Obstrucción intestinal secundaria a hematoma intramural espontáneo: Caso clínico / Bowel obstruction secondary to a spontaneous intramural hematoma. Report of one case

Spontaneous intramural hematoma (IMH) is an uncommon cause of bowel obstruction, generally secondary to trauma. Even rarer is the spontaneous hematoma, mainly described in anticoagulated patients. We report a 73-year-old female in anticoagulant therapy who presented with a bowel obstruction. A computed tomography (CT) of the abdomen showed a segmentary wall thickening of the distal jejunum, compatible with an IMH which obliterated the lumen and produced dilatation of the proximal bowel loops. Support management was initiated, achieving satisfactory evolution, allowing her discharge 12 days after admission.

Tratamiento mininvasivo de las complicaciones del traumatismo hepático cerrado / Minimally invasive management of blunt hepatic trauma complications

RESUMEN Antecedentes: el manejo no operatorio del traumatismo hepático cerrado es exitoso en el 95% de los pacientes hemodinámicamente normales. Las lesiones de alto grado presentan una tasa de complicaciones de hasta un 14%, y una mortalidad del 27% cuando requieren cirugía abierta. Material y métodos: estudio descriptivo de informe de casos. Resultados: 3 casos con traumatismo hepático de alto grado. "A": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, drenaje percutáneo de absceso hepático, recambio de catéter y CPRE, por fístula biliar persistente. "B": cirugía de control de daño inicial sin hepatectomía, drenaje percutáneo de absceso hepático y posterior recambio. "C": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, posterior drenaje percutáneo de absceso hepático y recambio de drenajes. No presentaron mortalidad. Conclusión: estos casos resumen la utilización de las diferentes modalidades del manejo del traumatismo hepático cerrado y la posibilidad del manejo mininvasivo de las complicaciones.

ABSTRACT Background: Nonoperative management of blunt hepatic trauma is successful in 95% of hemodynamically stable patients. The complication rate of high-grade injuries is 14% and mortality reaches 27% when they require open surgery. Material and methods: We conducted a descriptive study of case reports. Results: Three cases of high-grade hepatic trauma are reported. "A": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess, catheter replacement and ERCP due to persistent biliary fistula. "B": initial damage control surgery without liver resections, percutaneous drainage of liver abscess and catheter replacement. "C": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess and catheter replacement. None of the patients died. Conclusion: These cases summarize the use of different management modalities of blunt hepatic trauma and the possibility of minimally invasive management of the complications.

Surgical Repair of a Ruptured Giant Abdominal Aortic Aneurysm in a 16-Year-Old with Takayasu's Arteritis: Case Report and Etiological Review

Abstract Takayasu's arteritis is a type of primary systemic vasculitis that affects medium and large arteries, including the aorta and its main branches, as well as the pulmonary and coronary arteries. Although rare in children, it is the third most common vasculitis in the pediatric population, often with delayed diagnosis due to the nonspecific presentation of clinical symptoms in its initial phase. This is a case of a 16-year-old girl with a giant ruptured abdominal aortic aneurysm, who needed surgery on an emergency basis. The etiological aspects involved in aneurysms in young patients are also addressed.

Hematoma espontáneo del ligamento ancho luego de un parto vaginal normal: reporte de caso / Spontaneous hematoma of the broad ligament after a normal vaginal delivery: case report / Hematoma espontâneo do ligamento largo após um parto vaginal normal: apresentação de um caso clínico

La hemorragia posparto es una de las principales causas de muerte materna con una elevada morbimortalidad. El hematoma del ligamento ancho representa una entidad inusual, de difícil diagnóstico y alta sospecha clínica. Se presenta el caso clínico de una paciente con un hematoma del ligamento ancho espontáneo luego de un parto vaginal. Se optó por una conducta activa con laparotomía y antibioticoterapia obteniendo una buena evolución con egreso hospitalario a los 30 días. Se realiza la discusión del caso luego de revisar la bibliografía disponible.

Postpartum hemorrhage is one of the main causes of maternal death with high morbidity and mortality. The broad ligament hematoma represents an unusual entity, difficult to diagnose, in which clinical suspicion is determinant. The clinical case of a patient with a spontaneous broad ligament hematoma after a vaginal delivery is presented. An active management with laparotomy and antibiotic therapy was chosen, obtaining a satisfactory evolution with hospital discharge at 30 days. The case is discussed, after reviewing the available bibliography.

