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Background: Uterine leiomyoma is the most common pelvic tumor in women. Grave complications from this benign tumor are infrequent though can be life-threatening. This report is of a rare case of haemoperitoneum secondary to spontaneous bleeding from a uterine leiomyoma. Case Report: A 36-year-old single female presented with generalized acute abdominal pain and weakness. Clinical examination revealed a distended abdomen with initially stable vital signs. Few hours on admission, her vital signs became unstable. After assiduous resuscitation, abdominopelvic ultrasound scan (USS) and computed tomography imaging of the abdomen showed an intraperitoneal fluid collection and multiple large pedunculated subserosal uterine leiomyomata. Emergency laparotomy was performed, and the bleeding blood vessel overlying the anterior surface of the largest pedunculated subserosal leiomyoma was identified and ligated. The uterine myomas were excised completely and histology corroborated the diagnosis of benign leiomyomata. The postoperative period of the patient was uneventful. She was discharged from the hospital without complications on the seventh day of admission. Conclusion: Haemoperitoneum secondary to spontaneous bleeding of uterine leiomyoma is rare. Surgeons should consider the probability of this complication in women with acute abdominal pain and a history of uterine leiomyoma.

Background: Ectopic pregnancy and its consequences are the most severe form of obstetric emergency during first trimester of pregnancy. It is a kind of life threatening emergency leading to significant maternal morbidity and even mortality. Methods: A prospective study was conducted at a tertiary care centre GGH Kadapa from 01 Jan 2022 to 31 Dec 2022. All cases of ectopic pregnancy which were admitted and managed during this study period were included in the study. All Collected data were analysed with epitable 6.04 version and SPSS version 20 Software. Results: During the study period total 34 cases of ectopic pregnancy were studied. Classical symptoms of amenorrhoea, pain abdomen and bleeding per vaginum were observed in 7 cases (20.5 %) whereas 25 cases (73.5%) were associated with pain abdomen only and 7 cases (20.5%) had the symptoms of bleeding per vaginum only. All cases were managed surgically. The incidence of ectopic pregnancy was one in 200 delivered pregnancy. Most were multiparas and common in 25-35 yr age group (73.5%). Tubal ectopic pregnancy was common in right side 22 cases (61%). Approximately 18 cases (52%) presented with haemoperitoneum and (56%) 17 cases required more than 2 pint blood transfusion. Conclusions: Ectopic pregnancy mostly presents as an obstetrics emergency in our hospital especially with rupture ectopic pregnancy with haemoperitoneum. Early diagnosis and intervention suited best for the situation is mainstay for favourable and successful outcome. [ABSTRACT FROM AUTHOR]

Background: Blunt abdominal trauma constitute cases where there is an injury to one or more abdominal viscera with or without hemoperitoneum in the absence of external penetrating injury to the abdomen. Objectives: The aims of the present study were - To discuss various aspects of Blunt Abdominal Trauma, To evaluate the ability of US in detecting Haemoperitoneum, Intraperitoneal visceral injuries. Analysis of sonographic findings and its correlation with clinical background, laboratory investigations, conventional and contrast radiographic procedures, CT-scan and operative findings wherever possible. To evaluate the role of US in the follow-up of patients with BAT. Methodology: Prospective observational study on 40 cases with blunt trauma in Government Hospital Kurnool. Results: Road traffic accident was the major cause. Ultrasound was able to identify free fluid, solid organ injuries (lacerations, contusions, hematomas and rupture) and perivisceral fluid collection. The overall sensitivity of US in evaluation of BAT was 83%and specificity was 96%. The sensitivity of US in detecting free fluid in our study was 100% because not all cases were confirmed by CT or laparotomy. Amongst the visceral injuries, spleen, liver and kidney were the most common abdominal organs injured with incidence of 25%, 20% and 10% respectively. Also plays a major role in followup of patients with BAT. Conclusion: Thus the ability of US to accurately detect the presence of free fluid andto pin point the injured organ, helps the clinician in contemplating and planning the appropriate therapeutic approach to a patient with suspected blunt abdominal trauma. [ABSTRACT FROM AUTHOR]

Bilateral Renal Cortical Necrosis (BRCN) is a rare but serious condition characterised by the ischaemic necrosis of both kidneys’ cortical tissues. Concurrently, Reversible Cerebral Vasoconstriction Syndrome (RCVS) manifests as a transient constriction of cerebral blood vessels. The fusion of these two rare entities within the context of severe Postpartum Haemorrhage (PPH) poses a unique diagnostic and therapeutic dilemma for healthcare practitioners. This case study documents the intricate and severe complications experienced by a 32-year-old primiparous woman following abruptio placenta with Intrauterine Foetal Death (IUFD). The patient presented with massive vaginal bleeding, leading to an emergency Lower Segment Caesarean Section (LSCS) where bilateral uterine artery ligation and bilateral internal iliac artery ligation were performed to control haemorrhage. Despite initial interventions, the patient’s condition deteriorated, leading to signs of shock, haemoperitoneum, sepsis, Acute Kidney Injury (AKI), and cerebral complications. The medical journey unfolded with an urgent re-laparotomy, draining haemoperitoneum and conducting a subtotal hysterectomy. This case highlights the critical importance of a multidisciplinary approach involving obstetrics, nephrology, and intensive care, in managing such complex postpartum complications. Vigilant monitoring, collaborative decision-making, and meticulous postoperative care played pivotal roles. The successful outcome was attributed to early recognition, aggressive supportive measures, and timely interventions, including haemodialysis. The challenges faced underscore the need for accessible obstetric care, awareness about antenatal complications, and community-focused initiatives. Further research is warranted to unravel the intricate connections between PPH, RCVS, and associated complications, enhancing our understanding and improving patient outcomes in similar critical cases.

Background: Granulosa cell tumours (GCT) are the most common ovarian tumours in mares. The classical presentation of a GCT is a unilaterally enlarged ovary appearing as a multicystic honeycomb mass. In rare cases, GCTs cause haemoperitoneum as a result of rapid growth of the tumour. The clinical diagnosis of GCT is usually based on history, rectal examination, ultrasonographic examination and serum hormone analysis, and surgical removal of the affected ovary is the treatment of choice. The different surgical approaches are based on the dimension of the GCT. Case description: A 7-year-old mare was referred to the department for horses due to suspicion of a large colon impaction. The mare presented with clinical signs of colic, fever and signs of hypovolemic shock. Rectal and ultrasonographic examination showed haemoperitoneum and a honey-comb mass within the abdomen, and a granulosa cell tumour (GCT) as the cause of an acute haemoperitoneum was diagnosed based on the serum level of Anti-Mullerian hormone. After stabilization of the mare, the GCT was removed through a ventral midline incision. Because of the enormous dimensions of the GCT, intra-abdominal partial resection of the tumour using a tenotomy knife was necessary to exteriorize the ovarian pedicle. At 3 months follow-up, the mare was ridden for her intended use. Conclusion: This report provides an approach to an uncommon case of a very large and heavy GCT. [Open Vet J 2023; 13(9.000): 1212-1218]

