MyMedR

Spontaneous rupture of renal angiomyolipoma in pregnancy mimicking preterm labour

Basri NI, Dasrilsyah RA

BMJ Case Rep, 2024 Feb 06;17(2).

PMID: 38320830 DOI: 10.1136/bcr-2023-258979

Ruptured renal angiomyolipoma in pregnancy is uncommon. Pregnant women may present with nonspecific symptoms such as flank or abdominal pain, contraction pain and haematuria. A thorough assessment is needed to reach the correct diagnosis. Management varies between conservative measures, radiological intervention or surgery depending on the patient's haemodynamic status and foetal condition. We present a case of a woman in her 30s, gravida 5 para 3+1 at 28 weeks of gestation, who presented with pain. The pain worsened, and she went into hypovolaemic shock. An exploratory laparotomy and emergency caesarean section were done. Retroperitoneal haematoma was found intraoperatively, but the source of bleeding was difficult to determine. An abdominal CT angiogram subsequently revealed an ongoing bleeding from a ruptured angiomyolipoma. An emergency nephrectomy was performed, and the bleeding was secured.

Matched MeSH terms: Rupture, Spontaneous/surgery

Association of incidence rate of spontaneous tendon rupture and renal bone disease in end-stage renal disease patients' cohort

Koh KH, Arimuthu DA

Semin Dial, 2023;36(6):462-467.

PMID: 37170692 DOI: 10.1111/sdi.13145

INTRODUCTION: Spontaneous tendon rupture (STR) is one of the complications related to hyperparathyroidism. This study aims to verify this and to elucidate the feasibility of combined incidence rate of STR and bony fracture to assess clinical management of renal bone disease in dialysis cohort.

METHOD: This is a clinical audit of cases of STR and fracture with 5504 patient-year dialysis vintage over 10 years. In order to verify the risk factor, comparison of cases of tendon rupture, the gender, and dialysis vintage matched patients without tendon rupture were done, followed by comparison with post-parathyroidectomy patients.

RESULT: Six cases of STR involving eight tendons were identified, including a case of concurrent tendon rupture and bony fracture. These include two cases of double tendons ruptures. During this time, there were 15 cases of bony fracture without tendon rupture. The overall incidence rate for STR and fracture was of 0.0011 and 0.0029 incidence per year of dialysis vintage or one case per 917 and 344 patient-year dialysis vintage, respectively. For patients with PTH ≥ 600 pg/mL, the incidence rate of tendon rupture and fracture was 0.0199 and 0.0430 incidence per person-years or one case per 50 and 23 person-years, respectively. For patients with PTH 5202 and 1734 person-years. There was significant difference for incidence rates of tendon rupture and fracture between these two groups, with six incidences of tendon rupture per 302 patient-dialysis-years of PTH ≥ 600 pg/mL versus 0 incidence per 5202 patient-year dialysis vintage of PTH 600 pg/mL had high risk of tendon rupture and bony fracture. Parathyroidectomy might reduce the risk of tendon rupture and fracture with lowering ALP signifying reduction in bone turn over. Combined incidence rate of tendon rupture and fracture could be used to assess the control of hyperparathyroidism related issues in dialysis center.

Matched MeSH terms: Rupture, Spontaneous/complications; Rupture, Spontaneous/epidemiology

Fulltext The deceiving encounter of a spontaneously ruptured urinary bladder

Salleh H, Azli S, Khairul-Asri MG, Jagwani A

Ann R Coll Surg Engl, 2022 Mar;104(3):e67-e69.

PMID: 34812665 DOI: 10.1308/rcsann.2021.0129

Spontaneous urinary bladder rupture is a rare condition. Radiotherapy treatment for malignancy of a pelvic organ such as cervix or prostate is one cause of this condition. We report a case of a 71-year-old woman who presented with this illness 30 years after radiotherapy treatment.

