Placental site trophoblastic tumor: A rare case with an unusual presentation / Philippine Journal of Obstetrics and Gynecology

@#We present a rare case of a 23‑year‑old female with intraperitoneal hemorrhage from uterine rupture as an uncommon presentation of placental site trophoblastic tumor (PSTT) after spontaneous abortion. A high index of suspicion with this clinical presentation and the use of appropriate diagnostic tools to arrive at a diagnosis can go a long way in decreasing the adverse outcome of this disease. The histopathological findings and immunohistochemical staining were helpful armamentaria for the confirmation of PSTT. The patient was successfully managed with primary hysterectomy and postoperative chemotherapy.

An analysis of relaparotomy in operative obstetrics

Background: Relaparotomy in obstetrics following caesarean section or laparotomy is associated with high morbidity and mortality and hence, considered as maternal near miss. Selection of patient for the same is crucial. This study was done to know the incidence, indications, the risk factors, intraoperative procedures and mortality rates of relaparotomy.Methods: A retrospective analysis of relaparotomy after primary obstetric surgery over a period of two and half years (June 2016 to November 2018) was done in department of obstetrics and gynecology of Rajendra Institute of Medical Sciences, Ranchi, India.Results: During study period 28 cases of relaparotomy (18 inhouse and 10 referred cases) were identified. The incidence of relaparotomy was 0.24%. Intraperitoneal hemorrhage (39.2%) was commonest indication of reoperations followed by PPH (17.8%), rectus sheath hematoma (14.8%) and burst abdomen (10.7%). Obstructed labor (32.1%) was commonest indication of primary cesarean. Hysterectomy was required in 8 cases (25.7%), evacuation of blood for hemoperitoneum was required in another 8 cases. Most cases of hemorrhage were reopened within 24 hours, whereas most case of the rectus sheath hematoma, burst abdomen, and broad ligament hematoma were reopened between 5-9 days.Conclusions: Relaparotomy is often a lifesaving procedure. Decision to perform and manage relaparotomy should always be done by senior obstetricians. Meticulous surgical techniques to secure hemostasis at time of primary surgery should be adopted. Strict postoperative vigilance, is of utmost importance for early detection of intraperitoneal hemorrhage and other complications requiring relaparotomy as timely intervention.

Hemoperitoneum Induced by Gastrointestinal Stromal Tumor Rupture of the Stomach / 대한소화기내시경학회지

Gastrointestinal stromal tumors (GIST) form a group of uncommon neoplasms originated from the pleuripotential mesenchymal cell. There is no final conclusion about accurate diagnosis and prognostic factors of GIST. Clinical presentation is not specific and intraperitoneal bleeding is a very rare complication. We report a case of a malignant GIST complicated by intraperitoneal hemorrhage, which was diagnosed by abdominal CT and EUS before operation. A subtotal gastrectomy was perfomed without complication. The patient is still alive without recurrence.

Hemoperitoneum Induced by Gastrointestinal Stromal Tumor Rupture of the Stomach / 대한소화기내시경학회지

Gastrointestinal stromal tumors (GIST) form a group of uncommon neoplasms originated from the pleuripotential mesenchymal cell. There is no final conclusion about accurate diagnosis and prognostic factors of GIST. Clinical presentation is not specific and intraperitoneal bleeding is a very rare complication. We report a case of a malignant GIST complicated by intraperitoneal hemorrhage, which was diagnosed by abdominal CT and EUS before operation. A subtotal gastrectomy was perfomed without complication. The patient is still alive without recurrence.

Spontaneous Intraperitoneal Hemorrhage in a Cervical Spinal Cord Injured Patient with Warfarin Therapy: A Case Report

Spontaneous intraperitoneal hemorrhage in the patient who has cervical spinal cord injury and been treated by warfarin, is rarely reported. In general, adverse drug reactions of warfarin were reported as bleeding, cutaneous microvascular thrombosis. A 46-year-old C4 tetraplegia (ASIA A) patient had been treated by warfarin for a treatment and prevention of pulmonary embolism after cardiopulmonary resuscitation. Suddenly, the patient complained dyspnea and abdominal distension and we noticed that his hemoglobin count was very much lower than usual. So, we had the patient to take the abdominal CT and find out there was a bleeding in intraperitoneal area. We did angiography trying to find out the bleeding focus but in vain. We concluded that it was the spontaneous intraperitoneal hemorrhage due to warfarin therapy and we finally made an improvement with the conservative treatment.