Ruptured Ectopic Pregnancy: Epidemiology and Management in the General Surgery Department of the Ignace Deen National Hospital, Conakry University Hospital

Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Hospital. Methodology: This was a retrospective, descriptive study lasting two years (January 1, 2020 to December 31, 2022), carried out in the general surgery and gyneco-obstetrics departments of the Ignace Deen national hospital, Conakry University Hospital. We included all patients with a ruptured ectopic pregnancy who received surgical treatment during the study period. Results: We collected 13,524 cases of surgical interventions in the two services, among them, we recorded 89 cases or 0.66% GEUR. The average age of the patients was 24.26 years. Brides were the most represented with 80.96% of cases. Women practicing a liberal profession were 51.69% (n = 46) and housewives 26.97% (n = 24). Clinically, amenorrhea was noted in all patients, i.e. 100%, abdominal-pelvic pain in 95.2% (n = 85) of cases, metrorrhagia in 94.08% (n = 84), abdominal-pelvic sensitivity in 97.44% (n = 87) of cases and anemia in 85.39% of cases. The GEUR was ampullary in 69.66% (n = 62) cases. Salpingectomy was performed in 90.72% (n = 81). The surgical outcomes were satisfactory in 98.87% (n = 88) of cases. We recorded one case of surgical site infection. We have not recorded any deaths. The average length of hospitalization was 4 days. Conclusion: GEUR is relatively high in our context. A good understanding of the prognostic factors of GEUR, awareness and family planning could reduce GEUR.

Ruptured teratoma mimicking a pelvic inflammatory disease and ovarian malignancy:A case report

BACKGROUND We report a case of ruptured ovarian teratoma mimicking pelvic inflammatory disease(PID)and ovarian malignancy.The case indicates the need for reviewing the information on ovarian teratomas,as the symptoms are vague,and,therefore,diagnosis and treatment had to be structured accordingly.CASE SUMMARY A 60-year-old woman was admitted to the emergency department with acute lower abdominal pain.She experienced weight loss and increased abdominal girth.Pelvic ultrasound and computed tomography revealed a 14-cm pelvic tumor.Laboratory examination revealed leukocytosis(white blood cell count:12620/μL,segment:87.7%)and high levels of C-reactive protein(18.2 mg/dL).Elevated levels of the tumor marker cancer antigen 19-9(367.8 U/mL,normal value<35 U/mL)were also noted.Due to the impression of a ruptured tuboovarian abscess or a tumor with malignancy,she immediately underwent an exploratory laparotomy.A ruptured ovarian tumor with fat balls,hair strands,cartilage,and yellowish fluid was observed on the right side.Right salpingooophorectomy was performed.A pathological examination revealed a mature cystic teratoma.The patient recovered after surgery and was discharged on postoperative day three.No antibiotics were administered.CONCLUSION This case illustrates the differential diagnosis of an ovarian tumor.Therefore,surgery is the mainstay for treating a ruptured teratoma.

Delayed versus immediate intervention of ruptured brain arteriovenous malformations:A case report

BACKGROUND Brain arteriovenous malformations(bAVMs)remains one of the most prevalent causes of intracranial hemorrhage and stroke-like syndromes in the young adult population.Although it has been agreed upon that definitive treatment using either single or multi-modal approach is warranted for successful bAVM management,much debate still revolves regarding the optimal timing of definitive treatment.CASE SUMMARY In this report,we present a case of delayed,definitive endovascular treatment for ruptured bAVM in a 21-year-old female,3 mo post-ictus.The bAVM,with a left pericallosal feeding artery and cortical draining veins,was successfully obliterated through embolization using the Onyx 18.On follow-up the patient has recommenced her daily activities and experiences only mild occasional headaches with mild motor deficits.The report leads to our review on an important issue regarding the optimal timing of ruptured bAVM definitive management and bring forward the current evidence available on delayed vs immediate definitive bAVM intervention.We also highlight current issues that need to be addressed for clearer guidelines on definitive therapy initiation.CONCLUSION Current treatment paradigms of ruptured bAVM remains elusive,with substantial heterogeneity in the current literature.A consensus on the definition of“acute”vs“delayed”,management goal,follow-up length and outcome parameters are required to support formation of a clear paradigm.

