Application of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section

Objective:This study aimed to investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization for the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section.Methods:We performed a retrospective analysis of the clinical data for 623 patients who experienced pernicious placenta previa complicated with placenta accreta and received treatment in our hospital from January 2013 to January 2019.All patients underwent abdominal aortic balloon occlusion before their cesarean section.Seventyeight patients received bilateral uterine artery embolization,and among them,placenta accreta was found at the opening of the cervix in 13 patients.Due to suturing difficulty after the removal of the placenta,gauze packing was used to temporarily compress the hemorrhage.As soon as the uterus was sutured,emergent bilateral uterine artery embolization was performed.Active bleeding was noted in the remaining 65 patients when the lower part of the uterus was pressed after the placenta was removed and the uterus was sutured,therefor,bilateral uterine artery embolization was performed urgently.Results:Of the 623 patients,545 patients underwent only abdominal aortic balloon occlusion and 78 patients underwent additional emergent bilateral uterine artery embolization due to hemorrhaging during or after their cesarean section.No hysterectomies were performed.In the 78 patients,the amount of bleeding was 800-3,200 ml with an average of 1,650 ml during the operation;the volume of blood transfused was 360-1,750 ml(average:960 ml).The fetal fluoroscopy time was 3–8 s(average:5 s).The dose of radiation exposure was(4.2±2.9) m Gy.Fetal appearance,pulse,grimace,activity,and respiration(Apgar) score were normal.No serious complications were observed during or after the operation in the follow-up visits.Conclusion:For patients with pernicious placenta previa complicated with placenta accreta who experience active bleeding after cesarean section and abdominal aortic balloon occlusion,bilateral uterine artery embolization can effectively reduce blood loss and requirement of blood transfusion during the operation,and lowers the risk of hysterectomy.

Abdominal pregnancy secondary to iatrogenic uterine perforation: A case report and literature review

Abdominal pregnancy is a rare and life-threatening form of ectopic pregnancy.It is defined as an ectopic pregnancy in a region of the peritoneal cavity that does not include the fallopian tubes,ovaries,or their associated ligamentous structures.Many abdominal pregnancies are caused by secondary implantation in the peritoneal cavity after tubal abortion,rupture,or uterine rupture.Here,we report a case of abdominal pregnancy resulting from iatrogenic uterine perforation during the induced abortion of an early intrauterine pregnancy,which had been misdiagnosed as a ruptured corpus luteum cyst due to the sudden rupture of the abdominal gestational sac,complicating intra-abdominal hemorrhage.The true diagnosis was missed by vaginal ultrasound and confirmed by laparoscopic exploration.We discuss the details of the case management and review the relevant literature.©2023 Zhejiang University.

Removal of a guide-wire sliding into abdominal cavity via transgastric natural orifice transluminal endoscopic surgery: A case report

BACKGROUND Guidewire slippage into the peritoneal cavity during clinical operations is extremely rare.Therefore,this paper aims to report a successful case of guidewire removal using transgastric natural orifice transluminal endoscopic surgery(NOTES).The goal is to enhance physicians'understanding of the management plan for this unique scenario and provide a valuable reference for clinical practice.CASE SUMMARY A 64-year-old man presented with abdominal distension and was diagnosed with cirrhosis combined with massive ascites.To proceed with treatment,the patient underwent ultrasound-guided peritoneal puncture and underwent catheterization and drainage.Unfortunately,a 0.035-inch guidewire slipped into the abdominal cavity during the procedure.Following a comprehensive evaluation and consultation by a multidisciplinary team,the guidewire was successfully removed using NOTES.CONCLUSION This case highlights the potential consideration of transgastric NOTES removal when encountering a foreign body,such as a guidewire,within the abdominal cavity.

