Hemoperitoneum semiquantitative analysis on admission of blunt trauma patients improves the prediction of massive transfusion Jonathan Charbit, Martin Mahul, Jean-Paul Roustan, Pascal Latry, Ingrid Millet, Patrice Taourel, Xavier Capdevila
DOI: http://dx.doi.org/10.1016/j.ajem.2012.06.024
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: September 13 2012
x The purpose of this study was to define whether the semiquantitative analysis of hemoperitoneum increases the accuracy of early prediction of massive transfusion (MT).
Laparoscopic management for spontaneous rupture of left gastroepiploic vessel after forceful retching Young Sun Choi, Dong Jin Kim, Wook Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.034
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: August 17 2015
x Spontaneous rupture of the left gastroepiploic vessel causing abdominal apoplexy or spontaneous hemoperitoneum is extremely rare. Such ambiguous condition can delay diagnosis, resulting in hypovolemic shock. Reporting such rare cases is valuable to clinicians. Here, we report a 19-year-old man who initially presented left upper quadrant pain and diaphoresis followed by vomiting after ingesting alcohol. He was diagnosed with diffuse hemoperitoneum and large amount of hematoma in left side of lesser sac due to spontaneous rupture of left gastroepiploic vessel.
Elongated left lobe of the liver mimicking a subcapsular hematoma of the spleen on the focused assessment with sonography for trauma exam Robert Jones, Matthew Tabbut, Diane Gramer
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.050
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 6 2014
x The focused assessment with sonography for trauma examination has assumed the role of initial screening examination for the presence or absence of hemoperitoneum in the patient with blunt abdominal trauma. Sonographic pitfalls associated with the examination have primarily been related to mistaking contained fluid collections with hemoperitoneum. We present a case in which an elongated left lobe of the liver was misdiagnosed as a splenic subcapsular hematoma. It is imperative that emergency physicians and trauma surgeons be familiar with this normal variant of the liver and its associated sonographic appearance on the perisplenic window in order to prevent nontherapeutic laparotomies or embolizations.
Spontaneous rupture of the short gastric artery after vomiting Min-Po Ho, Chih-Jung Chang, Chun-Yen Huang, Ching-Juing Yu, Kuang-Chau Tsai, Hsin-An Chen, Wing-Keung Cheung
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.001
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: February 28 2011
x Spontaneous rupture of the short gastric artery is an extremely rare event that can cause abdominal apoplexy or spontaneous hemoperitoneum. For the emergency physician, simultaneous restoration of circulatory volume and a rapid diagnosis remain central to a successful outcome in such critical cases. We reported a 21-year-old man who initially presented with watery diarrhea and abdominal fullness followed by vomiting after the ingestion of alcohol but was later diagnosed with hemoperitoneum, resulting in hemorrhagic shock due to spontaneous rupture of the small branches of the short gastric artery.
Acute abdominal pain due to spontaneous rupture of the right gastric artery Seungwoon Choi, Seokyong Ryu, Taekyung Kang, Hyejin Kim, Sungchan Oh, Sukjin Cho
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.026
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: November 25 2013
x Abdominal apoplexy was reported by Barber in 1909 [1], and the occurrence rate of the apoplexy is known to be quite rare, but the mortality is high if untreated. We report an unusual case of abdominal apoplexy due to spontaneous rupture of gastric artery. A male patient in his fifth decade with recently diagnosed liver cirrhosis history arrived to the emergency department with severe abdominal pain, which led to abdominal computer tomography indicating spontaneous rupture of gastric artery. Celiac angiogram and embolization were conducted, and exploratory laparotomy was followed.
Angioembolization provides benefits in patients with concomitant unstable pelvic fracture and unstable hemodynamics Chih-Yuan Fu, Yu-Chun Wang, Shih-Chi Wu, Ray-Jade Chen, Chi-Hsun Hsieh, Hung-Chang Huang, Jui-Chien Huang, Chih-Wei Lu, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.005
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: December 15 2010
x Pelvic fractures result in hemodynamic instability in 5% to 20% of patients, and the reported mortality rate is 18% to 40%. Previous studies have reported the application of angioembolization in pelvic fracture patients with a systolic blood pressure (SBP) less than 90 mm Hg, a fluid resuscitation requirement of more than 2000 mL, or a blood transfusion of more than 4 to 6 units within 24 hours. In the current study, we attempted to delineate the efficacy and outcome of angioembolization in unstable pelvic fracture patients with concomitant unstable hypotension status.
