Vascular complication after sacrospinous ligament fixation with uterine preservation.

AIM OF THE VIDEO: Sacrospinous ligament fixation (SSLF) is a minimally invasive transvaginal procedure for correcting apical prolapse. Amongst perioperative complications, life-threatening hemorrhage has a reported occurrence rate ranging from 0.2 % to 2 %. We present a case of arterial hemorrhage following SSLF and a multispecialty approach to its successful management. METHODS: The video demonstrates the development of an unexpected progressive postoperative hematoma following left-side sacrospinous hysterocolpopexy via the anterior approach, despite minimal intraoperative bleeding. The mechanism of formation of the hematoma could have been laceration of an aberrant vaginal branch of the inferior vesical artery secondary to pulling the anchor which is tied off at the cervix after closure. To treat these patients effectively, it is essential for the surgeon to make a timely diagnosis, and in our patient, embolization of the inferior vesical artery provided a safe and effective treatment for the pelvic hemorrhage that eliminated the need for an invasive surgical intervention. CONCLUSION: Life-threatening bleeding is a rare complication of transvaginal SSLF. Pelvic vessel embolization can provide an effective, minimally invasive alternative to surgical re-exploration.

Intrapericardial teratoma diagnosed on CT.

Intrapericardial teratomas are rare tumors which usually present in infancy. These tumors may be life-threatening because of the associated large pericardial effusion and cardiac compression. Here we present a case of intrapericardial teratoma which presented with cardiac tamponade in a neonate and was diagnosed using multidetector spiral computed tomography. The imaging features, clinical presentation, and differential diagnosis of this seldom-encountered entity are discussed.

Unusual presentations of midgut volvulus with the whirlpool sign.

OBJECTIVE: The purpose of this series was to emphasize the varied presentations of midgut volvulus from neonatal life to well into adulthood and to evaluate the role of the whirlpool sign on sonography in diagnosing this condition. METHODS: A retrospective search of all midgut volvulus cases diagnosed in the radiology department of a 1500-bed general hospital between February 2002 and July 2005 was done. Eight patients with surgically confirmed midgut volvulus were found, all of whom had undergone sonography as the initial screening investigation. RESULTS: Eight patients, with ages ranging from 9 days to 32 years (mean age, 11.8 years), had undergone sonography for varied conditions, including bilious and nonbilious vomiting, vague abdominal pain, epigastric lumps, weight loss, features mimicking appendicitis, and pancreatitis. In all patients, the diagnosis of midgut volvulus was made on the basis of the clockwise whirlpool sign on sonography. Subsequently, 4 patients underwent upper gastrointestinal series, and contrast-enhanced computed tomography was done in 6 cases. Surgical confirmation of the diagnosis was obtained in all cases. Two patients were taken for surgery on the basis of only sonographic findings. CONCLUSIONS: Midgut volvulus can also appear much beyond the neonatal age group with a variety of clinical presentations, making the clinical diagnosis in such patients very difficult, if not impossible. Identification of the clockwise whirlpool sign on sonography is an accurate way of diagnosing this condition, which can preclude the need for further investigations and can allow prompt surgical intervention.