Large aneurysm in renal angiomyolipoma causing life-threatening retroperitoneal hemorrhage

Large aneurysms occurring in renal angiomyolipomas (AML) may be encountered. When present, they have a higher propensity to hemorrhage and cause catastrophic intratumoral and perirenal hemorrhages. They also tend to occur more in tuberous sclerosis-associated AML rather than in the sporadic form. A 22-year-old female presented with sudden onset of acute right abdominal pain, hematuria and fainting. At evaluation in the emergency department, the patient was found to be in hemorrhagic shock with hemoglobin of 4 g/dl and low blood pressure of 60/40 mmHg. Fullness and tenderness of the right abdominal flank was also noted. Contrast enhanced CT scan of the abdomen showed a large fatty mass of the right kidney with a surrounding perirenal hematoma. A 4.0 cm wide focus of contrast was seen within the mass highly suspicious of an aneurysm. A subsequent DSA angiogram of the right kidney confirmed the presence of the aneurysm within the mass as the cause of the hemorrhage. The patient underwent successful emergency coil and particle embolization of the aneurysm and mass with control of the bleeding. The patient was diagnosed with tuberous sclerosis syndrome with further clinical findings of cutaneous adenoma sebaceum and lung cystic changes.     

Internal packing in the control of hemorrhage from large retroperitoneal veins

BACKGROUND: Hemorrhage from large retroperitoneal veins is usually controlled by suturing the venous tear. Infrequently, the extent and location of the tear and amount of hemorrhage preclude successful suturing. METHODS: In seven patients with severe hemorrhage from large retroperitoneal veins encountered in association with resection of retroperitoneal sarcoma (6) or repair of a ruptured abdominal aortic aneurysm (1), packing of the area with sufficient amounts of Surgicel (Ethicon, Johnson & Johnson, Somerville, NJ) and pressure for one half hour was used. RESULTS: All seven patients did not show any bleeding postoperatively and no clinical sequelae developed, with the exception of one patient who developed an abscess requiring drainage. CONCLUSION: Internal packing with Surgicel appears to be reliable in controlling venous hemorrhage not manageable by the standard methods and may be preferable to roll gauze packing.     

腹膜后间隙出血的诊治

目的总结腹膜后间隙出血的诊治经验。方法回顾性分析1995年至2005年收治109例腹膜后出血患者资料。男70例,女39例,年龄6～69岁,平均33岁。外伤性89例,自发性20例。患者均因外伤后或自发性突然腰腹痛、血尿或休克表现就诊。109例经B超检查,104例行CT检查,7例急诊腹膜后探查术。109例患者中肾脏破裂出血101例（92．7％）、肾外病变破裂出血8例（7．3％）。外伤性89例中肾脏破裂84（94．4％）、腹膜后肾外病变破裂出血5例（5．6％）,自发性20例中肾脏破裂出血17例（85．0％）、肾外病变出血3例（15．0％）。肾外病变主要有嗜铬细胞瘤、平滑肌瘤、平滑肌肉瘤、神经鞘瘤、淋巴肉瘤等。结果109例患者中腹膜后手术26例,肾切除术8例、肾癌根治术8例、腹膜后肿瘤切除7例、肾切除加平滑肌瘤切除1例、肾包膜切开引液术2例。保守治疗83例,采取卧床休息、补液、止血、抗感染、输血、镇静治疗。10例恶性肿瘤患者中1例淋巴肉瘤患者术后10个月死亡,1例平滑肌肉瘤患者9个月死亡,8例肾癌患者中2例于术后18、20个月死于全身衰竭,余6例2年内未复发。其他99例患者痊愈出院后随访6个月,B超、CT检查未发现腹膜后病变复发。结论腹膜后出血可由肾脏或肾外病变破裂所致,B超能准确检查出腹膜后血肿,CT对辨别出血部位、范围、程度、原因及检出肿瘤有重要价值。对危及生命的腹膜后大出血应急诊手术,病情稳定者可先保守治疗,明确诊断后采取相应的治疗方式。     

Spontaneous retroperitoneal abscess as the first clinical manifestation of a non-functioning retroperitoneal paraganglioma

We demonstrate a novel clinical presentation of paraganglioma not described in the literature. The paraganglioma is a catecholamine secretory, or non-secretory, neuroendocrine tumour that derives from chromaffin cells. Its frequency, with regard to pheochromocytoma, is low, and the abdominal region is the most frequent localisation site, followed in importance by the cervical region. We report the case of a 54-year-old woman diagnosed with a retroperitoneal abscess; after drainage of the lesion, samples indicated necrotic paraganglioma cells, so it was decided to conduct a survey to determine catecholamine levels in urine, and carry out a MIBG gammagraphy, which described a non-functioning retroperitoneal paraganglioma that underwent surgical removal. There was no residual disease after 3-month follow-up.     

