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Ruptured Corpus Luteal Cyst: Prediction of Clinical Outcomes with CT
이명석,문민환,우현식,성창규,전혜원,이택상 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.4
Objective: To evaluate the determinant pretreatment CT findings that can predict surgical intervention for patients suffering from corpus luteal cyst rupture with hemoperitoneum. Materials and Methods: From January 2009 to December 2014, a total of 106 female patients (mean age, 26.1 years; range, 17–44 years) who visited the emergency room of our institute for acute abdominal pain and were subsequently diagnosed with ruptured corpus luteal cyst with hemoperitoneum were included in the retrospective study. The analysis of CT findings included cyst size, cyst shape, sentinel clot sign, ring of fire sign, hemoperitoneum depth, active bleeding in portal phase and attenuation of hemoperitoneum. The comparison of CT findings between the surgery and conservative management groups was performed with the Mann-Whitney U test or chi-square test. Logistic regression analysis was used to determine significant CT findings in predicting surgical intervention for a ruptured cyst. Results: Comparative analysis revealed that the presence of active bleeding and the hemoperitoneum depth were significantly different between the surgery and conservative management groups and were confirmed as significant CT findings for predicting surgery, with adjusted odds ratio (ORs) of 3.773 and 1.318, respectively (p < 0.01). On the receiver-operating characteristic curve analysis for hemoperitoneum depth, the optimal cut-off value was 5.8 cm with 73.7% sensitivity and 58.6% specificity (Az = 0.711, p = 0.004). In cases with a hemoperitoneum depth > 5.8 cm and concurrent active bleeding, the OR for surgery increased to 5.786. Conclusion: The presence of active bleeding and the hemoperitoneum depth on a pretreatment CT scan can be predictive warning signs of surgery for a patient with a ruptured corpus luteal cyst with hemoperitoneum.
진단적 대장내시경 후 비장 동맥 파열로 인한 혈복강 1예
강여울 ( Yeo Wool Kang ),이종윤 ( Jong Yoon Lee ),이종훈 ( Jong Hoon Lee ) 대한소화기학회 2020 대한소화기학회지 Vol.76 No.5
Colonoscopy is a safe and extremely popular diagnostic and therapeutic procedure. The most common complications are bleeding and perforation. Hemoperitoneum is a rare complication after a colonoscopy and is usually associated with splenic injury or solid organ pathology. This is potentially serious and can be life threatening. With the increasing number of colonoscopies performed, there has also been an increasing trend in reports of rare complications, such as pneumothorax, pneumomediastinum, appendicitis, small bowel perforation, septicemia, mesenteric tear, retroperitoneal abscess, and hemoperitoneum. This paper reports a unique case of hemoperitoneum after a recent colonoscopy without a splenic rupture or intra-abdominal abnormality, or external trauma. Most hemoperitoneum occurs within 48 hours after the inciting colonoscopy. In the present case, however, hemoperitoneum appeared 10 days after the colonoscopy. This case emphasizes that physicians should consider hemoperitoneum in a differential diagnosis of abdominal pain in patients after colonoscopy. (Korean J Gastroenterol 2020;76:246-250)
Case Report : Spontaneous Rupture of a Gastric Stromal Tumor Causing Hemoperitoneum
( Gun Wha Lee ),( Young Seok Kim ),( Sang Gyune Kim ),( Bong Min Ko ),( Moon Sung Lee ),( Kyu Seok Cho ),( Seong Jin Park ),( Hee Kyung Kim ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.2
We describe a 39-year-old man with spontaneous rupture of a gastric stromal tumor causing hemoperitoneum. Ultrasonography showed a large mass broadly abutting the stomach and liver. Computed tomography demonstrated a heterogeneous enhanced mass arising from the stomach and focal perforation of the tumor with hemoperitoneum; endoscopic ultrasonography showed an exophytic heterogeneous mass originating from the gastric muscle layer. Angiography revealed that the right gastric artery was the main artery supplying the tumor. A gastric stromal tumor with bloody fluid in the peritoneal cavity was seen at the laparotomy. The tumor was excised completely, and subsequent histological and immunohistochemical studies indicated that it was a gastric stromal tumor. We report a relatively rare case of gastric stromal tumor causing hemoperitoneum due to spontaneous rupture of the tumor. (Gut Liver 2010;4:278-282)
( Sang Seokg Seong ),( Chung Il Joung ) 대한내과학회 2010 The Korean Journal of Internal Medicine Vol.25 No.4
Thrombocytopenia is included in the classification criteria for systemic lupus erythematosus (SLE). However, severe thrombocytopenia causing spontaneous bleeding is rare. Here, we describe a 22-year-old woman who presented with spontaneous hemoperitoneum as the first manifestation of SLE. Laboratory findings compatible with SLE included positive antinuclear antibody and a false-positive venereal disease research laboratory. Symptoms suggesting the disease were not prominent early after admission, but headache and seizures that developed on the 3rd day of admission led to the diagnosis of SLE. The brain magnetic resonance imaging and angiography findings were compatible with the neuropsychiatric manifestations of SLE. High-dose steroid and monthly intravenous cyclophosphamide pulse therapy were effective at improving the headache and seizure, as well as the hemoperitoneum. (Korean J Intern Med 2010;25:458-460)
Hemoperitoneum Caused by Spontaneous Rupture of Uterine Leiomyoma in a Perimenopausal Woman
( Ji Hyun Choi ),( Hyun Ju Liu ),( Soo Min Heo ),( Soo Ah Kim ) 대한폐경학회 2021 대한폐경학회지 Vol.27 No.1
Uterine fibroid, or leiomyoma, is a common benign neoplasm in women, but serious complications are rarely reported. We present the case of a 48-year-old woman with acute onset of abdominal pain. She was hemodynamically unstable, and computed tomography revealed abundant fluid collection in the peritoneal cavity, suggesting hemoperitoneum. During emergency exploratory laparotomy, the subserosal vein overlying a uterine fibroid was identified as the source of bleeding. Hemostasis was accomplished with fibroid excision. Spontaneous hemorrhage originating from a uterine fibroid is extremely rare, but may lead to life-threatening conditions. Therefore, in female patients with acute abdominal pain and hemoperitoneum, uterine fibroid may be a potential etiology and emergency exploratory laparotomy should be considered.
