Meckel’s diverticulum with intraperitoneal hemorrhage in a child detected with screening laparoscopy: a case report

Background The most common presentation of symptomatic Meckel’s diverticulum (MD) are intestinal obstruction, gastrointestinal hemorrhage, and inflammation of the MD with or without perforation. Intraperitoneal hemorrhage because of MD is extremely rare. We report a case of MD with intraperitoneal hemorrhage in a child detected with screening laparoscopy. Case presentation An 11-year-old girl presented to another hospital with lower abdominal pain and vomiting that lasted for 2 days. Acute appendicitis was suspected, and she was referred to our department. Abdominal enhanced computed tomography showed an abscess in the lower abdomen with ascites in the pelvis. She was diagnosed with a localized intra-abdominal abscess and the decision was made to treat with antibiotics. However, her abdominal pain worsened, with abdominal distension, tenderness and guarding. She was diagnosed with panperitonitis and the decision was made for surgery 5 h after admission. During surgery, laparoscopic observation from the umbilical region revealed 200 ml of fresh blood throughout the peritoneal cavity, originating from the mesentery of the ileum. MD was observed with bleeding from the surrounding mesentery. Small bowel resection was performed, and the patient was discharged on the 5th postoperative day. Pathological findings revealed an MD containing ectopic gastric mucosa and small intestinal ulcer perforation at the base of the MD. Conclusions We report an extremely rare case of an MD with intraperitoneal hemorrhage in a child. In pediatric cases, it is possible that perforation with ectopic gastric mucosa may cause massive bleeding because of rupture of the surrounding mesenteric blood vessels.

“Mesenteric hematoma after an unusual blunt abdominal trauma– A case report and literature review”

In blunt abdominal trauma, lesions of the mesentery are often underdiagnosed, they represent the third most injured organ, with increasing morbidity and mortality. Mesenteric hematoma can be managed conservatively in the event that there is no associated active mesenteric hemorrhage however, must be clinically distinguished from spontaneous mesenteric intraperitoneal hemorrhage.

Association between Administration of Antithrombotics and Intraperitoneal Hemorrhage in Patients Undergoing Percutaneous Interventions for Liver Diseases

Currently, percutaneous interventions are essential for diagnosis and treatment of liver diseases. The most frequent complication of percutaneous interventions is intraperitoneal hemorrhage. Recently, the number of patients with liver diseases on antithrombotics has been increasing. This retrospective cohort study aimed to evaluate the risk factors for intraperitoneal hemorrhage in patients after percutaneous interventions for liver diseases. This study included 1025 patients who underwent percutaneous interventions for liver diseases from April 2015 to March 2020. All interventions were performed using an ultrasound-guided approach. The influence of antithrombotic drug administration in patients, who underwent percutaneous interventions according to the guidelines for the American Association for the Study of Liver Disease, was evaluated. Intraperitoneal hemorrhage after percutaneous interventions was detected by computed tomography. Intraperitoneal hemorrhage occurred in nine patients (0.88%); however, these adverse events were not severe. We compared clinical characteristics between the patients with and without intraperitoneal hemorrhage. Although, there was no difference based on the administration of antithrombotics (p = 0.1961), seven of nine patients who showed intraperitoneal hemorrhage received percutaneous treatments (radio frequency ablation or microwave ablation). Therefore, we divided patients who underwent treatments and liver biopsy and then investigated the influence of antithrombotics on the intraperitoneal hemorrhage. After propensity score matching in each patient group, the administration of antithrombotics was not identified as a risk factor for hemorrhage in patients who underwent interventional treatments and patients who underwent liver biopsy. When the antithrombotics were discontinued, according to the guidelines, it may not increase the risk factor for hemorrhage in patients of liver disease who underwent percutaneous interventions.

