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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (3): 455-458    DOI: 10.31083/j.ceog.2020.03.5159
Case Report Previous articles |
A low birth weight infant with unexpected hepatic artery pseudoaneurysm rupture: A case report and review of the literature
L. Xie1, X. Ru1, Y. Xu1, Y.F. Ouyang1, S.Y. Shu2, *()
1Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing 400014, P.R. China
2Department of Anesthesiology, the Second Affiliated Hospital of Chongqing Medical Unviersity Chongqing 400010, P.R.China
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Abstract  

Here, we describe an unusual case of a preterm infant presenting with massive bleeding as a result of sudden hepatic artery pseudoaneurysm rupture during exploratory laparotomy. During surgery, this low birth weight infant (1.8 kg) was administered chest compressions and a blood transfusion. However, he repeatedly experienced massive bleeding episodes and thus received a massive transfusion. The infant shows unbelievable tolerance and tenacious vitality.

Key words:  Cardiopulmonary resuscitation      Hemorrhage      Low birth weight infant      Massive blood transfusion     
Submitted:  13 January 2019      Accepted:  11 April 2019      Published:  15 June 2020     
Fund: 
81200053/National Natural Science Foundation of China
cstc2015jcyjA10095/Chongqing Science and Technology Commission, Chongqing People's Municipal Government
*Corresponding Author(s):  SHIYU SHU     E-mail:  shushiyu@hotmail.com

Cite this article: 

L. Xie, X. Ru, Y. Xu, Y.F. Ouyang, S.Y. Shu. A low birth weight infant with unexpected hepatic artery pseudoaneurysm rupture: A case report and review of the literature. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(3): 455-458.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.03.5159     OR     https://ceog.imrpress.com/EN/Y2020/V47/I3/455

Table 1  — The blood gas analysis results during the operation
Blood gas analysis Before operation(15:44) 20min after operation(16:43) 70min after operation(17:32) After First CPR(17:39) After Second CPR(18:23) In NICU(19:02)
pH 7.365 7.378 7.202 7.173 6.840 6.976
pCO2 (mmHg) 30.0 32.0 47.5 58.4 89.3 58.1
pO2(mmHg) 269.0 183.0 124.0 85.0 29.5 186.0
Hb(g/L) 124.00 112.00 84.00 79.00 66 101.00
Hct 38.00 34.40 25.80 24.10 20.10 30.90
K+(mmol/L) 3.20 3.40 2.90 3.30 5.20 3.40
Na+(mmol/L) 143.0 144.0 149.0 148.0 148.0 146.0
Ca2+(mmol/L) 0.73 0.92 0.93 0.74 1.21 1.40
Cl-(mmol/L) 110.00 112.00 113.00 108.00 103.00 103.00
Glu(mmol/L) 11.10 6.50 4.60 3.90 14.10 13.50
Lac(mmol/L) 6.60 5.00 3.50 2.80 5.20 4.90
ABE(mmol/L) -7.4 -5.8 -8.5 -6.2 -16.2 -16.7
SBE(mmol/L) -8.3 -6.3 -9.4 -7.0 -18.7 -18.1
SBC 18.5 19.7 17.5 19.2 11.3 11.9
SAT 100.00 100.00 100.00 96.900 39.400 99.100
Anion gap 16.30 13.40 18.10 17.90 29.70 30.00
Serum osmolality (mOsm) 297.70 294.50 303.40 299.20 310.80 305.90
p50 27.10 26.84 32.65 24.34 34.64 41.21
pO2(A-a) --- 57.50 99.30 126.50 148.20 26.70
F Shunt 2.70 2.50 4.70 11.80 53.20 1.90
Table 2  — The blood gas analysis results in neonate intensive care unit
Blood gas analysis 19:51 23:35 2:30
PH 6.960 7.240 7.400
pCO2(mmHg) 50.0 36.0 30.0
pO2(mmHg) 280.0 108.0 96.0
Hb(g/L) 105.0 119.0 133.0
Hct 31.00 35.00 39.00
K+(mmol/L) 3.90 3.20 2.30
Na+(mmol/L) 143.0 144.0 148.0
Ca2+(mmol/L) 0.55 1.55 0.90
Glu(mmol/L) 11.50 18.10 13.20
Lac(mmol/L) 6.50 11.30 11.30
ABE(mmol/L) -18.4 -12.0 -6.2
SBE(mmol/L) -18.2 -11.1 -5.0
SBC 10.8 16.3 21.0
HCO3- 13.5 15.4 18.6
TCO2 15.3 16.5 19.5
SAT 100.0 97.0 97.0
Figure 1.  — Brain MRI and CT scan. A: MRI: Obvious cerebral hemorrhage and edema one day after CPR; B: MRI: Cerebral hemorrhage and edema decreased 20 days after CPR; C: CT: Cerebral hemorrhage and edema decreased 28 days after CPR.

Table 3  — Preoperative and postoperative myocardial enzyme, coalgulation function and blood routine examination results
Parameter Preoperative Postoperative Reference value
Allergic troponin I (ug/L) 0.108↑ 1.282↑ <0.06
myoglobin(ug/L) 97.36↑ 150.35↑ <110
Creatine kinase MB Isoenzyme(ug/L) 7.09↑ 2.2 0.21-5
B-type brain natriuretic peptide(pg/nL) 2866.73↑ <100
Prothrombin time(seconds) 15.8 16.6 13.0-20.0
activated partial thromboplastin time APTT(seconds) 52.3 >240 37.0-45.0
Fibrinogen(g/L) 2.01 1.5 1.2-2.25
Thrombin time(seconds) 16.1 41.7 14.4-22.2
D-dimer(mg/L) 2.36 1.48 <0.55
Total bilirubin(μmol/L) 104.8↑ 182.8↑ 1-20.5
Conjugated bilirubin(μmol/L) 1 1 0-6.7
Unconjugated bilirubin(μmol/L) 103.7↑ 181.8↑ 0-19.5
Total protein(g/L) 44.3↓ 36.1↓ 60-83
Albumin(g/L) 31.1↓ 24.3↓ 37-52
Glutamic-pyruvic Transaminase(U/L) 21.1 21.1 0-50
Glutamic oxalacetic Transaminase(U/L) 76.7↑ 34.2 0-55
LDH(U/L) 380↑ 478.7↑ 140-270
Creatinine(Umol/L) 91 67.9 15.4-90.4
BUN(mmol/L) 6.86 6.41 2.42-6.72
WBC(×109/L) 4.71 3.26 15.0-20.0
PLT(×109/L) 225 12 100-300
RBC(×1012/L) 2.53 3.67 4.8-6.2
Hb(g/L) 98 115 170-200
Average red blood cell volume(fL) 113.4 99.2 98.0-112.0
MCV(pg) 38.7 31.3 26-32
Average hemoglobin concentration(g/L) 341 316 320-360
HCT(%) 28.7 36.4 50-70
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