Surgical case report—acalculous hemorrhagic cholecystitis

Haemorrhagic cholecystitis is a seldom seen cause of right upper quadrant pain that can result in gallbladder rupture, massive intraperitoneal haemorrhage and death if untreated. Haemorrhagic cholecystitis is usually seen in the presence of cholelithiasis, malignancy, trauma and coagulopathies. Here, we present the unusual case of an elderly man presenting with acalculous haemorrhagic cholecystitis, who was successfully treated with laparoscopic cholecystectomy. We review the radiological and laparoscopic findings of haemorrhagic acalculous cholecystitis. This case highlights the importance of prudent use of radiological imaging to differentiate haemorrhagic cholecystitis from alternate pathology and early surgical intervention to avoid massive intraperitoneal haemorrhage and the high mortality with which it is associated.

1. Two Cases of abdominal Section for intraperitoneal Haemorrhage due to ruptured ectopic gestation 2. Three fatal Cases of ectopic Gestation 3. Ectopic Molar pregnancy 4. A Case of plural ectopic gestation

To the Vorrat l. a woman was brought in a state of collapse with a diagnosis of an ectopic pregnancy; pulse 144, barely perceptible. The rupture occurred in 18 hours, there were fainting, vomiting. The abdomen is not distended, soft, the tumor cannot be felt from the outside, and per vaginam examination is not done to speed up the operation. When the abdomen was opened, the tissues were found bloodless: none of the vessels showed blood; a few pounds of liquid blood spilled out of the peritoneal cavity; clamps were placed on the stretched right fallopian tube and broad ligament, and the fallopian tube was excised along with the ovary; the rupture was near the uterus. The operated woman recovered, although W. did not count on it.

Re-laparotomy in OBG: a clinical study

Background: If laparotomy done within 60 days of primary surgery for the original disease it is called re-laparotomy. Aim of this study was to determine the risk factors causing re-laparotomy, the indications, management and outcomes of re-laparotomy.Methods: The study was conducted in the department of Obstetrics and Gynaecology, Vijayanagar Institute of Medical Sciences Hospital, Bellary, Karnataka. It is a 2 year prospective observational study of all the patients with re-laparotomy following operation done for obstetric or gynaecological indications.Results: Total 4105 patients underwent major surgery in two years between October 2013 to September 2015. Re-laparotomy was done in 10 cases. The incidence of re-laparotomy was 0.25% which is mainly for subacute intestinal obstruction, intraperitoneal haemorrhage, burst abdomen, PPH, rectus sheath hematoma.Conclusions: Hemorrhage, burst abdomen, infections are the main reasons for re-laparotomy after obstetric and gynaecological surgeries. Though the incidence of re-laparotomy is low and the outcome is favourable, several measures must be undertaken to prevent re-laparotomy such as careful surgical technique, meticulous hemostasis and strict asepsis should be maintained.

Unusual presentation of a life-threatening intraperitoneal haemorrhage after elective inguinal hernia repair

A 57-year-old man who was hypotensive at induction of anaesthesia was having intermittent episodes of hypotension after an uncomplicated and relatively bloodless open inguinal hernia repair of a large left-sided hernia . His hypotension was responsive to small fluid boluses. He did not show any tachycardia, had no abdominal pain, no signs of bruising or bleeding in his abdomen, flanks, or scrotum. Remained clinically well and alert throughout until being transferred to a tertiary centre. Eventually became haemodynamically unstable approximately 6 hours postoperatively. CT angiogram showed a large haemoperitoneum with active bleeding. Diagnostic laparoscopy revealed an actively bleeding inferior epigastric artery which was stopped. The patient received 2 units of red blood cells and made a full recovery.

Massive hemoperitoneum in case of large subserosal fibroid- a rare case report

Rupture of veins on the surface of uterine leiomyoma is an extremely uncommon gynaecological cause of haemoperitoneum. It is a life-threating emergency. In most cases, bleeding is a result of trauma or torsion. Here we report a case of massive intraperitoneal haemorrhage due to rupture of vessels on the surface of large sub-serous leiomyoma to stress on the fact that a differential diagnosis of rupture of surface vessels in a fibroid should be considered while dealing with a case of haemoperitoneum with pelvic masses

Deciduosis of the appendix: diagnostic dilemma continues despite MRI evidence

Deciduosis (ectopic or extrauterine decidua) is a phenomenon seen in the ovary and cervix and on serosal surfaces of abdominal and pelvic organs. It is thought to be the result of progesterone effects on extrauterine mesenchymal cells during pregnancy. Although deposits are typically asymptomatic and incidentally found in surgically removed tissues on microscopy, deciduosis has also been known to cause pain and intraperitoneal haemorrhage. We sourced all cases of appendiceal deciduosis that have occurred in Sir Charles Gairdner Hospital and Bunbury Hospital between the years 2006 and 2014. Clinical information was obtained from patients’ medical records. Four cases of ectopic decidua of the appendix, all of which were incidentally found in pregnant patients presenting with features highly suggestive of appendicitis, were reviewed. These patients underwent appendicectomy and subsequent histopathology findings showed deciduosis with no evidence of appendicitis. Deciduosis of the appendix can mimic acute appendicitis in pregnancy. At present, it is difficult to confidently differentiate one from the other either by way of clinical presentation or with current imaging modalities.