Staphylococcus species(15.6%),Acinetobacter baumannii(13.9%),and Klebsiella species(11.1%).No statistical correlation was found between positive packs and postoperative infection(P=0.10) or death(P=1.00).Multivariate regression analysis revealed that pre-existing abdominal infection(OR=22.4,P=0.02) and increased number of surgical procedures(OR=3.69,P=0.05) were the independent risk factors for post-operative infections.CONCLUSIONS Patients who undergo DCL with packing have a high incidence of postoperative infections.Pathogens and distribution are same as acquired infections.Pre-existing abdominal infection and increased number of surgical procedures are the independent risk factors for postoperative infections in these patients.
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The clinical data of 67 patients underwent orthotopic liver transplantation, including 4 cases of early intra abdominal hemorrhage after orthotopic liver transplantation, were analyzed retrospectively.Anastomotic liver artery hemorrhage was found in 2 cases, hemorrhage of IVC in 1 case and hemorrhage of right adrenal gland in 1 case. All the 4 patients were correctly dignosed and successfully treated by operation in time. It suggests that the early intra abdominal hemorrhage after orthotopic liver transplantation is mostly due to surgical technique. The improvement of surgical technique,correct diagnosis and timely operation are very important for the treatment of intra abdominal hemorrhage.