The Effect of Uterine Artery Occlusion with Tourniquet on Ovarian Reserve during Open Myomectomy at a University Teaching Hospital in Southern Nigeria

Background: The most common surgical treatment for symptomatic uterine fibroids, particularly in women with fertility concerns, is open myomectomy. Given the high vascularity of the uterus, haemorrhage during the procedure is a serious risk that is often mitigated with a uterine tourniquet. Aim and Objectives: To evaluate the effect of uterine artery occlusion with a tourniquet during open myomectomy on ovarian reserve using serial anti-Mullerian hormone (AMH) measurements. Materials and Methods: This was a prospective longitudinal study with a quasi-experimental design and a convenient sampling technique. The study enrolled 47 women who had abdominal myomectomy between September 1, 2021, and March 31, 2022, at the University of Port Harcourt Teaching Hospital. Blood samples were collected before anaesthesia was administered in theatre, on day two, and three months after open abdominal myomectomy for anti-Mullerian hormone assay. The data was collected using a semi-structured proforma, entered into an Excel spreadsheet, and analyzed using SPSS version 25.0 with a 95% confidence interval. Statistical significance level was set at 0.05. Results: The pre-surgery AMH mean value was 1.67 ± 1.44 ng/ml, while the values after using a uterine tourniquet at myomectomy on the second day and three months later were 1.22 ± 1.24 ng/ml and 1.59 ± 1.43 ng/ml, respectively. There was no statistically significant change in AMH levels, and there was no statistically significant relationship between blood loss and tourniquet time and AMH after open abdominal myomectomy. Conclusion: The use of a uterine tourniquet and blood loss during open myomectomy has no effect on ovarian reserve.

Embryonic natural orifice transluminal endoscopic surgery in the treatment of severe acute pancreatitis complicated by abdominal compartment syndrome

BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared.RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II(APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day(P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group(P<0.05). There were significant differences in complications and mortality between the two groups(P<0.01).CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.

Abdominal wall actinomycosis simulating a malignant neoplasm:Case report and review of the literature

Abdominal wall actinomycosis is a rare disease frequently associated with the presence of an intra uterine device.We report on a case of a 47-year-old woman who had used an intrauterine device for many years and had removed it about a month prior to the identif ication of an abdominal wall abscess caused by Actinomyces israelii.The abscess mimicked a malignancy and the patient underwent a demolitive surgical treatment.The diagnosis was obtained only after histopathological examination.Postoperatively,the patient developed an infection of the wound which was treated with daily medication.The combination of long-term high dose antibiotic therapy with surgery led to successful treatment.

Risk factors for post-endoscopic retrograde cholangiopancreatography(ERCP) abdominal pain in patients without post-ERCP pancreatitis

Background:Abdominal pain is often observed after endoscopic retrograde cholangiopancreatography(ERCP).Few studies have focused on the risk factors of post-ERCP abdominal pain without post-ERCP pancreatitis(PEP).This study aimed to identify risk factors of post-ERCP abdominal pain without PEP and investigate characteristics of the abdominal pain in non-PEP patients.Methods:Data from patients who underwent ERCP from August 2019 to January 2020 were retrospectively collected.Characteristics of the abdominal pain after ERCP were recorded and compared between PEP and non-PEP patients.Multivariate analysis was conducted to identify risk factors of non-PEP abdominal pain.Results:A total of 1295 ERCP procedures were investigated in this study,among which 100(7.72%)patients presented post-ERCP abdominal pain without PEP and 63(4.86%)patients with PEP.Multivariate analysis found 9 risk factors of non-PEP abdominal pain:age≤65 years[odds ratio(OR):1.971],primary ERCP(OR:2.442),dilated extrahepatic bile duct(OR:1.803),no papilla opening(OR:2.095),pancreatic guidewire passages(OR:2.258),white blood cells(WBC)≤6.0×10^(9)/L(OR:1.689),platelet(PLT)≤250×10^(9)/L(OR:2.505),serumγ-glutamyl transferase(γ-GT)≤35 U/L(OR:2.190),and albumin≥40 g/L(OR:1.762).The PEP group had later pain onset,higher pain frequency and longer hospital stay than those of the non-PEP pain group(P<0.05).There were no significant differences in the pain duration,visual analogue scale score and mortality between the PEP group and non-PEP pain group(P>0.05).Conclusions:This study indicated that age≤65 years,primary ERCP,dilated extrahepatic bile duct,no papilla opening,pancreatic guidewire passages,lower WBC,lower PLT,normalγ-GT and elevated albumin were independent risk factors for post-ERCP abdominal pain without PEP.The pain occurred earlier in non-PEP patients than in PEP patients.

