pituitrin and Hemoperitoneum

Pregnancy in a rudimentary horn is although rare, but is associated with the risk of rupture and life threatening hemorrhage. With the use of ultrasound the diagnosis can be made before symptoms occur. Management usually consists of excision of the rudimentary horn along with the pregnancy and the ipsilateral tube, traditionally by laparotomy.. We present a case of a 16-week ruptured rudimentary horn pregnancy diagnosed intraoperatively and managed laparoscopically in the presence of massive haemoperitoneum, which is first of its kind along with literature review.. This case demonstrates that laparoscopy is a feasible approach and can provide rapid diagnosis and control of bleeding in such cases provided there is availability of efficient multi-disciplinary teamwork, optimal anesthesia, advanced cardiovascular monitoring, laparoscopic expertise and ability to convert rapidly to laparotomy if required.

Topics: Adult; Female; Hemoperitoneum; Humans; Laparoscopy; Oxytocin; Pregnancy; Ultrasonography; Uterine Rupture; Uterus; Vasopressins

We reviewed the courses of 40 patients with variceal bleeding treated with a standardized protocol, including intravenous (IV) vasopressin (Pitressin) and transhepatic embolization. Twelve of the 32 patients with acute episodes of massive variceal bleeding responded to the administration of IV vasopressin alone. Of the 20 patients who did not respond to vasopressin therapy, emergency transhepatic portography with embolization produced cessation of bleeding in ten (50%). The remaining ten patients who failed to respond to either IV vasopressin therapy or transhepatic embolization died, regardless of whether they were treated with aggressive medical therapy or emergency portosystemic shunt. Transhepatic embolization in both the emergent and elective situation demonstrated a thrombotic complication rate of 20%, which limited or precluded eventual therapy with elective portosystemic shunt. Because of this relatively high incidence of occult portal thromboses after transhepatic embolization, transhepatic portography should be obtained routinely prior to elective portosystemic shunts in those patients who have a history of transhepatic embolization.

Topics: Adult; Aged; Embolization, Therapeutic; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemoperitoneum; Humans; Infusions, Parenteral; Male; Middle Aged; Portal System; Radiography; Thrombosis; Vasopressins

Topics: Angiography; Female; Hemoperitoneum; Humans; Infusions, Intra-Arterial; Mesenteric Arteries; Middle Aged; Rupture, Spontaneous; Splenic Vein; Varicose Veins; Vasopressins