[Right primary iliac artery rupture during transurethral resection of bladder tumor]. / Rotura de la arteria ilíaca primitiva derecha durante la resección transuretral de un tumor vesical.

Injury to a large-caliber artery transurethral resection of a bladder tumor is a rare but serious complication. It is important that an anesthesiologist be able to detect such an injury, in order to include it among the many differential etiological diagnoses for shock. A 75-years-old man reported hematuria. An ultrasound image of the bladder showed many neoformations consistent with a diagnosis of multiple bladder neoplasms, and transurethral endoscopy was performed under subarachnoid anesthesia. Acute hypotension, bradycardia and shock developed 30 minutes into the procedure. The diagnosis was hypovolemic shock due to acute intraoperative hemorrhage, and exploratory laparotomy revealed an opening in the common iliac artery. The rupture was sutured. In spite of administration of crystalloids, colloids, blood products and vasoactive agents, a second operation was required due to hemodynamic instability. The patient died in the intensive care unit.

[Splenectomy in a patient with beta thalassemia intermedia and severe hemolytic anemia]. / Esplenectomía en paciente con betatalasemia intermedia y anemia hemolítica grave.

A 36-year-old woman with beta thalassemia intermedia suffered a hemolytic crisis secondary to Epstein-Barr virus infection. She was given a transfusion of phenotypically compatible blood. However, severe hemolysis persisted (with hemoglobin levels around 4 g/dl) in spite of gamma globulin and corticosteroid administration. Emergency therapeutic splenectomy was performed. We discuss intraoperative management in situations of severe anemia, concluding that it is possible to survive significant decreases in hemoglobin concentration with cardiocirculatory reserve and respiration intact, maintaining normal volume.