Matched MeSH terms: Rupture, Spontaneous

Fulltext Spontaneous Rupture in a Non-Laboring Uterus at 20 Weeks: A Case Report

Omar NS, Mat Jin N, Mohd Zahid AZ, Abdullah B

Am J Case Rep, 2020 Aug 10;21:e924894.

PMID: 32776917 DOI: 10.12659/AJCR.924894

BACKGROUND Uterine rupture is uncommon but when it happens, it can cause significant morbidity and mortality to both mother and fetus. Incidence reportedly is higher in scarred than in unscarred uteri. Most cases occur in laboring women in their third trimester with a previous history of uterine surgery, such as caesarean delivery or myomectomy. We present a case of spontaneous uterine rupture in a non-laboring uterus in the mid-trimester of pregnancy. CASE REPORT The patient presented with threatened miscarriage at 17 weeks' gestation and ultrasound findings were that raised suspicion of a morbidly adherent placenta. Her history was significant for two previous cesarean deliveries more than 5 years ago followed by two spontaneous complete miscarriages in the first trimester. The patient was managed conservatively until 20 weeks' gestation, when she presented with acute abdomen with hypotensive shock. Her hemoglobin dropped to a level such that she required blood transfusion. An emergency exploratory laparotomy was performed, which revealed a 5-cm rupture in the lower part of the anterior wall of the uterus, out of which there was extrusion of part of the placenta. Given the patient's massive bleeding, the decision was made to proceed with subtotal hysterectomy. Histopathology of the specimen confirmed the diagnosis of placenta percreta. CONCLUSIONS Identification of uterine scarring with morbidly adherent placenta is crucial because even in early pregnancy, it can lead to uterine rupture. Furthermore, failure to recognize and promptly manage uterine rupture may prove fatal.

Matched MeSH terms: Rupture, Spontaneous/etiology*; Rupture, Spontaneous/surgery

Uterine-conserving approach in ruptured intramyometrial ectopic pregnancy

Esther LSY, Chew KT, Rahman RA, Zainuddin AA, Hing EY, Kampan N

Horm Mol Biol Clin Investig, 2020 Mar 13;41(2).

PMID: 32167930 DOI: 10.1515/hmbci-2020-0001

Intramyometrial ectopic pregnancy (IMEP) is a rare form of ectopic pregnancy. It is defined as a conceptus implanted within the myometrium and is completely surrounded by myometrium with clear separation from both the uterine cavity and tubes. IMEP possesses not only diagnostic but also therapeutic challenge. The majority of reported cases were managed by hysterectomy. Early management of unruptured IMEP using methotrexate may help to preserve fertility. We, for the first time, report a case of ruptured IMEP managed successfully using suction and curettage followed by Bakri balloon tamponade and avoiding hysterectomy. Post-procedure, the patient received two doses of intramuscular methotrexate 50 mg/m2 due to plateauing serial beta human chorionic gonadotropin (β-hCG) levels and subsequently achieved undetectable level 10 weeks post-methotrexate. She also had complete resolution of the ectopic intramyometrial mass.

Matched MeSH terms: Rupture, Spontaneous

Myocardial Rupture Secondary to Ventricular Septal Hematoma: A Case Report and Review of Contemporary Literature

Haranal M, Hew CC, Dillon JJ

World J Pediatr Congenit Heart Surg, 2019 11;10(6):793-795.

PMID: 31701824 DOI: 10.1177/2150135119872202

Interventricular septal hematoma following congenital cardiac surgery is an uncommon entity. Literature search reveals few cases of interventricular septal hematoma complicating pediatric cardiac surgery. We report a case of interventricular septal hematoma following patch closure of ventricular septal defect, with associated myocardial necrosis and myocardial rupture.

Matched MeSH terms: Rupture, Spontaneous

Fatal spontaneous rupture of splenic artery aneurysm in third trimester pregnancy

Samberkar PN, Chow TK, Samberkar SP

Malays J Pathol, 2018 Dec;40(3):337-341.