Ruptured gastric artery aneurysms in polyarteritis nodosa successfully treated with embolization

Dear editor,Polyarteritis nodosa(PAN) is a rare form of vasculitis involving small-and medium-sized vessels in multiple organs. Severe gastrointestinal(GI) hemorrhage in PAN due to multiple ruptures of aneurysms of arteries is uncommon and life-threatening.

Predictors of liver failure after transarterial chemoembolization in patients with spontaneously ruptured hepatocellular carcinoma:A retrospective study

Background: Spontaneously ruptured hepatocellular carcinoma(rHCC) is a life-threatening condition. Transarterial chemoembolization(TACE) is a widely accepted treatment;however, it can lead to serious complications,especially liver failure. We sought to identify preoperative predictors of liver failure in patients with rHCC undergoing TACE.Methods: Patients with rHCC who received TACE as the initial therapy were retrospectively studied at our institution between January 2016 and December 2021. Based on the occurrence of liver failure after TACE, the patients were divided into liver failure and no-liver failure groups. Predictors of liver failure after TACE were analyzed using univariate and multivariate regression analyses. The predictive performance was assessed using the area under the curve(AUC). Delong’s test was used to compare predictive efficiency.Results: Sixty patients(19 and 41 in the liver failure and non-liver failure groups, respectively) were included.Multivariate analysis showed that preoperative prothrombin activity(PTA) level(odds ratio [OR], 0.956;95%confidence interval [CI], 0.920–0.994;P = 0.024) and Child-Pugh grade B(OR, 6.419;95% CI, 1.123–36.677;P= 0.037) were independent predictors of liver failure after TACE in patients with rHCC. The AUCs of the preoperative PTA levels and Child-Pugh grade B for predicting liver failure after TACE in patients with rHCC were0.783 and 0.764, respectively.Conclusion: Preoperative PTA level and Child-Pugh grade B were significant independent risk factors for liver failure after TACE in patients with rHCC. These can be used to predict liver failure after TACE in patients with rHCC for individual decision-making regarding treatment planning.

Management of ruptured hepatocellular carcinoma:Implications for therapy

AIM:To assess the treatment and tumor-related variables associated with outcome after treatment of spontaneously ruptured hepatocellular carcinoma (HCC).METHODS: Patients with ruptured HCC were identif ied. The complications, mortality and survival were assessed. The relationship between tumor size and the severity of hemoperitoneum and between tumor size and grade were examined.RESULTS: From January 1993 to January 2008, 556 patients with HCC with or without cirrhosis were evaluated; of which, 16 (2.87%) presented with spontaneous rupture. All but 1 patient had cirrhosis. Twelve patients underwent surgical resection while 4 underwent trans-cutaneous arterial catheter embolization (TAE) (trans-cutaneous arterial embolization). Early mortality (<30 d) was 25% (4 of 16) and was inversely relatedto Child-Pugh score; 3 of the 4 early deaths occurred in patients treated with TAE with 1 of 12 occurring in the resected group. There was no correlation between tumor size and grade or between size and severity of hemoperitoneum.CONCLUSION: Tumor size did not correlate with severity of the hemoperitoneum. There was an inverse relationship between G1-G3 (grade of cellular differentiation) HCC and dimensions.

Risk Prediction Model for Surgical Treatment of Ruptured Corpus Luteum in the Ovary

Objective: To explore the related factors of surgical treatment of patients with corpus luteum rupture and establish a risk prediction model of surgical treatment of corpus luteum rupture. Methods: 222 patients with corpus luteum rupture treated in Jingzhou First People’s Hospital from January 2015 to March 2022 were analyzed retrospectively, including 45 cases of surgery and 177 cases of conservative treatment. The training set and validation set were randomly assigned according to 7:3. We collected the basic information, laboratory and ultrasonic examination data of 222 patients. Logistic regression analysis was used to determine the independent risk factors and combined predictors of surgical treatment of corpus luteum rupture. The risk prediction model was established and the nomogram was drawn. The discrimination and calibration of the prediction model were verified and evaluated by receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow goodness of fit test;Decision curve analysis (DCA) was used to evaluate the clinical effectiveness of the prediction model. Results: Univariate logistic regression showed that whole abdominal pain (OR: 2.314, 95% CI: 1.090 - 4.912), abdominal muscle tension (OR: 2.379, 95% CI: 1.112 - 5.089), adnexal mass ≥ 4 cm (OR: 3.926, 95% CI: 1.771 - 8.266), hemoglobin Conclusion: The nomogram prediction model containing three predictive variables (hemoglobin, depth of pelvic effusion under ultrasound and cervical lifting pain) can be used to predict the risk of surgical treatment in patients with corpus luteum rupture.