조형찬 ( Hyoung Chan Cho ),이승우 ( Seoung Woo Lee ),이승희 ( Seung Hee Lee ),권수현 ( Su Hyun Kwon ),정현정 ( Hyun Jung Chung ),송준호 ( Joon Ho Song ),김문재 ( Moon Jae Kim ) 대한신장학회 2008 Kidney Research and Clinical Practice Vol.27 No.6
Percutaneous transplant kidney biopsy has become the most important tool for diagnosing allograft dysfunction. However, renal biopsy has various complications. Among them, hemoperitoneum is a rare complication and has not been reported in Korea. We experienced a case of hemoperitoneum after transplant kidney biopsy. A 43-year-old man, 3 years after renal transplantation, was presented with elevated serum creatinine. Percutaneous renal biopsy was executed by real-time ultrasound guidance and 14-gauged spring loaded automated biopsy gun at upper pole of transplanted kidney. Renal biopsy was completed after 5 trials due to poor visualization of biopsy needle tip. After 2 hours, the patient complained of acute right side abdominal pain and dizziness. Abdominal pelvis CT showed moderate amount of hemoperitoneum. The patient underwent emergency laparotomy. Hematoma was seen in the omentum with minor vessel bleeding. Ligation was done. The patient was discharged after 15 days.
( Ji Hye Kweon ),( Chang Soo Choi ),( Chong Ju Im ),( Geom Seog Seo ),( Suck Chei Choi ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.2
Malignant fibrous histiocytoma (MFH) is an uncommon soft-tissue sarcoma that occurs primarily in the extremities and rarely involves the retroperitoneum and abdomen. A 63-year-old man was admitted to the emergency room because of epigastric pain. Computed tomography revealed a large heterogeneous enhanced mass originating from the omentum with hemoperitoneum. The patient underwent laparoscopic omental mass excision and hematoma evacuation. Histological examination of the resected tumor revealed MFH. This case was therefore omental MFH presenting with hemoperitoneum. (Gut Liver 2010;4:241-244)
Spontaneous Rupture of Uterine Vessels during 3rd Trimester of Pregnancy
김태영,김윤하,김종운,A Mi Kim,Yoon Mi Yang,Hye Kyung Yoon,Seo Yeong Park,박수진,Hee Young Bang 대한주산의학회 2020 Perinatology Vol.31 No.3
A 37-year-old pregnant woman, para 3, was transferred to our hospital at 30 weeks of gestational age with severe acute abdomen. Ultrasonography of the abdomen confirmed that body fluid around the uterus was retained. Paracentesis was performed and she was diagnosed with hemoperitoneum. Exploratory laparotomy was performed and arterial bleeding from the posterior of left round ligament was found. Spontaneous rupture of uterine vessel in pregnancy is associated with a high rate of mortality. Unfortunately, clinical symptoms of hemoperitoneum are non-specific. For the well-being of the mother and fetus, rapid diagnosis and surgical treatment of hemoperitoneum during pregnancy is needed. Non-invasive and easy-to-implement ultrasonography can be performed periodically to help diagnose quickly.
배정민 ( Jung Min Bae ),김세원 ( Se Won Kim ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.2
The stomach is the most frequent site of gastrointestinal stromal tumor (GIST). The common clinical manifestation of GIST are melena and hematochezia caused by gastointestinal bleeding. However, hemoperitoneum due to GIST rupture is a very rare condition. We describe a 33-year-old man with gastric GIST causing hemoperitoneum. A preoperative CT scan demonstrated large amount of fluid collection and extraluminal mass lesion in gastric antral area. He underwent an emergent laparotomy. The antral mass was polypoid shaped and showed ruptured focus. We performed a distal gastrectomy. The tumor was revealed as GIST with intermediate malignant risk by pathologic examination. The patient had an uneventful postoperative course and remains well. (Korean J Gastroenterol 2009;54:123-125)