Spontaneous retroperitoneal hemorrhage from kidney causes

Spontaneous retroperitoneal hemorrhage is an uncommon entity and even rarer when the underlying cause is from the kidney. Renal tumors comprise the majority of atraumatic kidney rupture. Renal cell carcinoma and angiomyolipoma are the most common diseases in this group. Oral anticoagulant therapy and hemodialysis could be responsible for a few cases. In 3 reported cases no pathological explanation could be found. With the help of modern facilities, diagnosis can be made preoperatively and conservative surgery is indicated in these patients. However, nephrectomy is the treatment of choice for patients presenting with shock as the initial symptom or solid renal mass with perirenal hematoma.     

原发性腹膜后肿瘤24例诊治体会

目的　探讨原发性腹膜后肿瘤(PRT)的诊断与外科治疗方法。方法　回顾性分析我院1986年10月~2004年10月诊治的24例原发性腹膜后肿瘤的临床资料。结果　恶性肿瘤16 例,肿瘤完整切除率50%,合并脏器切除率31%;良性肿瘤8 例,肿瘤完整切除率75%,合并脏器切除率25%。手术死亡1例。手术后并发症5例。结论　B型超声及CT检查是诊断本病的主要手段,手术完整切除肿瘤是治疗的主要方法,对复发肿瘤亦应争取再次手术。     

腹膜后肿瘤切除术中大出血的预防和处理

目的 降低腹膜后肿瘤切除术中的出血量,提高手术安全性。方法 回顾性分析了我院１９８３年～１９９８年腹膜后肿瘤切除术中出血量在３０００ｍｌ以上的患者５４例,其中出血量在５０００ｍｌ以上者２２例,出血量在８０００ｍｌ以上者７例,有２例出血量达１００００ｍｌ。结果 １７例术中出现低血容量性休克,其中２例死亡。５２例渡过术中出血难关。结论 应重视术前对腹膜后肿瘤切除术中出血的估计和预防措施的准备,强调避免术中大出血和发生大出血时的处理方法。     

Spontaneous intracerebral hemorrhage

We report on 146 patients with spontaneous intracerebral hemorrhage treated in the period between 1984 and 1988. The aim of this retrospective study was to point out factors for operative respectively conservative treatment.Looking for etiology, age, unconsciousness, localization and extension of hematoma as well as bleeding into the ventricles our results showed that patients over 70 years of age and/or in coma III and IV (Brussels Coma Scale) have a bad prognosis as well as patients with intraventricular bleeding. Patients seem to benefit from operation if hematoma is located in the hemisphere or cerebellar and the extension ranges from 3 to 5 cm.     

原发性腹膜后肿瘤的手术治疗及术后并发症的处理

目的　探讨原发性腹膜后肿瘤 (PRT)手术治疗经验及术后并发症的处理。方法　回顾性分析我院 196 4年 1月～ 1999年 12月收治的PRT的治疗经验 ,重点阐述手术适应证、手术方式及术后并发症的处理。结果　手术治疗PRT并经病理证实 2 5 2例 ,其中恶性肿瘤全切除 6 1例(35 .9% ) ,联合脏器切除 2 7例 (44 .3% ) ;部分切除 2 8例 (16 .5 % ) ,联合脏器切除 5例 (17.9% ) ,探查加活检 81例 (47.6 % )。良性肿瘤全切除 75例 (91.5 % ) ,联合脏器切除 3例 (4% ) ,部分切除 7例(8.5 % )。结论　PRT手术治疗必须掌握手术适应证 ,充分术前准备 ,选择手术方式 ,防治术后并发症是手术成败的关键。     

Spontaneous massive retroperitoneal hemorrhage from an adrenal gland cyst

Adrenal cyst are rare disease. Bleeding, particularly massive, from these cysts is even rarer. The cyst causing spontaneous massive retroperitoneal bleeding in a 17 year old girl is presented. Adrenalectomy was successfully carried out. The patient stayed symptom free so far.     

Spontaneous retroperitoneal hemorrhage: unusual presentation of renal cancer

Spontaneous retroperitoneal hemorrhage as the presenting sign of renal cancer is rare. A case of spontaneous retroperitoneal hemorrhage from a renal carcinoma is described and management possibilities presented. While it is true that renal angiomyolipomas are the main cause of spontaneous retroperitoneal renal bleeding, the possibility of renal cancer should be entertained more often in the differential diagnosis.     