Abdominal bronchogenic cyst:A rare case report

BACKGROUND Bronchogenic cysts are cystic masses caused by congenital abnormal development of the respiratory system,and usually occur in the pulmonary parenchyma or mediastinum.CASE SUMMARY A rare case of a bronchogenic cyst discovered in the abdominal cavity of a 35-year-old man is reported.Physical examination found a space-occupying lesion in the patient’s abdomen for 4 d.Laparoscopic exploration found the cyst tightly adhered to the stomach and its peripheral blood vessels;therefore,intraoperative laparotomy was performed.The cystic mass was resected en bloc with an Endo-GIA stapler.The final postoperative pathological diagnosis confirmed an abdominal bronchogenic cyst.CONCLUSION This is a rare case of a bronchogenic cyst that was discovered within the abdominal cavity of a male patient.The cyst is easily confused with or misdiagnosed as other lesions.Therefore,it is necessary to distinguish abdominal bronchogenic cyst from gastrointestinal stromal tumor,Meckel’s diverticulum,enteric duplication cyst,or lymphangioma.Although computer tomography and magnetic resonance imaging were the primary diagnostic approaches,endoscopic ultrasound-guided fine-needle aspiration could assist with clarification of the cytological or histopathological diagnosis before surgery.

22-gauge core vs 22-gauge aspiration needle for endoscopic ultrasound-guided sampling of abdominal masses

AIM To compare the aspiration needle(AN) and core biopsy needle(PC) in endoscopic ultrasound-guided fine needle aspiration(EUS-FNA) of abdominal masses.METHODS Consecutive patients referred for EUS-FNA were included in this prospective single-center trial. Each patient underwent a puncture of the lesion with both standard 22-gauge(G) AN(Echo Tip Ultra; Cook Medical, Bloomington, Indiana, United States) and the novel 22 G PC(Echo Tip Pro Core; Cook Medical, Bloomington, Indiana, United States) in a randomized fashion; histology was attempted in the PC group only. The main study endpoint was the overall diagnostic accuracy, including the contribution of histology to the final diagnosis. Secondary outcome measures included material adequacy, number of needle passes, and complications.RESULTS Fifty six consecutive patients(29 men; mean age 68 years) with pancreatic lesions(n = 38), lymphadenopathy(n = 13), submucosal tumors(n = 4), or others lesions(n = 1) underwent EUS-FNA using both of the needles in a randomized order. AN and PC reached similar overall results for diagnostic accuracy(AN: 88.9 vs PC: 96.1, P = 0.25), specimen adequacy(AN: 96.4% vs PC: 91.1%, P = 0.38), mean number of passes(AN: 1.5 vs PC: 1.7, P = 0.14), mean cellularity score(AN: 1.7 vs PC: 1.1, P = 0.058), and complications(none). A diagnosis on the basis of histology was achieved in the PC group in 36(64.3%) patients, and in 2 of those as the sole modality. In patients with available histology the mean cellularity score was higher for AN(AN: 1.7 vs PC: 1.0, P = 0.034); no other differences were of statistical significance.CONCLUSION Both needles achieved high overall diagnostic yields and similar performance characteristics for cytological diagnosis; histological analysis was only possible in 2/3 of cases with the new needle.

Endoscopic ultrasound-guided drainage of postoperative intra-abdominal abscesses

Although endoscopic ultrasound(EUS)-guided drainage has become the standard procedure for pancreatic pseudocysts in recent years and is generally regarded as a safe and effective method,there have been few reports of EUS-guided drainage of postoperative intra-abdominal abscesses.Here we report our experience with 4 cases of postoperative intraabdominal abscesses for which EUS-guided drainage was performed between May 2011 and May 2014.Distal pancreatectomy had been performed in 3 cases,whereas low anterior resection for rectal cancer was performed in the remaining case.All patients underwent transgastric naso-cystic drainage,which resulted in clinical improvement without complications,even when performed within 4 wk after surgery.On average,the naso-cystic drain was removed 10 d after placement,with no abscess recurrence.Based on these findings,we believe that EUS-guided drainage of postoperative intraabdominal abscesses is a safe and effective method,although further large-scale investigations are required to confirm our findings.