A hemorragia pós-parto é uma das principais causas de morte maternal com alta morbidade e mortalidade. O hematoma do ligamento largo representa uma entidade incomum, de difícil diagnóstico e alto suspeita clínica. A presentamos o caso clínico de uma paciente com hematoma espontâneo do ligamento largo, após parto vaginal. Foi optada por conduta ativa com laparotomía e antibioticoterapia, obtendo boa evolução com alta hospitalar após 30 dias. O caso é discutido depois de revisar a bibliografia disponível.

Left ventricular dissecting hematoma caused by tissue stabilizer

Abstract Coronary artery bypass grafting is a commonly performed procedure for coronary revascularization. We describe the successful management of left ventricular dissecting hematoma, caused by the tissue stabilizer, while performing off-pump coronary artery bypass graft procedure.

Sinonasal organising haematoma - a little known entity / Hematoma nasossinusal em organização - uma entidade pouco conhecida

Abstract Introduction: Sinonasal organising haematoma is a recently described, rare, benign inflammatory condition, which closely resembles malignancy in its clinical presentation. Objective: To describe the clinical features of organising haematoma and to review the evolution of surgical options successfully used. Methods: A retrospective review of charts of all patients with a histopathological diagnosis of sinonasal organising haematoma was performed. Results: Six (60%) of the 10 patients were male with a mean age of 47.4 years. All patients had unilateral disease with recurrent epistaxis as the presenting symptom. Maxillary sinus was the most commonly involved sinus. There was no history of trauma in any of the patients. Hypertension (80%) was the most commonly associated comorbidity. Contrast-enhanced CT scan of the paranasal sinuses showed heterogeneous sinus opacification with/without bone erosion. Histopathological examination was diagnostic. Complete endoscopic excision was done in all patients resulting in resolution of the disease. Conclusion: Awareness of this relatively new clinical entity and its evaluation and treatment is important for otolaryngologists, maxillofacial surgeons and pathologists alike. Despite the clinical picture of malignancy, histopathological features of benign disease can safely dispel such a diagnosis.

Resumo Introdução: Hematoma nasossinusal em organização é uma condição inflamatória benigna rara, recentemente descrita, que se assemelha a lesões malignas em sua apresentação clínica. Objetivo: Descrever as características clínicas do hematoma em organização e analisar a evolução das opções cirúrgicas usadas com sucesso. Método: Foi feita a revisão retrospectiva dos prontuários de todos os pacientes com diagnóstico histopatológico de hematoma nasossinusal em organização. Resultados: Seis (60%) dos 10 pacientes eram do sexo masculino, com média de 47,4 anos. Todos os pacientes apresentavam doença unilateral com epistaxe recorrente como sintoma de apresentação. O seio maxilar era o mais comumente afetado. Não havia histórico de trauma em qualquer dos pacientes. Hipertensão (80%) foi a comorbidade mais comumente associada. A tomografia computadorizada dos seios paranasais com contraste mostrou opacificação heterogênea do seio com/sem erosão óssea. O exame histopatológico foi diagnóstico. A excisão endoscópica completa foi feita em todos os pacientes, resultou na resolução da doença. Conclusão: A conscientização a respeito dessa entidade clínica relativamente nova e sua avaliação e tratamento são importantes para os otorrinolaringologistas, cirurgiões buco-maxilo-faciais e patologistas. Apesar do quadro clínico de malignidade, as características histopatológicas da doença benigna podem descartar com segurança esse diagnóstico.

Hematoma disecante del esófago a causa de abdomen agudo quirúrgico / Dissecting Hematoma of the Esophagus due to Acute Surgical Abdomen

RESUMEN El hematoma disecante del esófago es poco frecuente y solo existen pocos casos registrados en la literatura. Generalmente, se presenta después de un trauma asociado a procedimientos endoscópicos o de forma espontánea. Se describe clínicamente con la triada clásica de dolor torácico, odinofagia, disfagia o hematemesis. Se ha relacionado con un aumento rápido de la presión intraesofágica o un mecanismo de deglución anómala particularmente en presencia de trastornos de la hemostasia. La mayoría de los pacientes tienen un buen pronóstico pues resuelven con tratamiento conservador. Presentamos el caso clínico de un paciente con diagnóstico de hematoma disecante de esófago con ruptura a cavidad abdominal que causó hemoperitoneo importante. Se realiza una revisión del tema(AU)