Bilateral Renal Cortical Necrosis (BRCN) is a rare but serious condition characterised by the ischaemic necrosis of both kidneys' cortical tissues. Concurrently, Reversible Cerebral Vasoconstriction Syndrome (RCVS) manifests as a transient constriction of cerebral blood vessels. The fusion of these two rare entities within the context of severe Postpartum Haemorrhage (PPH) poses a unique diagnostic and therapeutic dilemma for healthcare practitioners. This case study documents the intricate and severe complications experienced by a 32-year-old primiparous woman following abruptio placenta with Intrauterine Foetal Death (IUFD). The patient presented with massive vaginal bleeding, leading to an emergency Lower Segment Caesarean Section (LSCS) where bilateral uterine artery ligation and bilateral internal iliac artery ligation were performed to control haemorrhage. Despite initial interventions, the patient's condition deteriorated, leading to signs of shock, haemoperitoneum, sepsis, Acute Kidney Injury (AKI), and cerebral complications. The medical journey unfolded with an urgent re-laparotomy, draining haemoperitoneum and conducting a subtotal hysterectomy. This case highlights the critical importance of a multidisciplinary approach involving obstetrics, nephrology, and intensive care, in managing such complex postpartum complications. Vigilant monitoring, collaborative decision-making, and meticulous postoperative care played pivotal roles. The successful outcome was attributed to early recognition, aggressive supportive measures, and timely interventions, including haemodialysis. The challenges faced underscore the need for accessible obstetric care, awareness about antenatal complications, and community-focused initiatives. Further research is warranted to unravel the intricate connections between PPH, RCVS, and associated complications, enhancing our understanding and improving patient outcomes in similar critical cases. [ABSTRACT FROM AUTHOR]

Mesenteric aneurysms and their complications can be a life-threatening presentation of acute abdomen to the emergency department. The majority of mesenteric artery aneurysms are incidentally detected on imaging investigations and are asymptomatic. Symptomatic mesenteric aneurysms manifest as hemoperitoneum or abdominal pain. In addition, treatment of symptomatic aneurysms is delayed due to the infrequent consideration of the diagnosis in patients presenting with abdominal pain. Timely and accurate diagnosis is of paramount importance as any delay in definitive surgical management can lead to increased patient's mortality and morbidity with up to 25% of mesenteric aneurysms may be complicated by rupture. [ABSTRACT FROM AUTHOR]

Cerebrospinal fluid (CSF) diversion for hydrocephalus via ventriculoperitoneal (VP) shunting is one of the most commonly performed neurosurgical procedures. Unfortunately, VP shunting also carries a high complication rate. While long-term complications of VP shunting are generally well-described, the literature on more acute, iatrogenic injury during shunt placement is essentially limited to easily identifiable intracranial bleeds. Herein is presented the first reported case of iatrogenic abdominal wall vessel injury as a consequence of blind distal VP shunt catheter placement causing a critical haemoperitoneum that necessitated multiple transfusions. Presentation and recognition of this bleed was delayed as it occurred over a number of days. Injury to the inferior epigastric artery, or potentially a distal branch of the superficial epigastric artery, is suspected to have occurred during either blind subcutaneous tunnelling of the shunt catheter passage or during penetration of the peritoneum. Haemoperitoneum as a potential complication of procedures involving manipulation or penetration of the abdominal wall (i.e. paracentesis) is well-described in the medical and general surgical literature, and ultrasound-guidance has been widely adopted to mitigate bleeding in these cases. Familiarity with intra-abdominal haemorrhage as a potential complication of VP shunting and an understanding of its presentation is critical for timely identification of this phenomenon. Furthermore, the use of real-time ultrasound-guidance for tunnelling and distal shunt catheter placement may decrease the incidence of intrabdominal complications after shunt placement more generally and should be considered an area of future study. [ABSTRACT FROM AUTHOR]

Uterine leiomyomas, or fibroids, are the most common benign tumours of the female genital tract. Although uterine fibroids are commonly associated with menorrhagia, dysmenorrhea, symptomatic anaemia, urinary or bowel symptoms and infertility, intra-abdominal haemorrhage is an exceedingly rare complication. Often, the diagnosis is poorly recognizable based on the patient's clinical presentation and alternative diagnoses such as ruptured ectopic pregnancy, ruptured ovarian cyst or perforated viscus are frequently considered.Herein, we describe a case of a 50-year-old perimenopausal woman who presented with acute, lower abdominal pain, evolving anaemia, hypovolaemic shock and haemoperitoneum with no discernable source. Emergency exploratory laparotomy confirmed the source of massive haemoperitoneum arising from a ruptured blood vessel supplying a large subserosal uterine leiomyoma and the patient subsequently underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy.Given the paucity of publications on this clinical entity, the aim of this report is to highlight a rare complication of uterine leiomyomas, its pathophysiological spectrum and its relevance to emergency physicians, general surgeons and gynaecologists.

Dengue fever is one of the most frequent arboviral diseases in the world. Dengue is known to cause myocarditis, hepatitis, and neurological illustrations but one of the established presentations is leakage of plasma resulting in circulatory failure. Spontaneous rupture of the spleen is one of the most infrequent but known outcome of dengue fever which has been reported from time to time in literature. We present, here, the case of a 50-year-old patient who developed this condition during dengue fever and was managed in our department successfully. This complication must be kept in mind while treating any case of dengue fever so that it can be avoided or if not then treated timely. Keywords: Spontaneous splenic rupture, Dengue Fever, Dengue haemorrhagic fever, Haemoperitoneum.

Spontaneous hepatic rupture in pregnancy (SHRP) is a rare but often fatal condition associated with pre-eclampsia or HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. SHRP is linked to significant maternal and perinatal morbidity and mortality, and maternal complications can extend past the initial intraoperative period. This case report describes the challenging perioperative course of a 35-year-old woman with SHRP. She underwent five laparotomies during a prolonged and complicated course in the intensive care unit. Despite these challenges, maternal and fetal outcomes were good. This case report serves to highlight key perioperative multidisciplinary issues in the care of these patients.

Summary: The abdominal seatbelt sign is well described in the literature as an indicative of intra-abdominal visceral injuries; it is considered rare because it is difficult to detect with no single observation providing reliable diagnosis. Consequently, it often presages a delayed diagnosis. We here report lessons from management of 44 year-old man professional driver, victim of a road traffic accident who underwent a damage control laparotomy and whose abdominal seatbelt sign was diagnosed late. To our knowledge, abdominal seatbelt sign has never been reported in a context of rural hospital with low technical facilities. The assessment of the injury revealed haemoperitoneum, rupture of the rectus abdominis, rupture of the appendix and the bowel loop with mesenteric tears. The patient had a second surgery due to a postoperative complication – a postoperative peritonitis with a parietal abscess; this resulted in a digestive fistula which was treated with twice-daily dressing. We learned from the management of this case that presence of an abdominal seatbelt sign in patient with good parameters should lead to paraclinical exploration. So, when faced with the presence of severe abdominal trauma, clinicians should always remember the principles of damage control laparotomy, regardless of the constraints encountered.