经腹膜外与经腹腔切除原发性腹膜后肿瘤的对比研究

目的　总结经腹膜外和经腹腔切除原发性腹膜后肿瘤的优缺点 ,探讨最佳手术途径。方法回顾性分析原发性腹膜后肿瘤切除术 4 6例 ,其中经腹腔途径 (transabdominalapproach ,TAA)手术 2 6例 ,为TAA组 ,经腹膜外途径 (extraperitonealapproach ,EPA)手术 2 0例 ,为EPA组。 结果术后并发症发生率EPA组 (2 / 2 0 )比TAA组 (11/ 2 6 )低 (P <0 0 5 ) ,EPA组输血量 4 0 0 (QR∶70 0 )ml少于TAA组 80 0 (QR∶180 0 )ml(u =2 136 85 ,P <0 0 5 ) ,手术时间EPA组 (2 0 5± 6 0 )min短于TAA组(2 5 9± 110 )min(t=2 12 74 ,P <0 0 5 ) ,术后住院天数EPA组 (13± 4 )d少于TAA组 (18± 8)d(t =2 95 33,P <0 0 1) ,差异均有显著意义。结论EPA是原发性腹膜后肿瘤简便安全的手术途径。     

Spontaneous mesenteric hemorrhage associated with ehlers-danlos syndrome

The vascular type of Ehlers-Danlos syndrome is a genetic disorder of connective tissue and is frequently associated with catastrophic arterial complications. Its surgical treatment is extremely difficult because of the fragility of vessels. This article describes three patients with vascular type of Ehlers-Danlos syndrome who developed mesenteric hemorrhage due to spontaneous arterial rupture. The clinical and molecular characteristics of the disease are briefly reviewed.     

Complications of laparoscopic retroperitoneal lymph node dissection in testicular cancer

Objectives  A proposed benefit of laparoscopic retroperitoneal lymph node dissection (LRPLND) is more favorable morbidity in comparison to open retroperitoneal lymph node dissection (RPLND). The objective of this review is to examine and summarize the literature regarding complications in both primary and post-chemotherapy LRPLND (PC-LRPLND) and, where appropriate, we include the opinions of the senior author regarding management. Methods  A MEDLINE search was performed using the terms “laparoscopy” or “laparoscopic,” “retroperitoneal lymph node dissection” or “RPLND,” and “testicular neoplasms.” Articles were included on the basis of study design and content. For series updated over time, an effort was made to include only the most recent data to avoid duplicate reporting of patients. Results  In primary LRPLND, vascular injury is the most common complication, occurring in 2.2–20% of reported cases. Bowel injury is rarely reported but potentially catastrophic. Rates of retrograde ejaculation are less than 5%. Chylous ascites and lymphocele are delayed post-operative complications. Rarely reported complications include nerve injury, retroperitoneal hematoma, and ureteral injury requiring internal stent placement. PC-LRPLND is challenging, with high rates of conversion and complications. Hemorrhage is common. Retrograde ejaculation is several-fold more common in PC-LRPLND than in primary LRPLND. No peri-operative mortality has been reported for either LRPLND or PC-LRPLND. Conclusions  LRPLND and PC-LRPLND are technically demanding. Hemorrhage and vascular injury are the most commonly reported complications. Prospective studies will help clarify the proposed benefits of LRPLND.     

Spontaneous retroperitoneal hemorrhage: our experience at last 10 years

Introduction and Objectives: Etiology, clinical features, diagnostic methods and treatment of spontaneous retroperitoneal hemorrhage were analyzed.Methods:We report 27 cases with diagnosis of spontaneous retroperitoneal hemorrhage treated in our hospital between January 1996 and December 2005. The imaging techniques were abdominal ultrasonography, abdominal CT scan and MRI.Results:The most common cause of retroperitoneal hemorrhage was renal angiomyolipoma rupture in 7 patients. Continuous flank or abdominal pain were the primary symptoms. Abdominal ultrasonography showed hematoma in 81.8% patients, but the actual etiologic diagnosis was ascertained in only 40.9% of them. Retroperitoneal hemorrhage was demonstrated by means of abdominal CT scan in all cases and bleeding origin was established in 92.6% of cases. Ten patients underwent urgent surgery while conservative treatment was attempted in the remaining 17.Conclusions:In our experience, in cases of spontaneous retroperitoneal hemorrhage, CT scan is the best imaging method to establish the diagnosis and the management of such entity although it will need to be individualized for every case because it depends on the hemodinamic situation and etiologic diagnosis.     

巨大腹膜后平滑肌肉瘤伴出血1例报告并文献复习

目的:探讨腹膜后平滑肌肉瘤的临床特点、影像学表现及治疗策略,以期对类似病例的诊治提供参考。方法:回顾性分析收治的1例腹膜后平滑肌肉瘤患者临床资料,并复习相关文献。结果:患者腹部胀痛伴贫血,影像学提示中下腹部恶性肿瘤伴出血,早期行液体复苏,进一步介入栓塞,超声引导下穿刺引流,避免腹腔隔室综合征的发生;复查待瘤体缩小,贫血纠正,行完整切除肿瘤,病理诊断为平滑肌肉瘤。术后随访16个月,患者恢复良好。结论:腹膜后平滑肌肉瘤是一种罕见的恶性肿瘤,起病隐匿,易复发和转移,手术完整切除是其主要治疗方式,配合以化疗、放疗等手段综合治疗,可改善患者预后。