ABSTRACT Dissecting hematoma of the esophagus is a rare condition and there are only few cases reported by the literature. Generally, it occurs after trauma associated with endoscopic procedures or spontaneously. It is described clinically with the classic triad of chest pain, odynophagia, dysphagia or hematemesis. It has been associated with a rapid increase in intra-esophageal pressure or an abnormal swallowing mechanism particularly in the presence of haemostasis disorders. Most patients have a good prognosis because they obtain a solution by means of a conservative treatment. We present the clinical case of a patient with a diagnosis of dissecting hematoma of the esophagus with rupture to the abdominal cavity causing significant hemoperitoneum. A review of the subject is carried out(AU)

Correlation between C-reactive Protein and Morphology of Aortic Intramural Hematoma on CT Angiography / 中国医学科学杂志(英文版)

Objectives To investigate the morphologic characteristics of intramural hematoma (IMH) on CT angiography (CTA), and evaluate the possible correlation of serum C-reactive protein (CRP) with morphologic characteristics of IMH. Material and Methods Forty-two patients who were initially diagnosed as IMH by aortic CTA and also had serum CRP examination on the same day of CTA were enrolled in this retrospective study, including 30 males and 12 females, with the mean age of 61 ± 14 years old. The volumetric CT data were retrospectively processed and analyzed on post-processing workstation. Based on the thickness of IMH and the length-area curve, the cross-sectional area of true lumen and total vessel were measured, the hematoma-vessel ratio (HVR) was calculated. Imaging characteristics were compared between patients who had pathological elevated CRP (> 0.8 mg/dl) and those did not. Spearman correlation analyses of CRP level and morphological characteristics of IMH were performed, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic validity of CRP. Results Of all 42 IMH patients, the mean serum CRP was 3.94 ± 4.71 mg/dl, and the mean HVR was 46.7%± 14.2%. HVR in patients with elevated CRP was significantly higher than those with normal CRP (49.7% ± 15.0% vs. 40.7% ± 10.5 %, P = 0.030). HVR was mildly correlated with CRP in all patients (r =0.48, P < 0.001). CRP levels differed neither between patients with Stanford type A and B (P = 0.207), nor between patients with and without intimal disruption (P = 0.230). To discriminate HVR > 47% (the mean value), the area under curve (AUC) were 0.700 (95% CI: 0.535-0.865) for CRP at a cutoff point of 3.55 mg/dl, with a sensitivity of 54.5% and a specificity of 90.0%. Conclusion CRP was mildly correlated with the severity of cross-sectional hematoma area of IMH, but not with Stanford types and the presence of intimal disruption.

Hematoma esofágico espontáneo: a propósito de un caso / Spontaneous esophagic hematoma: about a case

El dolor torácico es un motivo frecuente de consulta en los servicios de urgencias, sin embargo, el hematoma esofágico es una causa muy poco frecuente. Se manifiesta más frecuentemente en mujeres de edad media y avanzada, con una triada de dolor torácico súbito, disfagia u odinofagia y hematemesis. Presentamos un caso de una mujer de 89 años con antecedentes de hipertensión arterial en tratamiento, usuaria de antihipertensivos y aspirina, con una historia de dos días de evolución de dolor retroesternal, sensación febril, disnea y tos productiva secundario a un hematoma esofágico.

Thoracic pain is a frequent reason for consultation in the emergency department, however, esophageal hematoma is a very rare cause. It manifests more commonly in women of middle and advanced age, with a triad of sudden chest pain, dysphagia or odynophagia and hematemesis. We present a case of a 89 years old female patient, with a history of arterial hypertension in treatment, user of antihypertensive drugs and aspirin with a two day history of retrosternal pain, febrile sensation, dyspnea and productive cough due to a esophageal hematoma.