PMID: 30580366

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.

Matched MeSH terms: Rupture, Spontaneous/pathology

Rare postpartum ruptured degenerated fibroid: a case report

Tan YL, Naidu A

J Obstet Gynaecol Res, 2014 May;40(5):1423-5.

PMID: 24689652 DOI: 10.1111/jog.12334

Spontaneous rupture of uterine fibroid is rarely encountered. We present a case of a 31-year-old who presented with acute abdominal pain at 9 weeks postpartum. On examination, the abdomen had diffuse tenderness, with rebound tenderness in the suprapubic area and in both iliac fossae. On ultrasonography, a 12.7 × 8.6 × 8.9-cm sized hyperechoic mass was visible on the posterior wall of the uterus. A large amount of fluid was visible in the paracolic gutters and the Pouch of Douglas (POD). The patient underwent an exploratory laparotomy. A ruptured, cystic degenerated uterine fibroid with active bleeding was found, as well as approximately half a liter of free, bloodstained peritoneal fluid and pus. Myomectomy was performed, followed by evacuation of the fluid and clots. The patient's postoperative course was uneventful. In conclusion, preoperative diagnosis of a perforated, uterine fibroid with spontaneous intra-abdominal hemorrhage is difficult; exploratory laparotomy is both diagnostic and therapeutic in this rare, life-threatening condition.

Matched MeSH terms: Rupture, Spontaneous

Fulltext Infected and ruptured retroperitoneal teratoma

Shahizon AM, Mohd Zaki F, Julian MR, Hanafiah M

BMJ Case Rep, 2014;2014.

PMID: 24493108 DOI: 10.1136/bcr-2013-200862

Matched MeSH terms: Rupture, Spontaneous/complications; Rupture, Spontaneous/surgery

Fulltext Diagnosis and management of ruptured hepatoma: single center experience over 10 years

Letchumanan VP, Lim KF, Mohamad AB

Med J Malaysia, 2013 Oct;68(5):405-9.

PMID: 24632870 MyJurnal

INTRODUCTION: Spontaneous rupture is a dramatic presentation of HCC and it carries high mortality rate. To study the outcomes of ruptured HCC patients managed at a tertiary referral centre in Malaysia.
METHODS: A retrospective review of all ruptured HCC patients managed as inpatient at the Department of Hepatobiliary Surgery, Hospital Selayang between January 2001 and December 2010. Data was retrieved from the hospital electronic medical records, Powerchart (Cerner Corporation Inc., USA) and supplemented with registry from Interventional Radiology record of chemoembolization and registry from hepatobiliary operative surgery records.
RESULTS: There were 22 patients admitted with confirmed diagnosis of ruptured HCC over 10 years period. The common clinical findings on presentation were abdominal pain and presence of shock (36.4%). The mortality rate was 81.8% with only four patients noted to be alive during the follow up. One year overall survival for ER and DR are 40.0% and 72.7% respectively and the median survival in patients treated with DR was 433.3 days whereas it was 212.5 days in ER group.
CONCLUSIONS: This study supports the clinical practice of TAE should be the first line treatment followed by staged surgery in suitable candidates with ruptured HCC.

Matched MeSH terms: Rupture, Spontaneous

Fulltext Spontaneous biceps tendon rupture in a patient with mixed connective tissue disease

Ong SG

Malays Fam Physician, 2013;8(3):31-3.

PMID: 25893055 MyJurnal

Tendon rupture is a rare complication that occurs in patients receiving corticosteroid therapy. We report a case of a middle-aged man with mixed connective tissue disease who presented with spontaneous biceps tendon rupture 5 weeks after initiation of high-dose corticosteroid therapy. Musculoskeletal ultrasonography was performed at the clinic and helped to confirm the diagnosis. It is a new imaging modality that is increasingly used in rheumatology clinics in Malaysia as it serves as an extension to physical examination. Musculoskeletal ultrasonography is preferred by patients as it is noninvasive, does not involve ionising radiation, painless, relatively inexpensive and can be performed readily at the clinic.
KEYWORDS: corticosteroid; musculoskeletal ultrasonography; tendon rupture

Matched MeSH terms: Rupture, Spontaneous

Fulltext Bilateral spontaneous rupture of anterior lens capsules in a middle-aged woman

Hemalatha C, Norhafizah H, Shatriah I

Clin Ophthalmol, 2012;6:1955-7.