Summary: This report describes the likely development and growth of bilateral granulosa cell tumours (GCTs) in a Warmblood pony mare, during the first trimester of pregnancy after artificial insemination. The GCTs were initially suspected to be ovarian haematomas and were managed conservatively. However, they ultimately led to life‐threatening haemoperitoneum (HP) and were later diagnosed as GCTs with histopathology. The case was successfully managed with emergency standing laparoscopic‐assisted bilateral ovariectomy after haemodynamic supportive therapy. The mare made a full recovery and delivered a live filly foal at term. GCTs can be a rare cause of life‐threatening HP and can be successfully managed with haemodynamic support and standing laparoscopic‐assisted removal. Bilateral ovariectomy in a pregnant mare after 70 days of gestation can result in successful delivery of a live foal. [ABSTRACT FROM AUTHOR]

Abdominal Ectopic Pregnancy (AEP), a rare life-threatening obstetrical complication, is defined as ectopic implantation within the peritoneal cavity outside the uterus, tubes, ovaries, or intra-ligamentous locations. A series of three rare cases of early AEP is presented: (First case: a 32-year-old, gravida 2, para 1; Second case: a 31-year-old, gravida 3, para 2; and Third case: a 39-year-old gravida 4, para 2). All the cases were of early (

Usually, a hydatidiform mole (HM) develops inside the uterus. The occurrence of HM in ruptured tubal pregnancy is exceptional. Cases reported in the literature are scarce. In this article, a case of haemoperitoneum secondary to a ruptured fallopian tube by a complete mole is reported. A 50-year-old gravida 2, para 1 was admitted to the emergency department for acute abdominal pain. After the clinical examination, an abdominal sonography and CT scan were done, revealing the presence of an adnexal left mass associated with an important haemoperitoneum. A urine pregnancy test was done and was positive, indicating an immediate laparoscopic exploration. The laparoscopy revealed a haemoperitoneum secondary to a ruptured tubal mass. The pathological exam concluded a complete hydatidiform mole (CHM) invading the wall of the fallopian tube. Any acute abdominal pain in a potentially pregnant woman imposes first the routine realization of a pregnancy test. The occurrence of CHM in a ruptured fallopian tube is particularly rare and has exceptionally been diagnosed before the laparoscopic exploration.

We report a young male patient who presented with chest and shoulder tip pain with spontaneous intraperitoneal haemorrhage (haemoperitoneum) due to gastric vessel rupture. Point‐of‐care ultrasound detected abdominal free fluid, which led to a CT scan of the abdomen and reached the diagnosis. Intra‐abdominal bleeding can present as referred chest or shoulder tip pain, as more commonly seen in females with pelvic pathologies. Point‐of‐care ultrasound may add diagnostic value with the detection of a haemoperitoneum in this context. [ABSTRACT FROM AUTHOR]

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The liver can be damaged from an impact (such as in a car accident) or from penetrating trauma (such as a stab or gunshot wound). Liver lesions range from relatively small collections of blood (hematomas) to large deep lacerations. Since the liver is supplied with many large blood vessels, the main problem following a liver injury is severe bleeding. Almost all bleeding from a liver injury occurs in the abdominal cavity. Spontaneous rupture of the liver is a rare occurrence. This is often associated with underlying pathological conditions (pregnant women with HELLP syndrome, liver pathologies such as adenoma, hepatic lymphoma, hepatocellular carcinoma HCC, macronodular cirrhosis, hemangioma, metastatic tumors and peliosis hepatis) or following traumatic insults. The authors report a rare case of spontaneous rupture of the liver that occurred in a 72-year-old man without underlying pathologies predisposing this condition, in the absence of evident traumatic lesions in the abdominal area and with a near- negative pathological history of trauma (falls, road accidents, etc.).

Choriocarcinoma after a term pregnancy is rare and can be life-threatening, especially when it perforates the uterus, resulting in massive haemoperitoneum. As uterine rupture due to choriocarcinoma is uncommonly encountered in the clinical practice, its diagnosis is often missed or delayed. We present a case of a 41-year-old para 4 + 1 who had acute abdomen and hypovolaemic shock secondary to haemoperitoneum at three months postpartum period. The urine pregnancy test was positive, and, therefore, a provisional diagnosis of a ruptured ectopic pregnancy was made. She was managed aggressively with fluids and blood product transfusion at the emergency department to achieve haemodynamic stability. Subsequently, she underwent an emergency laparotomy where intraoperatively noted a perforation at the left posterior uterine cornu with purplish tissue spillage. A wedge resection was performed, and the histopathological examination (HPE) was reported as atypical trophoblastic cells, in which choriocarcinoma could not be ruled out. The patient then underwent a total abdominal hysterectomy three weeks later. The final HPE confirmed the diagnosis of choriocarcinoma. The clinical presentation of postpartum choriocarcinoma can be indistinguishable from a ruptured ectopic pregnancy. A high index of suspicion is crucial to allow early diagnosis. [ABSTRACT FROM AUTHOR]

Splenic rupture and/or splenectomy is/are not uncommon in clinical arena. Here we present this case of extensive haemorrhage-induced splenic rupture which resulted in splenectomy in a young healthy male (who did not have any previous medical conditions) following a Russell's viper bite. He developed upper abdominal and shoulder pain on his left side along with hypotension and reduced level of haemoglobin on the third day following bite despite antivenom treatment. Following confirmation of splenic rupture and haemoperitoneum by ultrasound and computed tomography scans, an emergency splenectomy was performed using laparotomy. Although Russell's viper bites are known to induce bleeding complications, splenic rupture due to haemorrhage in spleen has not been previously reported. Russell's viper venom toxins such as metalloproteases, serine proteases and phospholipase A 2 might have affected the vascular permeability resulting in excessive bleeding and increased pressure in the spleen leading to rupture. Further investigations are required to underpin the impact of snake venom toxins on the architecture and functions of spleen. However, the clinicians who treat snakebites should be aware of this type of rare complications so as to provide appropriate management for such victims. [Display omitted] • Snakebite-induced splenic rupture and subsequent splenectomy is a rare event. • We report Russell's viper bite-induced splenic rupture in a young healthy victim. • Splenic rupture has occurred due to excessive haemorrhage without any blood clots. • Russell's viper venom might have caused bleeding and vascular damage in spleen. • Clinicians should be aware of this rare event when treating snakebite victims. [ABSTRACT FROM AUTHOR]