A healthy young woman with massive hemorrhagic ascites Fumiaki Kishino, Ryota Inokuchi, Yohei Komaru, Nobuhiro Takaya, Miyuki Yamamoto, Susumu Nakajima, Naoki Yahagi
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.039
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: April 24 2015
x Retrograde menstruation is the backward movement of menstrual fluids. The underlying mechanisms remain unknown. The converse current itself is benign, but the result can be abdominal pain caused by peritoneal irritation and, eventually, endometriosis. The case was of a 25-year-old woman with lower abdominal pain accompanied by significant hemoperitoneum. Physical examination and inspection using abdominal ultrasonography and computed tomography failed to reveal a differential diagnosis. Detailed history taking revealed sexual activities during her menstrual period, which allowed for a diagnosis of retrograde menstruation.
Spontaneous rupture of spleen masquerading as acute pancreatitis Jyotindu Debnath, Samrat Sonkar, Vivek Sharma, Samar Chatterjee, Vikash Srivastava, Shiv Pankaj Khanna
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.036
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: November 25 2013
x Splenic rupture most commonly follows blunt abdominal trauma. Nontraumatic rupture of the spleen is rare. Nontraumatic rupture of the spleen has been described in a variety of pathologic conditions, which include neoplastic, infectious, and hematologic diseases affecting the spleen. Spontaneous rupture of nondiseased spleen is extremely rare. We report a case of spontaneous rupture of spleen in a chronic alcoholic clinically simulating acute pancreatitis.
Carotid blowout and cerebral gas embolism related to bidirectional carotid-esophageal fistula: a serious complication of esophageal cancer under radiotherapy Kuei-Hong Kuo, Hsu Hung-Lung, Pan Yi-Ju, Chun-Yang Huang
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.036
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: July 21 2015
x Carotid-esophageal fistula (CEF) could be a serious complication of esophageal cancer in a patient receiving radiotherapy. We reported a 47-year-old male patient with advanced cervical esophageal cancer under radiotherapy who developed CEF with the presentations of unstable vital signs and disturbances of consciousness. Carotid-esophageal fistula–associated life-threatening conditions of carotid blowout syndrome and cerebral gas embolism were diagnosed after presentation. Subsequently, intramural dissection of esophageal and gastric walls, profound hemoperitoneum, and hypovolemic shock occurred.
Spontaneous splenic rupture after thrombolysis for ischemic stroke Rachid Sirbou, Cindy Tissier, Yannick Bejot, Marc Freysz
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.057
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: August 26 2014
x Spontaneous spleen rupture with no recent report of trauma is an extremely rare and life-threatening cause of intraperitoneal hemorrhage. We present the first case of an atraumatic pathological splenic rupture following alteplase thrombolysis for ischemic stroke.
Isolated splenic peliosis with spontaneous rupture after a viperine bite Anupam Lal, Manphool Singhal, Navneet Sharma, Ashish Bhalla, Niranjan Khandelwal
DOI: http://dx.doi.org/10.1016/j.ajem.2013.09.021
The American Journal of Emergency Medicine , Vol. 32 , Issue 2 ,
Published online: November 27 2013
x Isolated splenic peliosis is an extremely uncommon condition that can present with atraumatic rupture and potential fatal outcome. We here report 1 such case that developed after a viperine bite in a 21-year-old woman. The case highlights the diagnostic findings on computed tomographic (CT) scan and its potential complications.
Analysis of risk classification for massive transfusion in severe trauma using the gray zone approach Takayuki Ogura, Minoru Nakano, Yoshimitsu Izawa, Mitsunobu Nakamura, Kenji Fujizuka, Alan T. Lefor
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.007
The American Journal of Emergency Medicine , Vol. 33 , Issue 9 ,
Published online: May 15 2015
x The Traumatic Bleeding Severity Score (TBSS) was developed to predict the need for massive transfusion (MT). The aim of this study is evaluation of clinical thresholds for activation of a MT protocol using the gray zone approach based on TBSS.
Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(12)00582-7
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published in issue: January 2013
Role of arterial embolization on blunt hepatic trauma patients with type I contrast extravasation Yu-Chun Wang, Chih-Yuan Fu, Yung-Fang Chen, Chi-Hsun Hsieh, Shih-Chi Wu, Chun-Chieh Yeh
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.001
The American Journal of Emergency Medicine , Vol. 29 , Issue 9 ,
Published online: September 27 2010
x Our aim was to evaluate the clinical effectiveness of transcatheter arterial embolization (TAE) in the management of hemodynamically stable blunt hepatic trauma (BHT) patients with contrast material extravasation into the peritoneal cavity, known as type I contrast material extravasation, on computed tomography (CT) scan.
