2 research outputs found
Ruptured heterotopic pregnancy presenting as hemorrhagic shock
Background: Heterotopic pregnancy is a rare event consisting of simultaneous intrauterine and extrauterine pregnancies. If undiagnosed, it is probable the patient will present to an Emergency Department and require emergent care.
Case Report: A 25 year-old woman arrived at the Emergency Department at 14 weeks gestation reporting sharp abdominal cramping and pelvic pain with a history of current tobacco use. Trans-abdominal ultrasound revealed a viable intrauterine pregnancy consistent with 14 weeks, closed cervix with free fluid noted in pelvis, and no evidence of ovarian torsion. Over the next three hours, the patient’s condition deteriorated and hemoglobin levels dropped. The surgeon on call was consulted and suspected ruptured hepatic adenoma versus hepatic hemangioma versus visceral aneurysm. A laparotomy was emergently performed with supraceliac control of aorta to permit resuscitation, and the right and left upper quadrants of the abdominal cavity were investigated without discovery of bleeding source. Further investigation revealed ruptured left tubal ectopic pregnancy and a partial salpingectomy was performed.
Conclusions: This case serves as a clinical reminder that while heterotopic pregnancy is thought to be rare, when a patient presents with known intrauterine pregnancy and abdominal pain, heterotopic pregnancy should be included in the differential diagnosis. More common use of assisted reproductive technology may increase the incidence of heterotopic pregnancies, making familiarity with the signs, symptoms, and risk factors for this condition important
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Duration of Antimicrobial Treatment for Complicated Intra-abdominal Infections after Definitive Source Control: A Systematic Review, Meta-Analysis, and Practice Management Guideline from the Eastern Association for the Surgery of Trauma
BACKGROUNDRecent studies have evaluated outcomes associated with duration of antimicrobial treatment for complicated intra-abdominal infections (cIAI). The goal of this guideline was to help clinicians better define appropriate antimicrobial duration in patients who have undergone definitive source control for cIAI. METHODSA working group of Eastern Association for the Surgery of Trauma (EAST) performed a systematic review and meta-analyses of the available data pertaining to the duration of antibiotics after definitive source control of cIAI in adult patients. Only studies that compared patients treated with short vs long duration antibiotic regimens were included. The critical outcomes of interest were selected by the group. Non-inferiority of short compared to long duration of antimicrobial treatment was defined as an indicator for a potential recommendation in favor of shorter antibiotics course. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was utilized to assess the quality of the evidence and to formulate recommendations. RESULTSSixteen studies were included. The short duration ranged from 1 dose to ≤10 days, with an average of 4 days, and the long duration ranged >1-28 days, with an average of 8 days. There were no differences between short and long duration of antibiotics in terms of mortality (odd ratio (OR) .90; 95% confidence interval (CI) 0.56-1.44), rate of surgical site infection (OR 0.88; 95% CI 0.56 to 1.38); persistent/recurrent abscess (OR 0.76, CI 0.45, 1.29); unplanned interventions (OR 0.53, CI 0.12, 2.26); hospital length of stay (mean difference -2.62 days, CI -7.08, 1.83); or readmissions (OR 0.92, CI 0.50, 1.69). The level of evidence was assessed as very low. CONCLUSIONThe group made a recommendation for shorter (four or less days) versus longer duration (eight or more days) of antimicrobial treatment in adult patients with cIAIs who had definitive source control.Level of Evidence: Systematic Review and Meta-Analysis, III