Introduction: Blunt abdominal trauma is a major cause of morbidity and mortality in young people. Abdominal Ultrasonography (USG) can detect organ injury and free intra-abdominal fluid which provides indirect evidence of injury. Multidetector Computed Tomography (MDCT) is the modality of choice in haemodynamically stable patients as it can accurately diagnose and ascertain the severity of injuries. It can also evaluate retroperitoneum and detect arterial contrast extravasation or pseudoaneurysm which predicts the need for surgery or angioembolisation. Aim: To study the spectrum of abdomino-pelvic injuries on MDCT and to compare the MDCT findings with operative findings wherever possible. Materials and Methods: The prospective cohort study was conducted in the Department of Radiodiagnosis at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from the period 1st June 2019 to 31st May 2020. Patients with history of Road Traffic Accidents, fall, or assault or other causes where clinically blunt trauma of abdomen was suspected and referred for MDCT abdomen and pelvis were included. The blunt abdominal patients who were Focused Assessment with Sonography for Trauma (FAST) positive or had clinical suspicion of abdomino-pelvic injury were evaluated with MDCT. The present study was conducted on 64 slice MDCT scanner light speed Volume Computed Tomography Xte General Electrics (VCT Xte GE) medical systems. All patients underwent CECT abdomen and pelvis in arterial (30 seconds) and porto-venous phase (60 seconds). The MDCT findings were compared with operative findings and clinical follow-up was done after three months. Data were entered into Microsoft Excel sheet and Statistical Package for the Social Sciences (SPSS) software 20.0 version was used for analysing data. Results: Thirty five haemodynamically stable patients with blunt abdominal trauma were included in the study with mean age of 28.5±8.8 years with male predominance. Road traffic accident was the most common mechanism of injury. Visceral injury or free fluid was seen in all the 35 patients on MDCT of abdomen and pelvis. Twenty eight patients were managed conservatively while seven patients were operated. Solid organ injury was seen in 28 patients. Amongst solid organ injury, spleen was the most common organ injured followed by liver. On comparing MDCT and operative findings, pancreatic transection was found in three patients. Sigmoid perforation, renal injury and UB perforation were confirmed in one patient each. On comparing with surgical findings, MDCT had a sensitivity of 100%, specificity of 100% for detecting solid organ injury and the Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 100% and 100%, respectively. Amongst hollow visceral injury, jejunal perforation was seen in two patients while ileal perforation and Urinary Bladder (UB) perforation was seen in one patient each. However, one case of sigmoid perforation was missed on MDCT. On comparing with surgical findings, MDCT has a sensitivity of 66.66%, specificity of 100% for detecting hollow visceral injury and the PPV and NPV were 100% and 80%, respectively. Conclusion: The MDCT is helpful in detecting solid organ injuries. The MDCT plays a major role in the management of blunt abdominal trauma and helps in making decision regarding operative and non operative treatment. Therefore, MDCT is the investigation of choice in patients with blunt abdominal trauma. [ABSTRACT FROM AUTHOR]

Non-traumatic haemoabdomen in dogs usually occurs due to abdominal neoplasia, coagulopathies or organ torsion. The most common sources of bleeding in neoplastic cases are the spleen and liver, but other abdominal organs can also be involved. However, in the available veterinary literature, ruptured lymph nodes are not described as a cause of haemoabdomen. In the present manuscript, two canine cases of intra-abdominal haemorrhage from ruptured lymph nodes secondary to B-cell lymphoma are described.

Abstract Background Uterine leiomyomas are common benign tumours found in women of reproductive age that are rarely associated with intra-abdominal haemorrhage. The aetiology behind this relationship is poorly understood and the aforementioned association poorly recognized from a patient’s clinical presentation. Available information in the literature is limited to case reports. The aim of this systematic review is to document and highlight the occurrence of intra-abdominal haemorrhage from uterine fibroids, and determine associated morbidity and mortality. Methods A systematic review of Medline, EMBASE, Web of Science, Scopus, and The Cochrane Library – CENTRAL was performed from the databases inception through to December 2018 for case report and series of patients who experienced intra-abdominal haemorrhage from uterine fibroids. Findings were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results We identified 115 publications reporting on 125 original case reports. The documented intra-abdominal haemorrhage were commonly due to the rupture of superficial blood vessels over the surface of a fibroid, followed by rupture and avulsion of the fibroid involved. A clinical picture of sudden and profound hypovolemic shock with severe abdominal pain was often the presenting complaint, with a correct pre-operative diagnosis only made in 7 cases on computed tomography imaging. Hysterectomy and myomectomy were the most common surgery performed. Mortality was reported in 4 cases which were directly related to complications of uterine fibroids. Conclusion Intra-abdominal haemorrhage secondary to uterine fibroids remained a rare phenomenon which is poorly recognized among clinicians. While this association is not representative of the population of interest, it highlights the pathophysiological spectrum of uterine fibroids and its relevance to emergency physicians, surgeons and gynaecologists during clinical practice.

Introduction: Blunt abdominal trauma is a major cause of morbidity and mortality in young people. Abdominal Ultrasonography (USG) can detect organ injury and free intraabdominal fluid which provides indirect evidence of injury. Multidetector Computed Tomography (MDCT) is the modality of choice in haemodynamically stable patients as it can accurately diagnose and ascertain the severity of injuries. It can also evaluate retroperitoneum and detect arterial contrast extravasation or pseudoaneurysm which predicts the need for surgery or angioembolisation. Aim: To study the spectrum of abdomino-pelvic injuries on MDCT and to compare the MDCT findings with operative findings wherever possible. Materials and Methods: The prospective cohort study was conducted in the Department of Radiodiagnosis at Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from the period 1st June 2019 to 31st May 2020. Patients with history of Road Traffic Accidents, fall, or assault or other causes where clinically blunt trauma of abdomen was suspected and referred for MDCT abdomen and pelvis were included. The blunt abdominal patients who were Focused Assessment with Sonography for Trauma (FAST) positive or had clinical suspicion of abdomino-pelvic injury were evaluated with MDCT. The present study was conducted on 64 slice MDCT scanner light speed Volume Computed Tomography Xte General Electrics (VCT Xte GE) medical systems. All patients underwent CECT abdomen and pelvis in arterial (30 seconds) and porto-venous phase (60 seconds). The MDCT findings were compared with operative findings and clinical follow-up was done after three months. Data were entered into Microsoft Excel sheet and Statistical Package for the Social Sciences (SPSS) software 20.0 version was used for analysing data. Results: Thirty five haemodynamically stable patients with blunt abdominal trauma were included in the study with mean age of 28.5±8.8 years with male predominance. Road traffic accident was the most common mechanism of injury. Visceral injury or free fluid was seen in all the 35 patients on MDCT of abdomen and pelvis. Twenty eight patients were managed conservatively while seven patients were operated. Solid organ injury was seen in 28 patients. Amongst solid organ injury, spleen was the most common organ injured followed by liver. On comparing MDCT and operative findings, pancreatic transection was found in three patients. Sigmoid perforation, renal injury and UB perforation were confirmed in one patient each. On comparing with surgical findings, MDCT had a sensitivity of 100%, specificity of 100% for detecting solid organ injury and the Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were 100% and 100%, respectively. Amongst hollow visceral injury, jejunal perforation was seen in two patients while ileal perforation and Urinary Bladder (UB) perforation was seen in one patient each. However, one case of sigmoid perforation was missed on MDCT. On comparing with surgical findings, MDCT has a sensitivity of 66.66%, specificity of 100% for detecting hollow visceral injury and the PPV and NPV were 100% and 80%, respectively. Conclusion: The MDCT is helpful in detecting solid organ injuries. The MDCT plays a major role in the management of blunt abdominal trauma and helps in making decision regarding operative and non operative treatment. Therefore, MDCT is the investigation of choice in patients with blunt abdominal trauma.

