Abdominal apoplexy

Gough, Ian; Strong, Ross

doi:10.1002/bjs.1800650509

Cited by 13 publications

(11 citation statements)

References 7 publications

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“…Emergency laparotomy and ligation of the ruptured vessel is essential [1,5,10,11], whereas evacuation of the hematoma and inspection of certain arteries are needed [1]. In some cases though, the site of bleeding cannot be identified at laparotomy [1,6,11].…”

Section: Discussionmentioning

confidence: 99%

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Abdominal apoplexy secondary to spontaneous rupture of the right gastric artery in a coagulopathic patient

Salemis¹,

Tsohataridis²

2008

Intern Emerg Med

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Section: Discussionmentioning

confidence: 99%

“…Abdominal apoplexy (spontaneous intraperitoneal hemorrhage) is the spontaneous rupture of an intra-abdominal artery in the absence of aneurysmal dilatation or direct trauma [1]. It is a very rare but life-threatening condition, and it usually poses a considerable intraoperative dilemma [2].…”

mentioning

confidence: 99%

Abdominal apoplexy secondary to spontaneous rupture of the right gastric artery in a coagulopathic patient

Salemis¹,

Tsohataridis²

2008

Intern Emerg Med

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“…pancreaticoduodenal, gastroduodenal, superior mesenteric, inferior mesenteric and colic arteries) show that these present mostly in middle-aged men as unexplained abdominal pain with other gastrointestinal or systemic associations that vary between the individual arteries; for example, gastroduodenal artery aneurysms were found to be related to pancreatitis and biliary disease; superior mesenteric artery aneurysms were associated with hypertension and endocarditis. 20,21 Although pain is almost always the presenting complaint 21 and is commonly associated with diarrhoea and vomiting, the lack of symptom specificity and the rarity of the clinical findings may result in delayed diagnosis. Some articles have reported congenital aneurysms involving anomalous visceral arteries of the celiomesenteric trunk; 7 others describe multiple congenital aneurysms associated with connective tissue/ vasculitic disorders such as Ehler Danlos, polyarteritis nodosa, 14 Takayasu's arteritis 15 and Wegener's granulomatosis.…”

Section: Discussionmentioning

confidence: 99%

Kehr's sign – a rare cause: Spontaneous phrenic artery rupture

Sutton

Marshall

White

et al. 2002

ANZ Journal of Surgery

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Pain referred to in the left shoulder along with left upper quadrant hyperaesthesia after splenic rupture is a well-recognized physical sign, and was originally described by Hans Kehr (1862Kehr ( -1916 in the late 19th century. 1 We describe a previously unreported case of Kehr's sign secondary to spontaneous rupture of the left inferior phrenic artery. CASE REPORTA 43-year-old woman was admitted as a surgical emergency patient with sudden onset left upper quadrant abdominal pain radiating to the left shoulder, which was exacerbated by coughing. On initial clinical examination the patient appeared well. She was haemodynamically stable with left upper quadrant abdominal pain but no signs of peritonitis. At this stage, her haemoglobin was 12.1 g/dL and her white cell count was 13.6; coagulation studies were normal. Erect chest and abdominal radiographs were unremarkable. An abdominal ultrasound scan demonstrated the presence of upper abdominal free fluid, and the spleen appeared enlarged and was surrounded by a mixed echogenic collection measuring approximately 10 cm in diameter. An initial diagnosis of spontaneous splenic rupture was made. She was managed conservatively with regular observation. The following morning, the patient had deteriorated with increasing abdominal pain, tachycardia and hypotension. Her haemoglobin was now 8.6 g/dL, so a transfusion was organized and an emergency laparotomy performed.Upon opening the peritoneal cavity, a small amount of fresh blood was seen anterior to the lesser curve of the stomach. The spleen appeared congested and there was a haematoma present in the transverse mesocolon and lesser sac. Upon re-inspection, the spleen had become displaced by a significant retroperitoneal haematoma, and it was thought that the patient had ruptured a splenic artery aneurysm (Fig. 1). The splenic artery was mobilized but it became immediately apparent that this was not the case. As the posterior wall of the lesser sac was incised there was 1.5 L of haematoma tracking behind the left triangular ligament. The left triangular ligament was mobilized and the haematoma was evacuated. A rupture of the left inferior phrenic artery was discovered on the inferior surface of the diaphragm and was under-run. The patient made an uneventful recovery and was discharged 4 days later. DISCUSSIONFew cases describing bleeding from the phrenic arteries have been documented. The phrenic arteries are vessels of complex anatomical arrangement characterized by their variable originfrom the aorta, coeliac trunk or renal arteries -and multiplicity of branches. 2,3 In a search of the literature, two articles were found which describe injury to these arteries by laceration: (i) following percutaneous needle lung biopsy presenting as a haemoperitoneum; 3 and (ii) as a complication of repairing pectus excavatum, 4 which presented as a haemothorax. Other rare cases of haemoperitoneum involving the phrenic arteries have been documented in which the underlying aetiology was attributed to aneurysmal dilatation of the vessel...

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“…The history may be helpful if non-specific abdominal symptoms precede the onset of shock and peritonism but the patient's condition usually precludes sophisticated investigation. Visceral angiography has been suggested if difficulty is encountered in locating the bleeding point (Gough and Strong, 1978). If the patient is pregnant in the second or third trimester and if the history is suggestive, rupture of the splenic artery is strongly indicated.…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous rupture of an intra-abdominal artery in the absence of trauma or aneurysm is a rare but well described cause of haemoperitoneum (Gough and Strong, 1978;Stevenson, Mansfield and Temple, 1978). In an analysis of 129 consecutive cases of haemoperitoneum, only 3 were ascribed to spontaneous intraperitoneal haemorrhage (Ellis, Griffiths and MacIntyre, 1958).…”

Section: Introductionmentioning

confidence: 99%

Distal pancreatectomy for spontaneous rupture of the splenic artery

Porter

Fenton

1981

Postgraduate Medical Journal

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Summary Two patients with haemoperitoneum due to spontaneous haemorrhage near the tail of the pancreas are described. One patient presented acutely with epigastric pain and was found to be bleeding from the main trunk of the splenic artery. The other presented with a prolonged history of epigastric pain culminating in a haematemesis and was found to have a partially organized haematoma in the tail of the pancreas. In both cases the bleeding was proximal to the splenic pedicle, and distal pancreatectomy with splenectomy was necessary to achieve haemostasis.

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Abdominal apoplexy

Cited by 13 publications

References 7 publications

Abdominal apoplexy secondary to spontaneous rupture of the right gastric artery in a coagulopathic patient

Abdominal apoplexy secondary to spontaneous rupture of the right gastric artery in a coagulopathic patient

Kehr's sign – a rare cause: Spontaneous phrenic artery rupture

Distal pancreatectomy for spontaneous rupture of the splenic artery

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