Hematoma espontáneo del recto anterior abdominal en paciente anticoagulado / Spontaneous rectus abdominis hematoma in anticoagulated patient

El hematoma espontáneo de pared abdominal es una patología infrecuente según la literatura. Sin embargo, en los últimos años esta tendencia ha cambiado debido al aumento del número creciente de indicaciones para anticoagulación, así como a la aparición de nuevos tratamientos anticoagulantes y al incremento en el número de pacientes que las precisan. Presentamos un paciente varón, de 80 años portador de marcapasos por fibrilación auricular bloqueada y prótesis mitral mecánica anticoagulado con acenocumarol, que presenta un cuadro de dolor abdominal agudo secundario hematoma espontáneo de la pared abdominal. Se trató de forma conservadora, mediante reversión de la anticoagulación y administración de analgesia con evolución favorable. Con este caso clínico ilustramos un tipo de patología que debemos tener presente, como parte del diagnóstico diferencial del dolor abdominal agudo en el paciente anticoagulado. La mayoría de los pacientes respondieron positivamente con tratamiento conservador(AU)

The abdominal wall spontaneous hematoma is an uncommon condition, according to the literature. In recent years, however, this tendency is changing due to the increased number of indications for anticoagulation, and the emerging of new anticoagulant treatment, and the increase in the number of patients who need it. Male patient, 80, carrier of a pacemaker for blocked atrial fibrillation and mechanical mitral prosthesis, anticoagulated with acenocoumarol, who presents acute abdominal pain secondary to spontaneous hematoma of the abdominal wall. He was treated conservatively, reversing anticoagulation and administering analgesia, with favorable evolution finally. This clinical case shows a type of pathology to keep in mind, as part of the differential diagnosis of acute abdominal pain in the anticoagulated patient, who, in most cases, respond to conservative treatment(AU)

Hematoma retroperitoneal como presentación de cáncer testicular / Retroperitoneal hematoma debut as testicular cancer

Resumen Introducción: El hematoma retroperitoneal (HR) es una enfermedad infrecuente con una elevada morbimortalidad, siendo complicado cuando se presenta con dolor y shock hipovolémico. Presentación del caso: Paciente del sexo masculino, de 20 años de edad, sin antecedentes mórbidos. Ingresa en Urgencias por dolor abdominal en el flanco izquierdo, irradiado a dorso y testículo ipsilateral, de 6 h de evolución, de inicio súbito e intensidad severa; el paciente está pálido, hemodinámicamente estable, sin signos de irritación peritoneal. Se solicita pielo-TC por sospecha de litiasis ureteral, que muestra un extenso HR, probable aneurisma aórtico roto. Una angio-TC informa HR adyacente y anterior a psoasilíaco izquierdo, de20 × 11 × 8,5 cm, volumen 972 cc, adenopatías retroperitoneales paraaórticas bilaterales sangrantes y múltiples nódulos pulmonares bilaterales indicativos de diseminación secundaria. Se constata testículo derecho duro, de tamaño normal, eco testicular con masa sólida quística, que indica de lesión orgánica. Discusión: Trauma y enfermedad tumoral son las principales causas de HR. El cáncer testicular suele presentarse en pacientes jóvenes, requiriendo una pronta derivación y estudio debido a su rápida progresión. En nuestro caso, el HR fue un hallazgo imagenológico, destacando que el sangrado de un conglomerado de adenopatías es anecdótico.

Abstract Introduction: Retroperitoneal hematoma (RH) is a rare disease with high morbidity, being complicated when presented with pain and hypovolemic shock. Case report: Male, 20 years old, no morbid history. Arrive to Emergency Service for abdominal pain in the left flank radiating to the back and ipsilateral testis, 6 h of evolution, sudden onset, high intensity; pacient pale, hemodynamically stable without signs of peritoneal irritation. Pielo-TC is requested on suspicion of ureteral stones showing extensive RH, likely ruptured aortic aneurysm. CT angiography reports RH and adjacent preceding left iliopsoas, 20 × 11 × 8.5 cm, volume 972 cc, retroperitoneal bleeding bilateral para-aortic lymphadenopathy and multiple bilateral pulmonary nodules suggestive of secondary spread. Hard right testicle with normal size, testicular ultrasound pointing solid cystic mass, suggestive of organic lesion. Discussion: Trauma and tumor pathology are the main causes of RH. Testicular cancer usually occurs in young patients, requiring early referal and study because of its rapid progression. In our case, the HR was an imaging finding, highlighting that the bleeding of a cluster of lymph nodes is anecdotal.