Study Question: Is acute haemoperitoneum that is managed conservatively a precursor of deep endometriosis?, Summary Answer: Our study provides evidence to suggest that acute haemoperitoneum may lead to the development of deep endometriosis in a significant proportion of cases., What Is Known Already: A recent pilot study was the first to suggest that acute haemoperitoneum could be a precursor of deep endometriosis. However, the sample size was small, and the follow-up was not standardized owing to unknown rates of clot absorption and development of endometriosis., Study Design Size Duration: This was a prospective observational cohort study conducted at a single centre over a 31-month period. A required sample size of 30 was calculated using results from a previous study, with a minimum of 15 women each in the groups with and without significant haemoperitoneum (study and control groups, respectively). A total of 59 women were recruited to the study and eight were lost to follow-up. The final sample comprised 51 women, 15 in the study group and 36 in the control group., Participants/materials Setting Methods: All non-pregnant, premenopausal women aged 18-50 years who consecutively presented to our dedicated gynaecological diagnostic unit with severe acute lower abdominal pain were eligible for this study. We only included women who were clinically stable and were suitable for conservative management. Those with prior history or evidence of endometriosis on their initial ultrasound scan, previous hysterectomy, or bilateral oophorectomy were excluded. Participants had standardized follow-up visits for 6 months, with pelvic ultrasound scans and the British Society of Gynaecological Endoscopy pelvic pain questionnaires completed at each visit. The primary outcome was the sonographically confirmed presence of newly formed endometriosis. Secondary outcomes were the presence and change of pelvic pain symptoms and health-related quality of life (HR-QOL)., Main Results and the Role of Chance: After completion of follow-up, 7/15 (47%; 95% CI 21.3-71.4%) women presenting with acute haemoperitoneum (study group) developed sonographic evidence of deep endometriosis, compared to 0/36 (0%; 97.5% CI 0.0-9.7%) women in the control group. A ruptured functional haemorrhagic cyst was the most common cause of haemoperitoneum, occurring in 13/15 cases (87%). The time from the initial event to sonographic evidence of endometriosis varied from 2 to 6 months. The EuroQol visual analogue scores were not significantly different at baseline between the groups that developed and did not develop endometriosis [28 (interquartile range (IQR) 15-40, n = 6) vs 56 (IQR 35-75, n = 44), P  =   0.09], while the EuroQol-5D values were lower in the endometriosis group [-0.01 (IQR -0.07 to 0.19, n = 6) vs 0.62 (IQR 0.24-0.73, n = 44), P  =   0.002]. At 6 months, the EuroQol-5D scores were improved in both groups, but remained significantly lower in the endometriosis group compared to the no endometriosis group [0.69 (IQR 0.66-0.80, n = 6) vs 0.85 (IQR 0.76-1.00, n = 44), P  =   0.03]. There was no clinically relevant difference in the pelvic pain scores at either time point., Limitations Reasons for Caution: It remains uncertain whether minimal, superficial endometriosis existed at commencement of the study and had a role in the development of deep endometriosis. Although the ultrasound findings were in keeping with deep endometriosis, this was not confirmed histologically. The pelvic pain and HR-QOL findings could have been influenced by the baseline scores being taken when the patient was admitted with acute pain. Also, the sample size was too small to draw reliable conclusions regarding the impact of newly developed endometriosis on QoL., Wider Implications of the Findings: Our study provides further evidence showing that significant haemoperitoneum may be a precursor of deep endometriosis. Haemodynamically stable women presenting with acute pelvic pain and significant haemoperitoneum should be counselled about the risk of developing deep endometriosis. Interventional studies should be carried out in the future to see whether laparoscopy and pelvic washout could prevent development of deep endometriosis. Preventative strategies, including treatment to suppress ovulation and formation of functional cysts, should be further investigated. This includes the combined and progesterone-only contraceptive pills. Larger future studies are also required to assess women over a longer period of time, with adjustment for confounding factors, to evaluate a possible effect on HR-QOL and pain symptoms., Study Funding/competing Interests: Funding was obtained from The Gynaecology Ultrasound Centre, London, UK. TT received personal fees from GE, Samsung, Medtronic, and Merck for lectures on ultrasound. TT also received a postdoctoral grant from the South-Eastern Norwegian Health Authority (grant number 2020083)., Trial Registration Number: researchregistry6472., Competing Interests: T.T. received personal fees from GE, Samsung, Medtronic, and Merck for lectures on ultrasound. T.T. also received a postdoctoral grant from the South-Eastern Norwegian Health Authority (grant number 2020083). The other authors report no conflict of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)

Placenta accreta syndrome does not have any specific signs and symptoms except for the associated bleeding per vagina.1 The diagnosis is generally made on ultrasound. Placenta percreta presenting with acute abdomen and haemorrhagic shock due to associated uterine rupture and haemoperitoneum has been reported.2 The uniqueness of this case is placenta accrete presenting as haemoperitoneum with haemorrhagic shock and live viable foetus. [ABSTRACT FROM AUTHOR]

Haemoperitoneum secondary to ruptured splenic tumours can be either benign or malignant in origin. The majority of previous studies of canine haemoperitoneum have been retrospective, which are associated with well‐recognized biases, such as the potential to underappreciate the diversity of outcomes in a complex presentation such as haemoperitoneum. This study seeks to prospectively define perioperative morbidity and mortality of haemoperitoneum in dogs secondary to ruptured splenic masses. Forty dogs with haemoperitoneum secondary to a ruptured splenic mass met the inclusion criteria. As expected, the cohort predominately consisted of older large breed dogs. All dogs underwent preoperative staging and had a splenectomy performed. Histopathologic analysis was performed on the splenic mass, as well as any possible metastatic lesions that were noted intra‐operatively. Perioperative care outside of splenectomy was delivered in specialty practices using current conventional approaches to care (eg, transfusions and anti‐arrhythmic medications). Fifteen dogs (37.5%) had benign splenic tumours and were cured with surgery alone, whereas 62.5% had malignant disease (most often haemangiosarcoma [HSA]). Surgical outcomes were highly favourable in the vast majority of dogs. Indeed, 38 dogs (95%) survived and were discharged after a median hospitalization of 39.5 hours. Independent predictors of longer hospitalization times included receiving a transfusion and the development of an arrhythmia. Although small, this cohort defines distinctive and optimistic perspectives for dogs with haemoperitoneum from splenic tumour rupture. These favourable outcomes from this prospective study are sufficient to ask if larger prospective studies should be conducted to better inform owners during this challenging cancer emergency presentation. [ABSTRACT FROM AUTHOR]