Survival outcome of patients with spontaneously ruptured hepatocellular carcinoma treated surgically or by transarterial embolization

AIM: To evaluate clinical outcomes of patients that underwent surgery, transarterial embolization (TAE), or supportive care for spontaneously ruptured hepatocellular carcinoma (HCC). METHODS: A consecutive 54 patients who diagnosed as spontaneously ruptured HCC at our institution between 2003 and 2012 were retrospectively enrolled. HCC was diagnosed based on the diagnostic guidelines issued by the 2005 American Association for the Study of Liver Diseases. HCC rupture was defined as disruption of the peritumoral liver capsule with enhanced fluid collection in the perihepatic area adjacent to the HCC by dynamic liver computed tomography, and when abdominal paracentesis showed an ascitic red blood cell count of > 50000 mm 3 /mL in bloody fluid. RESULTS: Of the 54 patients, 6 (11.1%) underwent surgery, 25 (46.3%) TAE, and 23 (42.6%) supportive care. The 2-, 4and 6-mo cumulative survival rates at 2, 4 and 6 mo were significantly higher in the surgery (60%, 60% and 60%) or TAE (36%, 20% and 20%) groups than in the supportive care group (8.7%, 0% and 0%), respectively (each, P < 0.01), and tended to be higher in the surgical group than in the TAE group. Multivariate analysis showed that serum bilirubin (HR = 1.09, P < 0.01), creatinine (HR = 1.46, P = 0.04), and vasopressor requirement (HR = 2.37, P = 0.02) were significantly associated with post-treatment mortality, whereas surgery (HR = 0.41, P < 0.01), and TAE (HR = 0.13, P = 0.01) were inversely associated with posttreatment mortality. CONCLUSION: Post-treatment survival after surgery or TAE was found to be better than after supportive care, and surgery tended to provide better survival benefit than TAE.

Ruptured hepatocellular carcinoma following chemoembolization:a western experience

BACKGROUND: Transcatheter arterial chemoembolization (TACE) is a recommended first line therapy for unresectable hepatocellular carcinoma (HCC). Serious complications such as neutropenic sepsis and hepatic decompensation are well known, but rupture of HCC following TACE is a rare and potentially fatal complication. The aim of this study was to identify the incidence of ruptured HCC following TACE and the associated risk factors. METHODS: A retrospective analysis was performed using our liver database with 'chemoembolization', 'ruptured HCC' covering the patients who received chemoembolization from January 1995 to December 2005. There were no exclusions. RESULTS: A total of 294 patients received chemoemboliza- tion in 530 sessions during the 10-year period. Of these, 2 ruptured following treatment (incidence 0.68%). The mean age was 65 years and the interval between the treatment and rupture was 2 and 24 days. The common factors were male sex, large tumor size (range 11-13 cm), and exophytic tumor growth. One patient died 2 days after rupture with hepatic decompensation while the second is alive after a 6-month follow up without tumor recurrence. CONCLUSIONS: Ruptured HCC following TACE is a rare but serious complication. Large tumor size, male sex, and exophytic growth of tumor may be predisposing factors for rupture.