Successful endoscopic treatment of biliary stricture following mesenteric tear caused by blunt abdominal trauma

Biliary duct injuries are frequently iatrogenic, being associated with surgery for gallbladder stones. However, blunt abdominal trauma such as a motor vehicle crash is a rare cause of extrahepatic biliary stricture. A few reports have been published on biliary strictures treated with endoscopic therapy. In the present study, we describe a suprapancreatic biliary stricture associated with mesenteric tear following road traffic accident. We performed endoscopic stent placement, which was successful in relieving the biliary stricture.

Application of Abdominal Aortic Balloon Occlusion Combined with Tourniquet in Pregnant Women with Severe Placenta Accreta Spectrum

Objective Abdominal aortic balloon occlusion(AABO)is a vascular intervention method that has been widely used in the treatment of severe placenta accreta spectrum(PAS).The aim of this study was to investigate the benefits,potential risks,and characteristics of AABO combined with tourniquet binding of the lower uterine segment(LUS)in treatment of pregnant women with PAS.Methods In this study,64 pregnant women with PAS scores greater than 5 were enrolled as research subjects and divided into two groups.Group A(n=34)underwent normal operative procedures including tourniquet binding of the LUS.Group B(n=30)underwent AABO combined with tourniquet binding of the LUS.General clinical characteristics,ultrasonography PAS score,intraoperative blood loss(IBL),blood loss within 24 h after surgery(24-h BL),postoperative complications,and neonatal data of the two groups were retrospectively reviewed.The influencing factors of IBL for the two groups were analyzed.Results The amounts of IBL,24-h BL,total input red blood cell,and the incidence of disseminated intravascular coagulation were significantly lower in group B than in group A(P<0.05),and this difference was even more significant in the subgroup of placenta percreta(PAS scores≥10).Further multivariate linear analysis showed that the combined therapy of AABO and tourniquet could independently predict lower IBL than normal operative procedures did(P=0.001).Conclusion AABO combined with tourniquet binding of the LUS could improve the outcomes of pregnant women with severe PAS and reduce serious peripartum complications of AABO.

Chronic abdominal pain secondary to mesenteric panniculitis treated successfully with endoscopic ultrasonography-guided celiac plexus block: A case report

Mesenteric panniculitis is a chronic illness that is characterized by fibrosing inflammation of the mesenteries that can lead to intractable abdominal pain. Pain control is a crucial component of the management plan. Most patients will improve with oral corticosteroids treatment, however, some patients will require a trial of other immunosuppressive agents, and a minority of patients will continue to have refractory disease. Endoscopic ultrasound guided celiac plexus block is used frequently to control abdominal pain in patients with pancreatic pathology. To our knowledge there are no case reports describing its use in mesenteric panniculitis patients with refractory abdominal pain.

Recurrent tense pneumoperitoneum due to air influx via abdominal wall stoma of a PEG tube

A 70 years old male on ventilatory and circulatory support for sepsis and non ST segment elevation myocardial infarction developed abdominal distension 14 d after placement of a percutaneous endoscopic gastrostomy tube for enteral feeding.Radiography revealed free air in the abdomen and gastrograffin(G) study showed no extravasation into the peritoneum.The G tube was successfully repositioned with mechanical release of air.Imaging showed complete elimination of free air but the patient had a recurrence of pneumoperitoneum.Mechanical release of air with sealing of the abdominal wound was performed.Later,the patient was restarted on tube feeding with no complications.This case demonstrates a late complication of pneumoperitoneum with air leakage from the abdominal wall stoma.

Abdominal pain post endoscopic mucosal resection: Treat the patient not the CT scan

An 85-year-old female, with hereditary nonpolyposis colorectal cancer syndrome, underwent a colonoscopy and endoscopic mucosal resection(EMR) of a 25-mm proximal ascending colon polyp(Paris classification 0-Is). Post-procedure, the patient developed abdominal pain in the right iliac fossa which settled 1 h later. An urgent computed tomography(CT) scan of her abdomen was organised which happened 6 h post onset of abdominal pain. She had radiological evidence of perforation on the CT scan but clinically remained well and was managed conservatively. The exact aetiology of this patient's symptoms is not known. We suspect the radiological findings are probably due to a combination of injectate within the colonic wall and leakage of insufflated air or CO2 following transmural passage of the EMR needle. As EMR is becoming an increasingly effective treatment modality in the management of large sessile polyps, clinicians need to be aware of potential complications of treatment. It is also important to recognise that radiological features of perforation can be seen post EMR in the absence of an EMR associated perforation.