Non-traumatic haemoabdomen in dogs usually occurs due to abdominal neoplasia, coagulopathies or organ torsion. The most common sources of bleeding in neoplastic cases are the spleen and liver, but other abdominal organs can also be involved. However, in the available veterinary literature, ruptured lymph nodes are not described as a cause of haemoabdomen. In the present manuscript, two canine cases of intra-abdominal haemorrhage from ruptured lymph nodes secondary to B-cell lymphoma are described. [ABSTRACT FROM AUTHOR]

Introduction: Splenic artery aneurysms (SAAs) are the most common (60%) of visceral artery aneurysms with the possibility of rupture. SAA rupture is associated with 20% mortality, which increases disproportionately to 75% in pregnant women, with fetal the mortality rate of 95%. Aim: We present a discussion based on the case report with a review of the literature on ruptured SAA in pregnancy as well as possible treatment options, complications and prognosis. Case study: Patient, 40-year-old pregnant woman, gravida 2, para 1, 33 week of pregnancy, with ruptured SAA, underwent cesarean section, splenectomy, and hypovolemic shock treatment. The outcomes of the mother and neonates were good. Postoperative recovery was complicated by right-sided pneumothorax. Results and discussion: 87% of patients with SAA are females. In our analysis of cases, with ruptured SAA in pregnancy, the parity may be the factor that influences the maternal and fetal outcomes. In third trimester of pregnancy (as in our case study) the most often mistaken indication for laparotomy was a suspected placental abruption. Conclusions: Ruptured SAA during pregnancy should be considered as one of the non-obstetric causes of intraabdominal bleeding. Careful observation of the patient from the onset of symptoms is a key approach that increases maternal and fetal survival. [ABSTRACT FROM AUTHOR]

Background: Uterine leiomyomas are common benign tumours found in women of reproductive age that are rarely associated with intra-abdominal haemorrhage. The aetiology behind this relationship is poorly understood and the aforementioned association poorly recognized from a patient's clinical presentation. Available information in the literature is limited to case reports. The aim of this systematic review is to document and highlight the occurrence of intra-abdominal haemorrhage from uterine fibroids, and determine associated morbidity and mortality.Methods: A systematic review of Medline, EMBASE, Web of Science, Scopus, and The Cochrane Library - CENTRAL was performed from the databases inception through to December 2018 for case report and series of patients who experienced intra-abdominal haemorrhage from uterine fibroids. Findings were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.Results: We identified 115 publications reporting on 125 original case reports. The documented intra-abdominal haemorrhage were commonly due to the rupture of superficial blood vessels over the surface of a fibroid, followed by rupture and avulsion of the fibroid involved. A clinical picture of sudden and profound hypovolemic shock with severe abdominal pain was often the presenting complaint, with a correct pre-operative diagnosis only made in 7 cases on computed tomography imaging. Hysterectomy and myomectomy were the most common surgery performed. Mortality was reported in 4 cases which were directly related to complications of uterine fibroids.Conclusion: Intra-abdominal haemorrhage secondary to uterine fibroids remained a rare phenomenon which is poorly recognized among clinicians. While this association is not representative of the population of interest, it highlights the pathophysiological spectrum of uterine fibroids and its relevance to emergency physicians, surgeons and gynaecologists during clinical practice. [ABSTRACT FROM AUTHOR]

Summary: Splenic trauma as a sequela to rib fracture is a recognised cause of haemoperitoneum in the horse. Although surgical repair to those areas damaged is advocated as the treatment of choice, information pertaining to the simultaneous repair of such sites is lacking. Additionally, the hypovolaemic case presents a separate anaesthetic challenge. This report is the first published description of a concurrent approach for a displaced rib fracture and an associated splenic capsular tear using laparoscopic technique in a standing sedated horse with acute haemoperitoneum. The rib fracture was reduced and stabilised using polyamide ties, and the splenic capsular tear repaired using intracorporeal suturing with knotless, unidirectional barbed suture. Total surgery time was 90 min and no complications were encountered during the procedure. The mare was discharged 6 days post‐operatively. Organ orientation in the standing case afforded excellent visibility to both the parietal surface of the spleen and fractured rib, and abolished the necessity for general anaesthesia. [ABSTRACT FROM AUTHOR]

Summary: This report describes two cases of successful surgical management of granulosa cell tumours (GCT) in mares presenting with haemoperitoneum (HP). Controlled abdominal drainage was initially attempted in Case 1 but was not successful. A ventral midline exploratory laparotomy allowed removal of a haemorrhaging 13 kg GCT. The mare made a full recovery and returned to normal work as a driving pony 11 months post‐operatively. In Case 2 controlled abdominal drainage was followed by standing left flank laparoscopic visualisation of the bleeding ovary and transection of the ovarian pedicle by electrocautery. The GCT was then removed via a ventral midline incision due to its large size. Haemoperitoneum can be associated with GCTs and in some cases is severe enough to prompt emergency treatment. Stabilisation of the patient and removal of the haemorrhaging GCT can lead to a successful outcome. [ABSTRACT FROM AUTHOR]

Introduction: Blunt Abdominal Trauma (BAT) is leading to most causes of death under 45 years of age. Ultrasonography (US) is useful in the evaluation of patients with BAT. Helical CT examination can produce more definitive diagnostic information in about the same time, it takes to perform a complete US examination. CT is accurate in the evaluation of abdominal visceral organ injuries and assessment of the retroperitoneum. Aim: To assess the role of US and CT in the evaluation of BAT and to compare operative findings or clinical follow-up in conservatively managed patients. Materials and Methods: This prospective study was conducted in the Department of Radiology from March 2017 to September 2018 on 64 patients with BAT. All patients underwent US and CT abdomen. The patients with haemoperitoneum or abdominal visceral injury or both were considered as positive for intra abdominal injury. The detection of organ injuries and haemoperitoneum on US were correlated with CT findings. Sensitivity, Specificity, PPV, NPV was used to find the correlation of US and CT scan with operative findings. Results: The overall sensitivity of US in the detection of solid organ injuries was 83.3% and specificity was 87.5%.The PPV was 93.7%, NPV was 70% and accuracy was 84%. The overall sensitivity and specificity in this study with respect to detection of solid organ injuries by CT was 94.7% and 100% respectively. The PPV was 100%, NPV 87.5% and accuracy of this study was 96%. Conclusion: US may be used as the initial diagnostic modality for suspected BAT. CT is accurate in the detection and quantification of haemoperitoneum and more sensitive in the detection of solid organ injury which is useful in the management of most patients.

Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Pleural ablation via thoracoscopy and hormonal therapy are mainstay treatment options to avoid recurrence. We present a case of a young adult female who experienced gradual painless abdominal distention that resolved spontaneously after each menses twelve years post menarche. She was first seen at a peripheral facility where laparotomy undertaken was negative for suspected ectopic pregnancy. However, a bleeding omental mass was noticed and a biopsy taken. Histopathology reported it as an endometriotic tissue. The patient subsequently had recurrent cyclical chest pains and breathlessness leading to the diagnosis of catamenial pneumothorax. She had chemical pleurodesis done with sterile talc after chest tube drainage and has been well over two years now.

