Rectus sheath haematoma after laparotomy.

Case (1) - A 32 years old, P2+1 lady was referred to Central Women's Hospital (CWH), Yangon with shock for 18 hours following laparotomy for ruptured ectopic pregnancy at Tike Gyi Hospital. Resuscitated measures were carried out. The urgent re-laparotomy was done with the diagnosis of intra-abdominal bleeding. The operative findings were rectus sheath haematoma (about 100ml), haemoperitoneum (about 300 ml) and intact left tubal ligation stump. The source of bleeding was from inferior epigastric vessels. The bleeding point was secured and abdominal and sub-rectus sheath drains were inserted. At post operative period, her condition deteriorated and she had acute renal failure (ARF) and disseminated intravascular coagulopathy (DIC). She was referred to renal medical unit on post-operative day 2 for peritoneal dialysis. However, she expired on the next day. Case (2) - A 28years old, G2 P1+0 lady was admitted to CWH, Yangon for previous one scar with twins pregnancy at 37 week gestation. Elective Caesarean Section was done at 38 week gestation with the indication of previous one scar with twins pregnancy. At 4 hours after operation, she had shock with clinical features of intra-abdominal bleeding and abdominal wound haematoma. Urgent laparotomy was undertaken and the operative findings revealed the 9x10 cm right sub-rectus sheath haematoma with active bleeding from right inferior epigastric vessels and 1000 ml of haemoperitoneum. Her post-operative period was uneventful and she was discharged on post-operative day 10.

Rupture uterus: Carelessness or negligence.

Uterus is the most unique reproductive organ in humans. Rupture uterus is a hazardous complication of pregnancy and labour, and carries high risk both to the mother and the foetus. Uterine rupture during third trimester of pregnancy is a rare complication but if there is rupture and not suspect with in time may have fatal out come for the mother, foetus or both. In this modern medical era, prenatal check-up, advanced non invasive diagnostic facilities and subsequent treatment does not produce such life threatening complication. Rupture uterus cases are observed due to either carelessness of the patient or negligence of the doctor. Three cases of rupture uterus are discussed in this paper of full term pregnancy, had complete antenatal visits with all investigations including ultrasonography and attended the hospital well in time before death. Most cases of rupture uterus are preventable with good ante-natal and intra-partum care, and proper identification of high-risk cases.

Experience in Diagnosis and Treatment of Bleeding Complications in Severe Acute Pancreatitis by TAE / 华中科技大学学报（医学）（英德文版）

The experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis (SAP) by transcatheter arterial embolization was summarized. The clinical data of 19 SAP patients complicated with intra-abdominal bleeding in our hospital from Jan. 2000 to Jan. 2003 were analyzed retrospectively and the therapeutic outcome of TAE was evaluated statistically. The results showed that the short-term successful rate of hemostasis by TAE was 89.5 % (17/19), the incidence of re-bleeding after TAE was 36.8 % (7/19) and the successful rate of hemostatis by second TAE was 71.4 % (5/7). It was concluded that the intra-abdominal bleeding in SAP was mainly caused by the rupture of erosive/infected pseudoaneurysm. Mostly, the broken vessels were splenic artery and gastroduodenal artery. In terms of emergence hemostatis, TAE is the most effective method. Surgical hemostasis is necessary if hemostasis by TAE is failed or re-bleeding occurs after TAE.