Comparison between laparoscopic surgery and laparotomy for the treatment of acute ruptured ectopic pregnancy

Objective: To study the stress reaction after laparoscopic surgery and laparotomy for the treatment of acute ruptured ectopic pregnancy. Methods: 68 patients with acute ruptured ectopic pregnancy who received emergency surgical treatment in Pangang Group General Hospital between July 2013 and September 2016 were selected and analyzed retrospectively, including 29 patients with laparoscopic surgery and 39 patients with laparotomy who were included in the laparoscopy group and laparotomy group respectively. Before operation as well as 1d and 3d after operation, serum was collected to detect biochemical indexes and stress hormones. Results: 1d and 3d after operation, serum Alb, AST, ALT, BUN, Scr and UA levels were not significantly different between laparoscopy group and laparotomy group (P>0.05);serum NE (149.65±17.58 vs. 186.61±23.52, 162.32±20.15 vs. 295.86±28.97 pg/ml), E (135.28±19.85 vs. 179.55±22.52, 152.11±18.52 vs. 231.38±29.58 pg/ml), ACTH (3.88±0.49 vs. 5.12±0.82, 4.39±0.52 vs. 6.58±0.92 pmol/L), Cor (177.64±20.12 vs. 224.59±35.55, 185.21±22.12 vs. 289.45±41.28 ng/ml), Ins (12.21±1.86 vs. 17.58±2.52, 18.95±2.68 vs. 27.61±4.12 IU/mL), PRA (1.65±0.25 vs. 2.18±0.35, 1.73±0.21 vs. 2.55±0.47ng/ml), AngⅡ (44.12±7.64 vs. 59.63±7.92, 52.27±7.95 vs. 76.12±9.35 pg/ml) and ALD (155.22±19.76 vs. 205.62±24.52, 189.10±22.58 vs. 316.85±42.85 pg/ml) levels of laparoscopy group were significantly lower than those of laparotomy group (P<0.05). Conclusions: Laparoscopic surgery for acute ruptured ectopic pregnancy causes less adrenal stress reaction and RAAS system stress reaction, and the overall level of trauma is lower than that of laparotomy.

Diagnosis of ruptured superior mesenteric artery aneurysm mimicking a pancreatic mass

Aneurysms and pseudoaneurysms of the superior mesenteric artery are potentially lethal and should be treated as urgently as possible.In a 52-year-old man with occasional epigastric pain,we accidentally discovered a superior mesenteric artery aneurysm that was ruptured with spontaneous tamponade in the uncinate process and in the head of the pancreas.The ruptured aneurysm had a heterogeneous appearance due to its thrombotic and hemorrhagic content,and it simulated a voluminous mass in the head and uncinate process of the pancreas,associated with mild dilatation of the main pancreatic duct.Recent advances in multidetector computed tomography and magnetic resonance imaging have enabled radiologists to develop a correct diagnosis of mesenteric aneurysms and pseudoaneurysms of the visceral branches of the abdominal aorta,and to differentiate this diagnosis from that of pancreatic or peripancreatic masses;angiography is currently used to confirm a diagnosis and to develop therapeutic treatments.

Ruptured hydatid cyst in a patient with shock

Echinococcosis is a severe helminthic zoonosis largely caused by Echinococcus granulosus and frequently encountered in endemic areas.The liver and lung are the most frequently involved organs.Cyst rupture into the peritoneal cavity represents a rare but serious complication.Herein,we describe an acute occurrence of anaphylactic shock due to a spontaneous rupture of hydatid cyst in a 21-year-old Turkish patient unwittingly infected by Echinococcosis.Resection surgery of the perforated cyst in combination with cleaning of the abdominal cavity was performed.The patient rapidly improved and no relapse occurred during a follow-up of 8 months.Anaphylaxis is a serious complication of hydatid cyst rupture and needs to be promptly diagnosed.The main objective of our report is to underscore this life-threatening complication that should be considered when anaphylactic shock of unknown origin occurs,even in non-endemic regions.Moreover,we emphasize the need for a radical surgical approach to avoid widespread dissemination.

Peritonitis secondary to ruptured splenic abscess:A grave complication of typhoid fever

Splenic abscesses are increasingly being identified,possibly due to widespread use of imaging modalities in clinical practice.The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain.These symptoms are similar to most infectious diseases prevalent in the tropics,making imaging by ultrasonography or computer tomography a necessity in the diagnosis.There are reports from different geographic areas on splenic abscesses associated with typhoid fever.We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

Intravitreal aflibercept for ruptured retinal arterial macroaneurysm

Dear Editor,Retinal arterial macroaneurysm（RAM）,which usually occurs within the first three orders of arterial bifurcation,is acquired fusiform or saccular dilatations of retinal arterioles^（[1-2]）.Aging,the female gender,and systemic vascular