Spontaneous rupture of a liver metastasis is a life-threatening complication of metastatic liver disease. Although metastatic liver lesions are much more common than primary tumours, spontaneous rupture of a liver metastasis is rare. Therapeutic decisions must take into account the extent of metastatic liver disease and the patient’s performance status. Transarterial embolization may be considered in cases of ongoing haemorrhage despite initial conservative measures. We describe a case of haemoperitoneum due to spontaneous rupture of a liver metastasis in a 72-year-old patient with carcinoma of unknown origin who responded well to conservative management.

Background The spleen is one of the most common solid organs injured in blunt abdominal trauma with significant mortality. The management of splenic injury has significantly changed over the last few decades, ranging from certain splenectomies to non-operative management (NOM). Although several retrospective studies have been published on the NOM of minor spleen injuries, few studies have analyzed the results of NOM for high-grade splenic injuries. The pertinent question that we attempt to answer is, "Is it possible to manage extensive splenic injuries non-operatively?". Objectives To study the feasibility of NOM for the American Association for the Surgery of Trauma (AAST) Grade 3, 4, and 5 splenic injuries and to assess the demographic profile and cases for AAST Grade 3, 4, and 5 splenic injuries. Methods and methodology We, retrospectively, studied patients admitted with AAST Grade 3, 4, and 5 splenic injuries from blunt abdominal trauma admitted at the Government Medical College, Thiruvananthapuram, India, between January 2014 and October 2020. Their demographics, grade of splenic injuries, associated injuries, and methods of management were collected, and statistical analysis was done. Results The study included 132 patients with AAST Grade 3, 4, and 5 splenic injuries. Fifty percent of patients had Grade 3 injuries, 39.4% had Grade 4 injuries, and 10.6% were found to have Grade 5 splenic injuries. Grade 3 and 4 injuries were mainly managed non-operatively, while Grade 5 injuries had a failure rate of nearly 65% when managed non-operatively. Additionally, 73.5% of splenic injuries were successfully managed non-operatively. A significant association was noted between the severity of injuries and the need for operative management (p<0.001). Meanwhile, 64.29% of the patients with Grade 5 splenic injuries ended up needing operative management, as opposed to 34.62% in Grade 4 and 12.12% in Grade 3 splenic injuries. Conclusion We suggest that NOM may be undertaken successfully in appropriately designed areas with close observation for hemodynamically stable patients with extra vigilance in the case of the elderly and those with associated injuries. There should be a low threshold for switching to operative management, especially in Grade 5 injuries., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Chandran et al.)

Splenic laceration antepartum or postpartum is a rare, frequently misdiagnosed and potentially catastrophic pathology that can lead to high maternal and fetal mortality and morbidity. It is therefore, imperative that a differential diagnosis of spleen related pathology or event as in splenic rupture or splenic artery aneurysm should be kept in mind in any woman presenting with upper abdominal pain or in shock during pregnancy.

Background: Spontaneously ruptured hepatoma is increasingly reported in Asia. However, data from Malaysia is lacking. They often present with abdominal pain, discomfort or distension. When there is hemoperitoneum with hypotension, it is potentially life threatening. The mortality rate has improved with the advances in treatment options such as transarterial embolization, perihepatic packing or liver resection. Case summary: We report 4 cases of spontaneously ruptured HCC which presented with hypotension with massive hemoperitoneum. Two patients had damage control perihepatic packing followed by transarterial embolization and achieved favourable outcome. One patient had transarterial embolization alone. Selective hepatic artery angiogram with embolization were performed with gel foam in all 3 patients and they survived more than 1 year on follow up. Another patient had perihepatic packing done alone but succumbed later due to nosocomial infection. Conclusion: Transarterial embolization is effective in haemorrhage control for spontaneously ruptured hepatoma with favourable early post-procedural outcome. Damage control perihepatic packing with subsequent embolization is effective in physiologically compromised patient due to rupture HCC. Further large-scale local study is recommended to propose a local treatment algorithm. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to describe the clinical use and outcome of autologous transfusions in cats with intracavitary haemorrhage. Methods: A retrospective descriptive study was performed. Computerised medical records of a single referral centre were searched for cats receiving an autotransfusion. Medical records were evaluated for underlying disease process, autotransfusion technique, autotransfusion volume, time period over which the autotransfusion was given, packed cell volume (PCV) pre- and post-autotransfusion, percentage rise in PCV, use of other blood products and any complications of the procedure. Survival to discharge and survival at 2 months was documented. Results: Between July 2012 and March 2018 a total of 12 autotransfusions were performed in eight cats. All patients were diagnosed with haemoperitoneum. Four of the eight cats were diagnosed with abdominal neoplasia, three had postoperative haemorrhage and one had a traumatic haemoperitoneum. Three cats received more than one autotransfusion. Blood was collected using a 23 G butterfly catheter and 20 ml syringe in 7/12 collections, a 23 G needle and 20 ml syringe in 2/12 collections and directly into syringes from the open abdomen at the time of surgery in 3/12 collections. A median volume of 50 ml (range 25–80 ml) was collected and administered, meaning a median volume of 16.5 ml/kg (range 9–26 ml/kg) was administered. The autologous transfusions were given over a median of 3 h (0.25–6 h). Five cats were given another blood product alongside the autotransfusion. Median percentage PCV increase was 5% (range 1–7%). Anticoagulant was used in 5/12 autotransfusions. No clinically relevant adverse effects were reported. Six of the eight cats survived to discharge. Two month survival was 60% (3/5). Conclusions and relevance: Autologous transfusion appears to be a safe and effective technique for stabilising cats with haemoperitoneum. This technique allows rapid and cheap provision of blood and avoids the need for an allogenic blood donor. [ABSTRACT FROM AUTHOR]

Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Pleural ablation via thoracoscopy and hormonal therapy are mainstay treatment options to avoid recurrence. We present a case of a young adult female who experienced gradual painless abdominal distention that resolved spontaneously after each menses twelve years post menarche. She was first seen at a peripheral facility where laparotomy undertaken was negative for suspected ectopic pregnancy. However, a bleeding omental mass was noticed and a biopsy taken. Histopathology reported it as an endometriotic tissue. The patient subsequently had recurrent cyclical chest pains and breathlessness leading to the diagnosis of catamenial pneumothorax. She had chemical pleurodesis done with sterile talc after chest tube drainage and has been well over two years now. [ABSTRACT FROM AUTHOR]

A 15-year-old Warmblood gelding was referred to the clinic because of abdominal discomfort. One year before clinical evaluation, the horse presented with a mass in the back muscles that had first appeared 3 years prior. The mass, located in the caudal saddle position, was of an unknown cause and did not disturb the horse in any way. A calcification was recognized radiologically; however, treatment was not pursued because of high risk of poor wound healing and infection in this area. On the day of referral the horse was presenting signs of colic as a result of a haemoperitoneum following a ruptured haematoma in the liver, which was diagnosed by laparoscopy in the standing position. The horse was euthanized because of persistent, extensive haemorrhage from the unstoppable bleeding of the liver. At necropsy liver amyloidosis with subcapsular and intrahepatic haematoma was diagnosed. The calcified mass in the horse's back muscle was considered to be an old infected wound that could be the trigger for Amyloid-A (AA) amyloidosis. To the author's knowledge, this condition has not yet been described in horses. [ABSTRACT FROM AUTHOR]