PMID: 23225999 DOI: 10.2147/OPTH.S37276

Hypermature cataracts are commonly seen in developing countries. Spontaneous rupture of the anterior capsule, resulting in dislocation of the lens nucleus into the anterior chamber, presents rarely in hypermature cataracts. We describe a middle-aged woman who presented with spontaneous anterior dislocation of the nucleus in both eyes. The presence of calcification spots in the posterior capsule at the pupillary edge strongly suggested that our patient had hypermature cataracts. It is important to highlight this uncommon cause of nucleus dislocation in a patient with no previous history of ocular trauma.

Matched MeSH terms: Rupture, Spontaneous

Fulltext Morbidly adherent placenta at extreme prematurity: can major haemorrhage and hysterectomy be prevented?

Shafiee, M.N., Rahana, A.R., Lim, P.S., Nor Azlin, M.I., Wan Faraliza, Z.A., Isa, M.R., et al.

Journal of Surgical Academia, 2011;1(1):56-60.

MyJurnal

Morbidly adherent placenta with spontaneous rupture of membrane at extreme prematurity poses poor pregnancy outcome. Various issues on different management modalities still remain perplexed and individual consideration is vital. Two cases of morbidly adherent placenta with symptomatic per vaginal bleeding and spontaneous rupture of membrane at severe prematurity were reviewed and discussed. We found that, active intervention by termination of pregnancy and methotrexate therapy at early gestation can prevent the need of hysterectomy following major obstetrics haemorrhage.

Matched MeSH terms: Rupture, Spontaneous

Fulltext Spontaneous bladder perforation: a rare complication of tuberculosis

Kong CH, Ali SA, Singam P, Hong GE, Cheok LB, Zainuddin ZM

Int J Infect Dis, 2010 Sep;14 Suppl 3:e250-2.

PMID: 20117032 DOI: 10.1016/j.ijid.2009.10.006

Spontaneous bladder perforation secondary to tuberculosis (TB) is very rare. Only three cases have been reported so far in the literature. Due to its rarity, the diagnosis of spontaneous bladder perforation is often missed. Confirmation of TB via culture takes a long time and starting empirical treatment for TB is necessary. We relate our experience with a young woman who presented with clinical features of a perforated appendix and was only diagnosed with bladder perforation during laparotomy. She also had distal right ureteral stricture and left infundibular stenosis. The provisional diagnosis of TB was attained via typical histopathological features and a positive Mantoux test. She was started empirically on anti-TB treatment and recovered without any complications. Urine culture after 6 weeks confirmed the diagnosis of TB.

Matched MeSH terms: Rupture, Spontaneous/diagnosis; Rupture, Spontaneous/etiology; Rupture, Spontaneous/surgery

Pocket-sized Heimlich valve (Pneumostat) after bullae resection: a 5-year review

Abdul Rahman MR, Min Joanna OS, Fikri AM, Adeeb SM, Zamrin DM

Ann Thorac Surg, 2009 Sep;88(3):979-81.

PMID: 19699932 DOI: 10.1016/j.athoracsur.2009.03.065

This study was conducted to evaluate the practicability, effectiveness, and potential complications of a newly improvised pocket-sized Heimlich valve named the Pneumostat (Atrium Medical Corp, Hudson, NH).

Matched MeSH terms: Rupture, Spontaneous

Percutaneous, non-operative radio frequency ablation for haemostasis of ruptured hepatocellular carcinoma

Manikam J, Mahadeva S, Goh KL, Abdullah BJ

Hepatogastroenterology, 2009 Jan-Feb;56(89):227-30.