Supraceliac Aortic Clamping for Repair of Ruptured Abdominal Aortic Aneurysm in Patients with Short Aortic Neck Length

Objective: Prompt bleeding control with proximal aortic clamping and subsequent aortic repair are very important for ruptured abdominal aortic aneurysm. However, unsuitable anatomy, such as short aortic neck length, not only disturbs the means to an expeditious repair, but may also increase morbidity and mortality. In the present study, we aimed to evaluate the efficacy of supraceliac aortic clamping for improving surgical outcomes for patients with ruptured abdominal aortic aneurysm, who have a short aortic neck length. Method: Between April 2010 and September 2015, eighteen patients underwent emergent open surgical repair of ruptured abdominal aortic aneurysm. Eight patients with a short aortic neck length underwent supraceliac aortic clamping, and 10 underwent infrarenal aortic clamping. Results: The mean supraceliac aortic clamping time was 30 ± 7 minutes. There was 1 operative death in the infrarenal aortic clamping group due to respiratory failure, and the overall operative mortality was 6%. There were no significant differences between the 2 groups with respect to postoperative complication rates or mortality. Furthermore, there were no significant differences in variables of renal function between the 2 groups, through-out the study period. Conclusion: Supraceliac aortic clamping was associated with minimal mortality and morbidity, but not with harmful effects on postoperative renal function. Thus, supraceliac aortic clamping can be safely applied for ruptured abdominal aortic aneurysm with short aortic neck length.

The Presence but not the Location of an Appendicolith Affects the Success of Interval Appendectomy in Children with Ruptured Appendicitis

Purpose: To determine whether the presence and/or location of an appendicolith can predict failure of initial non-operative management in children with ruptured appendicitis. Methods: A retrospective chart review of pediatric patients presenting with ruptured appendicitis was performed. Patients in whom the intent to treat was with initial non-operative management and interval appendectomy (IA) were selected (n = 117). One patient was excluded due to the presence of both intraluminal and extraluminal appendicoliths. Children who failed initial non-operative management were assigned to the “failure” group (n = 22). Children that improved and underwent elective IA were assigned to the “success” group (n = 94). Age, gender, duration of symptoms, presence of an appendicolith, appendicolith location (intraluminal/extraluminal), presence of a drainable abscess, and complications were reviewed. Results: There was an overall 18.8% failure rate for IA. Patients with an appendicolith had a 41.7% failure rate, and patients without an appendicolith had a 13% failure rate (p = 0.003). Patients with intraluminal or extraluminal appendicoliths each had a 41.7% failure rate. The presence or absence of a drainable in-tra-abdominal abscess did not affect the failure rate. Children in the failure group presented to the hospital earlier (6.57 ± 2.59 vs. 10.02 ± 7.21 days;p = 0.030). Conclusions: The presence of an appendicolith increases the likelihood of failure of initial non-operative management of ruptured appendicitis in children;however, the location of the appendicolith is not a predictor of failure.

Giant Omphalocele Ruptured: An Operated Case and Review of the Literature

Background: The omphalocele is a congenital defect of closure of the abdominal wall at the level of the umbilical ring with evisceration of the intra-abdominal organs in the form of a bag covered with a membrane. This membrane can rupture and become an extreme emergency that can put the infant’s life at stake. Aim: The purpose of this case report is to present a case of ruptured omphalocele operated successfully and describe the factors of good prognosis. Case Presentation: A female new-born with a giant omphalocele. This omphalocele ruptured during conservative treatment. An emergency surgery was organised and the defect was closed by using a prosthesis. The postoperative course was simple. During the 12 months follow-up, we have seen no complication. Conclusion: The management of ruptured omphaloceles is a surgical and anesthetic challenge. The mortality of this condition can be improved in our context by setting up well-equipped neonatal resuscitation units.