Highlights • Hyperfibrinolysis, as determined by rotational thromboelastometry (ROTEM) analysis, occurs in both dogs and cats. • In cats, hyperfibrinolysis occurs with trauma and cavitary bleeding. • In dogs, hyperfibrinolysis can occur in angiostrongylosis, cavitary bleeding, neoplasia, liver disease and other conditions. • Hyperfibrinolysis is associated with EXTEM (ROTEM activated by tissue factor) hypocoagulability in bleeding dogs. Abstract Hyperfibrinolysis (HFL) is a pathophysiological mechanism that has not been described in dogs or cats extensively. The aim of this study was to describe rotational thromboelastometry (ROTEM) parameters and underlying diagnosis in dogs and cats with HFL and evaluate association with bleeding diathesis. The ROTEM database was retrospectively searched for EXTEM (ROTEM activated with proprietary tissue factor) tracings with maximum lysis at 60 min ≥15%. Concurrent ROTEM and plasma coagulation tests, thrombocyte number, diagnosis and survival to hospital discharge were extracted from medical records. Analysis of differences between dogs and cats and of factors associated with bleeding, fulminant HFL (clot breakdown within 30 min) and survival to hospital discharge were performed. Hyperfibrinolysis was detected in eight cats presenting with haemoabdomen or haemothorax (n = 4/8, 50%) and trauma (n = 3/8, 38%) and in 36 dogs with angiostrongylosis (n = 12, 33%), neoplasia (n = 7, 19%), liver disease (n = 4, 11%) and others including apparently healthy dogs (n = 3, 8%). Hyperfibrinolysis was associated with prolonged EXTEM and APTEM (EXTEM with added apoprotein for inhibition of HFL) clotting time and decreased FIBTEM (EXTEM with added cytochalasin D for inhibition of thrombocytes) maximum clot firmness (MCF) in dogs and cats and with decreased EXTEM MCF in dogs. Bleeding dogs had significantly hypocoagulable EXTEM tracings. Fulminant HFL was associated with severe hypofibrinogenaemia in dogs (P = 0.005) and was not associated with survival to hospital discharge. Evidence of HFL was demonstrated in dogs and cats with bleeding, trauma, parasitic and neoplastic disease. HFL is associated with late and weak clot formation. [ABSTRACT FROM AUTHOR]

Introduction: Unforeseen emergency in late pregnancy can be catastrophic and cause unexpected maternal and foetal demise. Moreover, lack of awareness and failure of prompt treatment raise mortality rate. Such fatalities warrant a forensic autopsy as it may raise redundant medico-legal concerns. Case Report: We report a case that revealed significant intra-abdominal haemorrhage at autopsy. The source of haemorrhage was at the spleen hilum and histology established rupture of splenic artery aneurysm. There was no associated obstetric cause found. Conclusion: Knowledge of spontaneous rupture of splenic artery aneurysm in late pregnancy is essential for monitoring maternal and foetal, morbidity and mortality. However, in the eventuality of death a comprehensive forensic autopsy is the only investigation to recognise such calamity and clear clinical confusion. [ABSTRACT FROM AUTHOR]

Haemoperitoneum in women of reproductive age usually suggests either ruptured ectopic pregnancy or ruptured ovarian cysts. Metastatic choriocarcinoma is considered the least common cause of haemoperitoneum in women of childbearing age. We report a rare case of pancreatic and hepatic metastasis of choriocarcinoma in a young, 30-year-old female who had delivered 10 months prior at term gestation with no previous history of gestational trophoblastic disease or molar pregnancy. She had a short history of fever and pain in the right hypochondrium, with findings of hypovolaemic shock due to intraperitoneal haemorrhage. Unfortunately, the patient expired with massive uncontrolled bleeding from liver metastasis despite 2 emergency laparotomies within 12 h. This case report is an apt reminder to clinicians to include metastatic choriocarcinoma on the list of differential diagnoses for haemoperitoneum with a positive pregnancy test in women of reproductive age to diagnose early and to avoid life-threatening consequences.

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Unscarred uterine rupture is rare and disastrous for the mother and the foetus. It has been reported in each trimester of pregnancy and its presentation varies from silent uterine rupture to haemorrhagic shock. It may occur in prelabour stage, second stage or even in fourth stage of labour causing uncontrolled postpartum haemorrhage. Here, we report 4 cases of unscarred uterine rupture during labour. First case was of gravida 3, para 2 who came in shock following failed attempt of forceps application during second stage of labour. Laparotomy revealed uterine rupture with dead foetus. Second case was of gravida 2 para 1 who was referred in view of deep transverse arrest but she went into shock and uterine rupture was confirmed on laparotomy with delivery of an alive baby with poor APGAR score. Third case was of a primigravida who had cessation of uterine contraction after applying fundal pressure. Clinically, she was diagnosed with rupture uterus that was confirmed on laparotomy with delivery of still born baby. Fourth case was of a primigravida who was induced with misoprostol. She had foetal bradycardia followed by cessation of uterine contractions during second stage of labour. On laparotomy she had uterine rupture and a still born baby was delivered. All these cases were survived as a result of timely diagnosis and immediate laparotomy. All of them received multiple blood transfusions and discharged in satisfactory condition. High index of suspicion of an unscarred uterine rupture should be kept in mind irrespective of trimester or phase of labour. Immediate action must be taken to prevent major maternal and foetal morbidity.

Spontaneous hepatic rupture (SHR) during pregnancy is a rare but well known complication and it usually occurs alongside eclampsia or HELLP syndrome. SHR in uncomplicated pregnancy is extremely rare and can be associated to different undiagnosed pathological conditions. We report the case of a nulliparous woman, 27 weeks pregnant, with a peliosis hepatis, previously unknown, who was admitted to our unit due to SHR and massive hemoperitoneum. The conception was obtained by embryo transfer after multiple attempts of hormone-supported cycles using estrogens and progesterone. After emergency laparotomy the patient was submitted to deliver of the dead foetus and damage control of the hepatic bleeding source. At relaparotomy a right posterior sectionectomy (segments VI and VII) and segmentectomy of segment V were performed. The patient was discharged in good physical conditions after 18 days from admission. If hepatic rupture is suspected in a pregnant patient a collaborative multidisciplinary approach is mandatory. The cornerstones of medical and surgical management are highlighted. At the best of our knowledge this is the first case of SHR in a pregnant woman with peliosis hepatis. A possible correlation of an increased risk for SHR in a pregnant patient who was submitted to several attempts for embryo transfer is discussed. The relevant scientific literature of the possible causative role of the estrogen therapy in inducing politic liver damage is also reviewed.