Major hemorrhage from hepatic laceration after cardiopulmonary resuscitation GregoryS. Zahn, MargaretG. Hauck, DavidA. Pearson, John M. Green, Alan C. Heffner
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.048
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: January 6 2015
x Visceral injury from cardiac arrest resuscitation is a rare but potentially life-threatening complication. We describe and review 2 cases of hepatic laceration complicated by major abdominal hemorrhage manifested as delayed shock following cardiopulmonary resuscitation after cardiac arrest. Two patients enrolled in our institutional postcardiac arrest resuscitation clinical pathway had evidence of major liver laceration presenting as delayed shock due to massive hemoperitoneum. Case analysis revealed coagulopathy due to systemic anticoagulation as a risk factor for major hemorrhage.
Intra-abdominal injury is easily overlooked in the patients with concomitant unstable hemodynamics and pelvic fractures Chih-Yuan Fu, Chien-An Liao, Chien-Hung Liao, Shih-Ching Kang, Shang-Yu Wang, Yu-Pao Hsu, Being-Chuan Lin, Kuo-Ching Yuan, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.013
The American Journal of Emergency Medicine , Vol. 32 , Issue 6 ,
Published online: February 19 2014
x Transcatheter arterial embolization (TAE) is usually necessary in the management of hemodynamically unstable patients with concomitant pelvic fractures. Given the critical conditions of such patients, TAE is at times performed only according to the results of a primary evaluation without computed tomographic (CT) imaging. Therefore, the evaluation of associated intra-abdominal injuries (IAIs) might be insufficient. Clinically, some patients have required post-TAE laparotomy due to further deterioration.
An unusual complication of morbid obesity: epidural lipomatosis El Noh
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.043
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: December 1 2014
x Epidural lipomatosis is a rare disease to cause spinal cord compression and progressive neurologic deficits. Hypertrophy of adipose tissue located in the spinal epidural space encroaches on the spinal canal and compresses the neural elements. Most patients will present with worsening myelopathy, but radicular symptoms may also be seen. It is found most commonly in patients with excess of steroids in the body either due to endogenous source or exogenous intake. However, we report a rare case in which a young, morbidly obese patient admits to relapsing and remitting paraparesis and incontinence—which later is found to be caused by epidural lipomatosis evidenced via magnetic resonance imaging of the spine.
Urgent interscalene brachial plexus block for management of traumatic luxatio erecta in the ED Graham Brant-Zawadzki, Andrew Herring
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.036
The American Journal of Emergency Medicine , Vol. 33 , Issue 7 ,
Published online: December 26 2014
x Trauma in the emergency department may present providers with a myriad of unforeseen clinical scenarios. We present an example of how an urgent nerve block facilitated rapid management of a luxatio erecta shoulder fracture-dislocation without sedation. A 20-year-old female pedestrian presented to our level II trauma center after being stuck by a motor vehicle. At arrival, she had clinical indications of severe blunt trauma as well as a left-sided luxatio erecta shoulder dislocation and fracture.
Liver trauma diagnosis with contrast-enhanced ultrasound: interobserver variability between radiologist and emergency physician in an animal study Je Sung You, Yong Eun Chung, Hye-Jeong Lee, Sung Phil Chung, Incheol Park, Myeong-Jin Kim, Mi-Suk Park, Joon Seok Lim, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.012
The American Journal of Emergency Medicine , Vol. 30 , Issue 7 ,
Published online: August 26 2011
x The purpose of our study was to evaluate interobserver variability between the radiologist and emergency physician in detecting blunt liver trauma by conventional and contrast-enhanced ultrasound (US) (CEUS).
Splenic rupture after uncomplicated colonoscopy Sean Sachdev, Hariharan Thangarajah, Judith Keddington
DOI: http://dx.doi.org/10.1016/j.ajem.2011.01.013
The American Journal of Emergency Medicine , Vol. 30 , Issue 3 ,
Published online: March 30 2011
x Colonoscopy is a commonly performed medical procedure generally considered safe and effective. Rare complications include postpolypectomy bleeding and perforation. A far less common and more unusual complication is splenic injury. We present the case of a patient who developed this very outcome, presenting to the emergency department with abdominal pain several hours after the procedure. The mechanism of such injury is not known but has been hypothesized to be either traction on the splenocolic ligament or previously formed adhesions, direct blunt injury, or special maneuvers used to advance the colonoscope.