Clipping versus Coiling in Ruptured Aneurysms of the Anterior Cerebral Circulation

Objective: To evaluate and compare the outcomes of microsurgical clipping and endovascular coiling of ruptured anterior cerebral circulation aneurysms. Methods: The current study retrospectively included 61 patients presented with subarachnoid hemorrhage (SAH), treated by clipping or coiling for ruptured aneurysms located in anterior circulation. Anatomic outcome and post-operative ischemic events were evaluated. The primary clinical outcomes were evaluated as operative complications while the secondary clinical outcome was evaluated by modified Rankin scale (mRS) at discharge. Results: Of 61 ruptured aneurysms, 47 and 14 were treated by surgery and coiling, respectively. The average follow-up duration was 19.1 ± 18.6 months for clipping and 21.7 ± 14.8 months for coiling. Complete occlusion was greater in surgery group (80.8%) than endovascular group (21.4%). Re-growth occurred in 2 cases of the coiling group only. Ischemic events were encountered in both groups;silent ones were higher in coiling group (21.4%) than in clipping group (6.3%), while symptomatic ones were higher in the clipping group (49%). Good outcome (mRS 0 - 2) was 51% and 71.4% after clipping and coiling respectively. Postoperative hospital period was longer after clipping (P = 0.04). Conclusions: For anterior circulation ruptured aneurysms, both treatments are feasible, coiling showed lower rate of morbidity while clipping results were better regarding durability and recurrence. Coil embolization may be preferred, which is the current point proved by the RCT like ISAT, but if you choose the patients carefully and find out the optimal candidate for the clipping, the clipping is still enough feasible as a mainstream.

Clinical Efficacy of Shenmai Injection in the Treatment of Cerebral Vasospasm after Ruptured Aneurysm Surgery

Objective: To investigate the therapeutic effect of Shenmai Injection on postoperative cerebral vasospasm in patients with ruptured aneurysms. Methods: Seventy patients undergoing craniotomy for ruptured aneurysms in our hospital were selected as study subjects and randomly divided into control (n = 33) and research (n = 37) groups, they were treated with nimodipine and nimodipine combined with Shenmai injection after operation. The blood flow velocity in the middle cerebral artery (MCA) before and at 1, 3, 7, 11 and 14 days after surgery and the incidence of cerebral vasospasm during these days were compared, and the GCS scores at 14 days postoperatively and GOS scores at 6 months postoperatively were compared between the two groups. Results: There were no statistically significant differences in the occurrence of cerebral vasospasm, GCS or GOS scores between the two groups (P > 0.05), but the period of postoperative cerebral vasospasm in the study group was significantly shorter than that in the control group. Conclusion: Shenmai injection has the effect of shortening the cycle of occurrence of cerebral vasospasm after the operation of ruptured aneurysms, promoting patients to recover as early as possible and reducing their physical and mental burden.

Prognostic factors of spontaneously ruptured hepatocellular carcinoma

AIM: To evaluate the prognostic factors in patients with spontaneously ruptured hepatocellular carcinoma(HCC). METHODS: Seventy-nine patients experiencing spontaneous rupture of HCC between April 2004 and August 2014 were enrolled in this study. The clinical features, treatment modalities and outcomes were reviewed. The statistical methods used in this work included univariate analysis, Kaplan-Meier survival analysis with log-rank tests, and multivariate analysis using a Cox regression hazard model. RESULTS: Of the 79 patients with HCC rupture, 17(21.5%) underwent surgery, 32(40.5%) underwent transarterial embolization(TAE), and 30(38%) received conservative treatment. The median survival time was 125 d, and the mortality rate at 30 d was 27.8%. Multivariate analysis revealed that lesion length(HR = 1.46, P < 0.001), lesion number(HR = 1.37, P = 0.042), treatment before tumor rupture(HR = 4.36, P = 0.019), alanine transaminase levels(HR = 1.0, P = 0.011), bicarbonate levels(HR = 1.18, P < 0.001), age(HR = 0.96, P = 0.026), anti-tumor therapy during the followup period(HR = 0.21, P = 0.008), and albumin levels(HR = 0.89, P = 0.010) were independent prognostic factors of survival after HCC rupture. The BarcelonaClinic Liver Cancer(BCLC) stage was also an important prognostic factor; the median survival times for BCLC stages A, B and C were 251, 175 and 40 d, respectively(P < 0.001).CONCLUSION: Anti-tumor therapy during the followup period, without a history of anti-tumor therapy prior to HCC rupture, small tumor length and number, and early BCLC stage are the most crucial predictors associated with satisfactory overall survival. Other factors play only a small role in overall survival.