Intraparenchymal hematoma as a late complication of retrograde intrarenal surgery

ABSTRACT A 34 year-old woman was admitted to our hospital with left flank pain. A non-contrast enhanced computerized tomography (NCCT) revealed a 1.5x2cm left proximal ureter stone. Patient was scheduled for ureterorenoscopy (URS) and stone removal. She was submitted to retrograde intrarenal surgery (RIRS). At the postoperative 1st day, the patient began to suffer from left flank pain. A NCCT was taken, which revealed a subcapsular hematoma and perirenal fluid. The patient was managed conservatively with intravenous fluid, antibiotic and non-steroidal anti-inflammatory drug therapy and was discharged at the postoperative 6th day. Two weeks after the discharge the patient was admitted to emergency department with severe left flank pain, palpitation and malaise. KUB (kidney-ureter-bladder) radiography showed double-J stent (DJS) to be repositioned to the proximal ureter. Patient was evaluated with contrast enhanced CT which revealed an 8cm intraparenchymal hematoma/abscess in the middle part of the kidney. A percutaneous drainage catheter was inserted into the collection. The percutaneous drainage catheter and the DJS were removed at the 10th day of second hospitalization. RIRS surgery is an effective and feasible choice for renal stones with high success and acceptable complication rates. However, clinician should be alert to possible complications.

Diagnóstico prenatal de trombohematoma subcoriónico masivo (mola de Breus) / Prenatal diagnosis of massive subchorionic thrombohematoma (Breus mole)

El trombohematoma subcoriónico masivo o Mola de Breus, por ser éste el autor que lo describió por primera vez en abortos, es un hematoma subcorial de al menos 1 cm de grosor que ocupa al menos, el 50% de la superficie fetal. Suele asociar una alta morbimortalidad fetal y perinatal, en forma de abortos, retraso del crecimiento intrauterino, muerte intrauterina, desprendimiento de placenta normalmente inserta y recién nacidos de bajo peso, generalmente pretérminos. Esta entidad debe diferenciarse de otros procesos que pueden asentar bajo la placa corial, hacia la superficie fetal como: corioangioma, depósitos de fibrina y trombosis del espacio intervelloso. Se han intentado postular mecanismos que pudieran causar dicha circunstancia, sin que por el momento podamos definir factores de riesgo médicos que claramente predispongan a padecer esta entidad. El objetivo de describir estos dos casos clínicos diagnosticados en 2013 es resaltar que, gracias a la sospecha ecográfica de un trombohematoma subcoriónico masivo, podemos estudiar la pieza de placenta y membranas tras la finalización de la gestación, con lo que obtendríamos así la confirmación anátomo-patológica, de otra manera esta información podría perderse.

The massive subchorionictrombo hematoma or Breus's Mola, this was the author who first described it in miscarriages, is a subchorionic hematoma at least 1 cm in thickness which occupies at least 50% of the fetal surface. Usually associated with high fetal and perinatal morbidity and mortality, as miscarriages, intrau-terine growth retardation, stillbirth, placental abruption and low birth weight, preterm generally. This entity should be distinguished from other processes that can seat under the chorionic plate to the fetal surface as chorioangioma, fibrin deposition and thrombosis intervillous space. They have tried to apply mechanisms that could cause such a circumstance, but for now we don't define medical risk factors that predispose clearly suffer from this entity. In order to describe these two cases diagnosed in 2013 is to emphasize that thanks to the sonographic suspicion of a massive subchorionic trombohematoma, can study the piece of placenta and membranes after the end of pregnancy, so it would provide pathologic confirmation, otherwise this information could be lost.

Time-dependent low-field MRI characteristics of canine blood: an in vitro study

This study was conducted to assess time-sensitive magnetic resonance (MR) changes in canine blood using low-field MR. Arterial and venous blood samples were collected from eight healthy beagle dogs. Samples were placed in 5-mL tubes and imaged within 3 hours of collection at 1 day intervals from day 1 to day 30. The following sequences were used: T1-weighted (T1W), T2-weighted (T2W), fluid-attenuated inversion recovery (FLAIR), short tau inversion recovery (STIR), and T2-star gradient-echo (T2*-GRE). Visual comparison of the images revealed that four relatively homogenous blood clots and twelve heterogeneous blood clots developed. The margination of the clot and plasma changed significantly on day 2 and day 13. On day 2, heterogeneous blood clots were differentiated into 2 to 3 signal layers in the T2W, T1W, and especially the STIR images. Hypointense signal layers were also detected in the blood clots in STIR images, which have T2 hypo, FLAIR hypo, and T1 hyper intense signals. In all images, these signal layers remained relatively unchanged until day 13. Overall, the results suggest that hematomas are complex on low-field MRI. Accordingly, it may not be feasible to accurately characterize hemorrhages and predict clot age based on low-field MRI.