Hemoperitoneum after transperineal prostate biopsy / Hemoperitoneo tras biopsia prostática transperineal

Abstract Bleeding is the most common complication after a prostate biopsy, commonly self-limited. We describe a case of a patient who developed a hemoperitoneum after a transperineal prostate biopsy. A 65-year-old man with a history of prostate cancer diagnosed in 2016 by transurethral resection, with no further urologic control until 2020 when a rise in the serum prostate-specific antigen was diagnosed: 4.49 ng/ml. Pros tate digital rectal examination had no pathologic findings. Magnetic resonance imaging informed anequivocal lesion. A target transperineal fusion biopsy was performed, guided by ultrasound (US). Pre-surgical blood tests, including coagulogram, were normal. No immediate postoperative complications were recorded, and the patient was discharged. Hours later, he returned after a head concussion due to orthostatic hypotension and diffuse abdominal pain. Blood test showed a drop in hematocrit and hemoglobin values. Abdominal US and abdomi nopelvic computed tomography scan showed free intraperitoneal fluid and intraperitoneal hematic collection on top of the bladder of 104 × 86 mm with no active bleeding. The patient was admitted to intensive care unit due to persistent hypotension despite fluid restoration. He received a single-unit blood transfusion and had a good response to vasopressors. Abdominal pain decreased. He was finally discharged with stable hematocrit 48 hours after admission. Clinical management with no surgery or radiologic angio-embolization was required. We found no clear origin of the intraperitoneal bleeding, but we hypothesize that maybe the previous transurethral resection of the prostate made anatomical changes that facilitated blood passage to the abdominal cavity after puncture of branches from the inferior vesical artery.

Resumen La complicación más frecuente tras una biopsia prostática es el sangrado, generalmente autolimitado. Aquí describimos un caso de he moperitoneo secundario a dicho procedimiento. Hombre de 65 años con antecedentes de cáncer de próstata diagnosticado en 2016 por una resección transuretral de próstata, sin seguimiento urológico, consultó en 2020 por aumento del antígeno prostático específico: 4.49 ng/ml, asociado a tacto rectal normal y una resonancia multiparamétrica de próstata mostró una lesión indeterminada. Se realizó una biopsia prostática transperineal por fusión guiado por ecografía. Los análisis preoperatorios, incluido coagulograma, eran normales. No se registraron complicaciones intraquirúrgicas y se indicó el alta. Horas más tarde, consultó al hospital por hipotensión ortos tática y dolor abdominal difuso. Los análisis demostraron caída del hematocrito y hemoglobina. Una ecografía y posterior tomografía computada evidenciaron una colección supravesical de 104 × 86mm sin signos de sangrado activo. Se indicó internación en sala de cuidados intensivos debido a hipotensión refractaria a expansiones con requerimiento de vasopresores. Recibió una transfusión de glóbulos rojos. Por favorable evolución, 48 horas después del ingreso recibió el alta. En este caso, fue posible un manejo conservador, sin requerimiento de cirugía o embolización. Si bien no se encontró sitio exacto del sangrado, creemos que la resección transuretral previa podría haber generado cambios anatómicos que facilitaran el pasaje de sangre, posiblemente proveniente de ramas de la arteria vesical inferior a cavidad abdominal luego de la punción.

Comparison between laparoscopy and laparotomy in the management of ectopic pregnancy: a retrospective study

Background: Ectopic pregnancy is one of the most important causes of maternal mortality and morbidity in the first trimester of pregnancy. Objective of this study was to compare the safety, feasibility and advantage of laparoscopic approach with that of laparotomy in management of ectopic pregnancy.Methods: A retrospective study was conducted at two tertiary hospitals over a period of two years i.e.; from Aug 2015 to July 2017. Seventy-five patients who had histopathology confirmed tubal ectopic pregnancy were divided into two groups; laparoscopy (Group I, no-39) and laparotomy (Group II no-36). The main outcome measures were operative time, blood loss, and requirement of blood transfusion, requirement of analgesia and duration of hospital stay.Results: Seventy-five patients of ectopic pregnancy who were managed surgically were studied. There were 39 cases in laparoscopy group and 36 cases in laparotomy group. The incidence of ectopic pregnancy was 1.56% (out of all deliveries over 2 years). Ampullary region was the commonest site of ectopic pregnancy (74.6%). No difference was found in the two groups regarding age, site of tubal pregnancy, pre op Hb status and haemoperitoneum. Mean operating time was significantly shorter in the laparoscopy group 39 min (range 30 - 52 min) versus 50 min (range 40-60 min) in the laparotomy group. There was no difference between the groups regarding the treatment with blood products and perioperative complications. Hospital stay was significantly longer in the laparotomy group (3.5 days) as compared to 2 days in laparoscopy group. The duration of post op analgesia requirement was also longer in laparotomy group (4 days) as compared to 2 days in laparoscopy group.Conclusions: Laparoscopic management of ectopic pregnancy is a safe, effective and beneficial option in the hands of an experienced laparoscopic surgeon even in cases of massive haemoperitoneum. It definitely offers the advantage of shorter duration of surgery, faster post op recovery, shorter duration of hospital stays and lesser requirement of post op analgesia.