Rupture of a Rudimentary Uterine Horn: A Case Report

Pregnancy in an abnormal uterus is a high-risk situation in obstetrics. Uterus bicornis unicollis with a rudimentary horn is often discovered incidentally. The aim of this report is to warn obstetricians about recurrent abdominal pain in the second trimester of pregnancy without any cause identified. Pregnancy can proceed in the rudimentary horn. We presented a case of a rupture of the rudimentary horn which occurred at 25 weeks of amenorrhea in an unmarried 19-year-old primigravida. The rudimentary horn was removed after performing an emergency laparotomy for an intraperitoneal hemorrhage with signs of shock. This abnormality is often revealed by uterine rupture, which usually occurs in the second trimester of pregnancy. Conclusion: We emphasize the importance of early diagnosis of this uterine abnormality, before pregnancy if possible. Undiagnosed, this condition evolves towards uterine rupture during pregnancy and requires emergency surgery with excision of the rudimentary horn.

The perplexing entity of rudimentary uterine horn

A rudimentary uterine horn may be responsible for intriguing presentations in different stages of life. These presentations often masquerade commoner gynaecologic disorders resulting in diagnostic and management challenges for the treating clinicians. Whereas many of these anomalies may be discovered during the investigative workup for cryptomenorrhoea, dysmenorrhoea and infertility, lack of symptoms especially in a parous woman, a large proportion remains undiagnosed. We report here, two interesting presentations of this benign entity resulting in significant morbidity. The first case report describes late activation of a rudimentary horn presenting as chronic pelvic pain. The second patient presented with a failed second trimester induction of labor (abortion) for fetal demise. Her examination and investigations suggested an abdominal pregnancy, yet, on laparotomy, a 15 week pregnancy within an accessory uterine horn was discovered.

Ampullary Neuroendocrine Tumor: A Rare Cause of Recurrent Abdominal Pain

Ampullary Neuroendocrine tumor (ANET) is a rare GI malignancy, representing less than 1% of GI neuroendocrine tumors and less than 2% of ampullary tumors. Traditional treatment is often a pancreaticoduodenectomy;however, local and endoscopic resections have been successful. We report a rare case of ANET in a 21-year-old Burmese man who presented with a 6-year history of non-specific intermittent abdominal pain who was successfully managed through transduodenal ampullectomy. At 24 months postoperatively he remains disease and symptom free. ANET is a rare cause of recurrent abdominal pain, and local excision of small ANETs can be an alternative, less morbid treatment for young patients. We follow the case with a brief review of the literature.

Full term secondary abdominal pregnancy in a Jehovah’s witness: A case report

We describe a rare case of full term abdominal pregnancy in a Jehovah’s witness patient;she underwent laparotomy successfully without blood transfusion. Despite their belief regarding transfusion, Jehovah’s witnesses may not necessarily have a higher morbidity or mortality rate following a complex obstetric surgery as seen in the present case.

腹主动脉球囊阻断术与改良后子宫血管阻断术在胎盘植入性疾病患者再次剖宫产中的应用比较

目的研究预置腹主动脉球囊阻断术与改良后子宫血管阻断术在前置胎盘伴胎盘植入性疾病再次剖宫产中的应用效果。方法选取2016年4月至2022年12月在合肥市妇幼保健院行再次剖宫产手术治疗的前置胎盘伴胎盘植入性疾病的瘢痕子宫患者97例。术前行腹主动脉球囊阻断术48例为对照组,术中行改良后子宫血管阻断术49例为观察组。观察比较两组患者术中、术后情况。结果观察组的术后行双侧子宫动脉栓塞术数、人均住院费用均小于对照组,差异均有统计学意义(P<0.05);两组的术中平均出血量、输注红细胞悬液量、子宫切除率、膀胱破裂率差异无统计学意义(P>0.05)。结论两种手术方式在完全性前置胎盘伴胎盘植入患者的再次剖宫产手术治疗中均能有效减少术中出血,而使用改良后子宫血管阻断术,未出现血管介入手术并发症,无需X线暴露,母儿安全性高,同时降低了住院费用,具有临床推广潜力。