PMID: 19453063

Spontaneous rupture and hemorrhage is a devastating complication of hepatocellular carcinoma (HCC). Results from current therapeutic modalities remain varied. Recent development of percutaneous radiofrequency ablation (RFA) in the management of this condition has shown promise. We describe 2 cases of ruptured HCC in which nonoperative, percutaneous radio frequency ablation (RFA) was successful in achieving hemostasis. The advantageous of RFA over other interventional techniques in the management of ruptured HCC are discussed.

Matched MeSH terms: Rupture, Spontaneous

Giant cell myocarditis with cardiac tamponade: a rare combination

Murty OP

Am J Forensic Med Pathol, 2008 Sep;29(3):245-8.

PMID: 18725781 DOI: 10.1097/PAF.0b013e318183d55f

Giant cell myocarditis (GCM) is a rare but fatal disease of idiopathic origin. It results in focal necrosis of myocardium. This is a case report of middle aged Malaysian Indian female who died due to cardiac tamponade due to rupture myocardium and tear in the root of aorta. On naked eye examination, it simply resembled as recent as well as old fibrotic areas of myocardial infarction. She was clinically diagnosed as a case of obstructive cardiomyopathy with atrioventricular block, and was on pace maker. There was subendocardial fibrosis and left ventricular transmural infarction in the left ventricle. On histopathology, this was diagnosed as GCM, there were widespread areas of inflammatory cellular infiltration within the myocardium with multinucleated giant cells and granulomas interspersed with lymphocytes. Microscopic field showed up to 10 multinucleated giant cells. In this case, there were focal areas at multiple locations and caused uneven thickness in the left ventricle wall. Idiopathic GCM is very rare and causation of hemopericardium is the unique feature of this case. In this case the direct link of GCM with aortitis and rupture of left ventricle wall resulting in hemopericardium is shown. This case is documented through macroscopic as well as microscopic photographs in H&E, Ziel-Nelson, and GMS staining.

Matched MeSH terms: Rupture, Spontaneous

Recurrence of peripheral ulcerative keratitis on the corneoscleral button in a young man treated successfully with oral corticosteroids

Wahid WA, Selvaraja V, Bakiah S, Ibrahim M

Cornea, 2008 Aug;27(7):837-9.

PMID: 18650673 DOI: 10.1097/ICO.0b013e318169d6cc

To describe recurrent peripheral ulcerative keratitis (PUK) on the corneoscleral graft in a young man treated successfully with oral corticosteroids.

Matched MeSH terms: Rupture, Spontaneous

A viable secondary intra-abdominal pregnancy resulting from rupture of uterine scar: role of MRI

Teng HC, Kumar G, Ramli NM

Br J Radiol, 2007 Jul;80(955):e134-6.

PMID: 17704308

Pre-natal diagnosis of intra-abdominal pregnancy is difficult. Ultrasound has been the frontline modality to date; however, it gives a diagnostic error of 50-90% and its use is disappointing. In recent years, MRI has emerged as an appealing imaging modality. With its good soft tissue contrast and non-ionizing property, it acts as a means of definitive non-invasive assessment before surgical intervention when ultrasound is inconclusive.

Matched MeSH terms: Rupture, Spontaneous/diagnosis

Fulltext Tarsal tunnel syndrome caused by ganglion

Ng WM, Chan KY

Med J Malaysia, 2004 Dec;59 Suppl F:69-71.

PMID: 15941169

We report a case of delayed diagnosis of tarsal tunnel syndrome caused by a ganglion arising from the talo-calcaneal joint. Unusually the symptoms were mainly due to the lateral planter nerve compression with a positive Tinel's sign. A surgical decompression was successful in relieving the dysaesthesia in spite of a 7 years history.

Matched MeSH terms: Rupture, Spontaneous

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