Spontaneous rupture of splenic artery aneurysm in pregnancy: an autopsy-based case report

Splenic artery aneurysm (SAA) is an infrequent form of vascular disease that has a significant potential for rupture, resulting in life-threatening intraperitoneal hemorrhage commonly during pregnancy. The incidence of splenic artery aneurysms has been estimated between 0.01% and 0.98%. We describe a case of sudden death of a 36 years old full term, primigravida female. During autopsy we found ruptured splenic artery aneurysm about 2.0 cm in diameter near hilum with intraperitoneal hemorrhage. It is important to be alert about the possibility of SAA in pregnant women for its early diagnosis, as the chance of it getting ruptured during pregnancy is high with high maternal and fetal mortality rates.

Administration of Antithrombotic Treatment Was a Risk Factor for Intraperitoneal Hemorrhage in Patients Undergoing Percutaneous Interventions for Liver Diseases.

Percutaneous interventions for liver diseases are currently essential for diagnosis and treatment. The most frequent complication of percutaneous interventions is intraperitoneal hemorrhage. Recently, the number of patients with liver diseases and administered antithrombotics has been increasing. This retrospective cohort study aimed to evaluate the risk factors for intraperitoneal hemorrhage after percutaneous interventions for liver diseases. This study recruited 1025 patients who underwent percutaneous interventions for liver diseases from April 2015 to March 2020. All interventions were performed using an ultrasound-guided approach. Intraperitoneal hemorrhage after percutaneous interventions was detected by abdominal computed tomography. Intraperitoneal hemorrhage occurred in 9 patients (0.88%), and these adverse events weren’t severe. We compared clinical characteristics between the patients with intraperitoneal hemorrhage and without. There were differences regarding patients who underwent percutaneous treatments of liver tumor (p = 0.1271), administration of antithrombotics (p = 0.1961), and prothrombin time (p = 0.1683). Thereafter, to evaluate the influence of antithrombotics on hemorrhage, we compared the patients with antithrombotics and without. After propensity score matching, hemorrhage in patients treated with antithrombotics was significantly increased than in those without (p = 0.0407). The administration of antithrombotics was a risk factor for intraperitoneal hemorrhage in patients undergoing percutaneous interventions for liver diseases.

MODERN CONCEPT OF RENDERING AID TO WOMEN WITH OVARIAN HEMORRHAGES

Aim: Analysis of modern medical care for women with ovarian hemorrhage, determination of the main diagnostic criteria that influence the choice of treatment tactics and further prognosis of the outcome of treatment of ovarian apoplexy. Material and methods: The provision of medical care to 888 women with ovarian apoplexy. Depending on the volume of hemoperitoneum, all patients were divided into three groups.: Group I – 480 (54.0%) women in whom intraabdominal bleeding did not exceed 200 ml; Group II – 283 (31.8%) patients with hemoperitoneum ranged from 200 to 500 ml; Group III – 125 (14.1%) patients with hemoperitoneum volume greater than 500 ml. Results: According to the data of the transvaginal US , a linear dependence was observed between the level of free liquid and the volume of hemoperitoneum (r=0.63, p<0.05). In 792 (89.2%) patients the diagnosis of apoplexy of the ovary and intraperitoneal hemorrhage was made to surgical intervention- on the basis of clinical picture and US data. The most frequently performed hemostatic operation was resection of the ovary – 477 (77.2%) interventions. The average volume of hemoperitoneum discovered in patients with AO, in absence of the adhesive process was (273.5±21.3) ml, whereas in patients with the expressed adhesive process of the small pelvis organs it was (141.4±35.5) ml. The cause of AO was the corpus luteum or cyst of the corpus luteum in more than the half of the cases – 348 (56.3%). Conclusions: The manifestation of the clinical symptoms in apoplexy of the ovaries depends on the volume of intraperitoneal hemorrhage. The application of laparoscopy as a main therapeutic and prophylactic method in AO allows to preserve, and sometimes to restore the reproductive function of a woman and to reduce the rate of the disease relapse development.