Subject(s)
Abdominal Pain/microbiology , Biological Products/adverse effects , Crohn Disease/drug therapy , Cryptococcus neoformans/isolation & purification , Fever/microbiology , Immunosuppressive Agents/adverse effects , Meningitis, Cryptococcal/microbiology , Meningoencephalitis/microbiology , Opportunistic Infections/microbiology , Abdominal Pain/diagnosis , Antifungal Agents/therapeutic use , Biopsy , Crohn Disease/diagnosis , Crohn Disease/immunology , Cryptococcus neoformans/immunology , Fever/diagnosis , Humans , Immunocompromised Host , Male , Meningitis, Cryptococcal/diagnosis , Meningitis, Cryptococcal/drug therapy , Meningitis, Cryptococcal/immunology , Meningoencephalitis/diagnosis , Meningoencephalitis/drug therapy , Meningoencephalitis/immunology , Middle Aged , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Opportunistic Infections/immunology , Predictive Value of Tests , Risk Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Abdominal paracentesis is a frequently employed diagnostic and therapeutic procedure for patients with refractory ascites, typically in patients with cirrhosis. It is generally regarded as a safe procedure with significant complications occurring in <1% of cases. Most hemorrhagic complications are due to abdominal wall trauma, during which clear evidence of active bleeding is usually visualized during the procedure. Delayed hemoperitoneum is a rare complication of large-volume paracentesis in which clinical evidence of active bleeding is typically absent until substantial blood loss has taken place (often several days to a week later), leading to an exceedingly high mortality rate. Herein we describe a case of delayed hemoperitoneum in a 55-year-old man with heart failure. This case emphasizes the importance of identifying patients who are at high risk for delayed hemoperitoneum as well as the need to closely monitor complete blood counts in the days following a large-volume paracentesis.
ABSTRACT
A 76 year old woman with bloody stools and symptomatic anemia presented to the Emergency Department approximately 2 wk after computed tomography (CT)-guided cryoablation to a 4.5 cm renal cell carcinoma on her left posterior kidney. The patient was initially prepped for a colonoscopy to view possible causes of lower gastrointestinal bleeding. However, the patient had a CT with PO contrast that revealed a variation of a renoalimentary fistula. The patient was subsequently brought to the operating room, and it was discovered that a colo-renal fistula had formed, with transmural perforation of the posterior descending colon. A left nephrectomy, left colectomy with colostomy and Hartmann's pouch was performed.