Spontaneous Hemoperitoneum in Pregnancy - A Rare Case

Introduction: Spontaneous haemoperitoneum is rare duringpregnancy but a life threatening complication. It is consideredidiopathic as the source of bleeding is not known.Case report: Presenting here a case of 20 years primigravidapatient who was taken up for caesarean section because ofpersistent foetal tachycardia. Patient had no significant pastor family history, had normal hemogram and coagulationprofile with all other normal investigations. Unexpectedlyintra-operatively hemoperitoneum was observed for which noidentifiable cause could be established.Conclusion: Though it is a rare entity but it can be lifethreatening. Shock and foetal distress have a much moregradual onset when the amount of bleeding is less severe.

Extramedullary hematopoiesis in ovary: a rare presentation of CML

Extramedullary hematopoiesis (EMH) is a rare phenomenon, and represents infiltration and proliferation of myeloid, erythroid, and megakaryocytic cells in non-bone marrow sites. Extramedullary hematopoiesis (EMH) is normal during fetal life, but after birth, the presence of EMH is considered to be abnormal.  EMH has been associated with CML (chronic myeloid leukaemia). Lymph node is the most common site of involvement, other sites being the abdomen (liver, spleen) and thorax (bone, mediastinum) but very rarely in the gynecological tract. Here authors report a case of a 20-year young female, a known case of CML who presented with abdominal pain with hemoperitonium, with negative urine pregnancy test. Initially hemorrhagic corpus luteal cyst was thought to be the cause of hemoperitonium and patient was taken for surgery wherein histopathology confirmed the diagnosis of extra medullary hematopoiesis of ovary. Women with CML when presents with hemoperitoneum, extramedullary hematopoiesis should be a differential diagnosis apart from rupture ectopic and other causes of spontaneous hemoperitoneum.  Patient was started on imatinib after diagnosis and is doing well.

Fatal spontaneous rupture of splenic artery aneurysm in third trimester pregnancy

@#Introduction: Unforeseen emergency in late pregnancy can be catastrophic and cause unexpected maternal and foetal demise. Moreover, lack of awareness and failure of prompt treatment raise mortality rate. Such fatalities warrant a forensic autopsy as it may raise redundant medico-legal concerns. Case Report: We report a case that revealed significant intra-abdominal haemorrhage at autopsy. The source of haemorrhage was at the spleen hilum and histology established rupture of splenic artery aneurysm. There was no associated obstetric cause found. Conclusion: Knowledge of spontaneous rupture of splenic artery aneurysm in late pregnancy is essential for monitoring maternal and foetal, morbidity and mortality. However, in the eventuality of death a comprehensive forensic autopsy is the only investigation to recognise such calamity and clear clinical confusion.

Ruptured Rudimentary Horn in Pregnancy at 20 Weeks with Previous Caesserian Section: A Case Report.

Pregnancy in a non communicating rudimentary horn is extremely rare and usually terminates in rupture during first or second trimester of pregnancy . Diagnosis of rudimentary horn and its rupture in a woman with previous caesarean section is difficult . It can be missed on routine ultrasound scan and is usually diagnosed after rupture. We report a case of rupture of rudimentary horn in a patient with previous caesarean section at 20 wks of gestation. Timely laprotomy revealed rupture of left rudimentary horn with massive haemoperitoneum. Excision of horn and blood transfusion saved the patient in a young female with pregnancy is reported for its unusual presentation.

Death due to isolated mesenteric vascular injury following blunt abdominal trauma: A case report.

Death due to isolated injury to small bowel mesentery following abdominal trauma is rare. It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury and that the mesentery of the small bowel is injured more frequently than that of the colon. Focal mesenteric infiltration associated with haemoperitoneum, particularly in the absence of solid organ injury, is highly suggestive of a mesenteric tear. In this report one such seat belt abdominal injury with subsequent mesenteric tear and bowel infarction with significant haemoperitoneum leading to death on the Operation table is being discussed. The main significance of this injury is delay and difficulty in diagnosis, especially when there is minimal signs and symptoms to warrant an exploratory laparotomy. Early detection and emergency surgical intervention when necessary are critical in improving the outcome of treatment.

Invasive Mole Presenting as Acute Haemoperitoneum

We report a case of invasive hydatidiform mole presenting as an acute primary haemoperitoneum. The patient presented with acute abdominal pain and signs of haemoperitoneum. Emergency laparotomy revealed a molar pregnancy perforating through the uterine fundus, resulting in massive haemoperitoneum. The serum beta chorionic gonado-tropin (ß-hCG) levels regressed spontaneously following evacuation of the molar pregnancy.