Management of massive hemorrhage associated with abdominal trauma

Control of massive hemorrhage from intra-abdominal organs and major vascular structures may tax the ingenuity of the trauma surgeon. It is emphasized, however, that total blood loss and the amount of transfused blood are far less critical than the duration and severity of shock.     

An autopsy case of medulloblastoma with massive hemorrhage

Hemorrhage in medulloblastoma is reported to be extremely rare. This is an autopsy report documenting massive hemorrhage in medulloblastoma in an 11-year-old girl. She had a 3-week history of headache, vomiting and a tendency to fall to the left side, and suddenly developed respiratory arrest followed by coma. At autopsy, there were marked upward herniation of the anterior vermis and left cerebellar hemisphere and downward herniation of the cerebellar tonsils. Horizontal sections through the cerebellum showed a large tumor with a hematoma involving the entire vermis and left part of the cerebellar hemisphere. The histopathological diagnosis was medulloblastoma and no significant changes of tumor vessels were observed. Upward herniation played a significant role in the hemorrhage in this particular case. The presence of upward herniation was not described in the previously reported three autopsy cases of medulloblastoma with hemorrhage.     

酒精所致胃炎并发大出血的外科处理

目的为探讨酒精所致胃炎大出血的外科处理。方法对１９９０年１月～１９９５年１２月因酒精所致胃炎并发大出因１１例手术治疗的临床资料进行分析。结果行包括十二指肠在内的胃体窦部切除,保留胃底或部分胃底的手术者１０例痊愈,１例仅行胃切开探查者于术后６０小时因再出血死亡。结论对于非手术疗法不能控制酒精性胃炎出血,包括十二指肠在内的胃体窦部切除术,在紧急情况下是达到止血目的的一个较好的办法。     

Cerebral neoplasms initially presenting with massive intracerebral hemorrhage

In three patients, clinically silent brain tumors led to massive intracerebral hemorrhage. These patients represented 0.6% of 497 consecutive patients with primary or secondary brain tumors and 2.5% of 119 patients with hypertensive or spontaneous intracerebral hemorrhage. Examination by computed tomography and angiography provided no evidence suggestive of the presence of neoplasms. All three patients were surgically treated and the lesions were histologically confirmed to be metastatic bronchogenic carcinoma, metastatic clear-cell carcinoma and low-grade astrocytoma, respectively.     

Pancreatic pseudocyst bleeding associated with massive intraperitoneal hemorrhage

BACKGROUND: Pancreatic pseudocyst bleeding is an unusual entity of acute abdomen, usually occurring among alcoholics. A high mortality developed in patients with conservative treatment of hemorrhagic pancreatic pseudocyst. We report a 37-year-old male with a pseudoaneurysm in the tail of the pancreas presenting with sudden onset of abdominal pain and swelling. Emergency laparotomy after blood transfusion and fluid resuscitation was successfully performed. METHODS: An abdominal radiography showed multiple calcifications in the epigastric area. Computed tomography of the abdomen showed a cystic lesion with a calcified wall in the tail of the pancreas and a large amount of ascites. After contrast enhancement, there was hemorrhage into the pancreatic pseudocyst with extravasation of contrast into the peritoneal cavity. RESULTS: At operation, active bleeding was noted from a ruptured pseudocyst in the tail of the pancreas and ligation of the bleeding vessel was done. CONCLUSIONS: Hemorrhage into the pancreatic pseudocyst associated with intraperitoneal bleeding is a potentially life threatening condition. Emergency surgical treatment should be carried out as soon as possible.     

Duodenal ulceration into the cystic artery with resultant massive hemorrhage

Anterior duodenal ulceration with erosion into the cystic artery is an extremely rare source of upper gastrointestinal hemorrhage. Interventions that have previously been reported include open exploration with cholecystectomy, open exploration while leaving the gallbladder in situ, and angiographic management. We report a case of massive upper gastrointestinal bleeding related to duodenal ulcer penetration of the cystic artery and discuss potential management strategies.     

Spontaneous rupture of hydronephrotic renal pelvis with massive hemorrhage

Spontaneous rupture of a hydronephrotic renal pelvis with massive hemorrhage presents as a perplexing diagnostic challenge to the urologist. The preoperative distinction between this condition and spontaneous rupture of the kidney (Wunderlich disease) may prove uncertain or equivocal despite the application of exhaustive diagnostic modalities. Surgical intervention should follow initial stabilization, and nephrectomy has been the procedure of choice.     

经皮肾镜取石并发大出血的临床治疗

目的探讨经皮肾镜取石并发大出血的临床治疗。方法自2000年3月至2009年6月行经皮肾镜取石术共1150例,其中11例患者并发术后大出血,对其中9例行选择性肾动脉栓塞术,2例行开放性手术止血。结果 11例患者的治疗均取得成功,无手术并发症,无肾切除病例。结论经皮肾镜取石术并发大出血行选择性肾动脉栓塞术创伤小、见效快,可以最大限度保护肾功能,可作为首选治疗,而开放性手术止血对于出血凶猛、无条件及时行栓塞术时,也是一种有效的办法,还可处理残余结石及伴随疾病。     

Intravesical irrigation with alum for the control of massive bladder hemorrhage

Continuous vesical irrigation with 1 per cent alum solution was performed without anesthesia in 9 patients in whom massive bladder hemorrhage persisted despite evacuation of clots and normal saline irrigation for at least 24 hours. Hematuria ceased promptly in all patients, although the effect was transient in 3. No side effect was observed. Biopsy of the tumor subsequent to alum irrigation showed no alteration in the histological characteristics. Biopsy of the normal-appearing bladder mucosa also showed no evidence of epithelial damage. Ultrastructure of the tumor in 1 patient in whom transurethral resection was performed 2 weeks after alum irrigation revealed well preserved nuclear chromatin, thus, suggesting that whatever changes occur after alum irrigation are short-lived.