Sharp lower abdominal pain and calcified abdominal mass

Uterine lipoleiomyosarcoma is a heterologous sarcoma composed of variable proportions of malignant lipoblasts histologically corresponding to well differentiated liposarcoma and malignant smooth muscle cells corresponding to leiomyosarcoma. Finding of benign lipomatous component in a typical leiomyoma (lipoleiomyoma) is not an uncommon, however, lipoleiomyosarcoma is an extremely rare malignant tumor and only very few cases have been reported so far. We report a case of lipoleiomyosarcoma of uterine corpus in a postmenopausal woman presenting with lower abdominal pain and abdominal mass. Diagnosis of lipoleiomyosarcoma was confirmed by histopathological examination of hysterectomy specimen. This is the first case of lipoleiomyosarcoma of uterus reported from Nepal. Keywords: Lipoleiomyosarcoma, uterus, histopathology, unusual case. doi:10.3126/njog.v2i1.1482 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 67 - 70 May -June 2007

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Dysgerminoma: diagnostic impasse

International Surgery Journal ◽

10.18203/2349-2902.isj20204700 ◽

2020 ◽

Vol 7 (11) ◽

pp. 3811

Author(s):

Indrajit Anandakannan ◽

Shanthi Ponnandai Swaminathan ◽

Vikas Kawarat ◽

Rajeshwari Mani ◽

Kannan R.

Keyword(s):

Abdominal Pain ◽

Abdominal Mass ◽

Germ Cell Tumour ◽

Lower Abdominal Pain ◽

Gastrointestinal Stromal Tumour ◽

Reproductive Age ◽

Ca 125 ◽

Abdominal Radiograph ◽

Bowel Loop ◽

Plain Abdominal Radiograph

Dysgerminoma is a rare malignant ovarian tumour in women of reproductive age group, featuring lower abdominal pain and abdominal mass with elevated tumour markers. The tumour grows rapidly and diagnosed at an earlier stage. We present a short-statured 20 years girl with intermittent abdominal pain and distention for 4 months, on examination huge abdominal mass of size 20x15 cm, firm in consistency was palpable, lower limit not ascertained. Routine blood investigations normal, thyroid function test showed hypothyroidism. A plain abdominal radiograph shows a large homogenous mass fitting mid part of abdomen with displaced bowel loop. Contrast-enhanced computed tomography abdomen and pelvis show up 20x18.5x9.5 cm well defined heterogeneous mass, with areas of necrosis suggesting mesenchymal tumour or germ cell tumour. CA 125, alpha-fetoprotein, lactate dehydrogenase, beta human chorionic gonadotropin were raised. Magnetic resonance imaging abdomen and pelvis show 10x16x17cm hetero intense lesion, bilateral ovary normal. After tumour board discussion image-guided biopsy was done, suggestive of epithelioid gastrointestinal stromal tumour. Laparotomy displayed a large mass 22x16x10 cm arising from left ovary, no enlarged lymph node, completed with left salpingo-oophorectomy. Histopathology examination and immunohistochemistry definitive of dysgerminoma. In this clinical scenario, we narrate the importance of clinical examination and increased dependence on imaging modalities in diagnosing the patient. The treatment is based on the international federation of gynaecology and obstetrics staging with surgical treatment, adjuvant chemotherapy and radiotherapy.

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Primary Amenorrhoea with Transverse Vaginal Septum Presented with Infected Pyometra of 24 Weeks Size

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v12i1.18986 ◽

2018 ◽

Vol 12 (1) ◽

pp. 66-68

Author(s):

Rekha Paudel ◽

Ganesh Dangal ◽

Aruna Karki ◽

Hema Pradhan ◽

Ranjana Shrestha ◽

...

Keyword(s):

Abdominal Pain ◽

Abdominal Mass ◽

Lower Abdominal Pain ◽

Sex Characteristics ◽

Vaginal Septum ◽

Primary Amenorrhoea ◽

Tanner Staging ◽

Secondary Sex Characteristics ◽

Transverse Vaginal Septum ◽

Female Genital

Transverse vaginal septum is a congenital anomaly of the female genital outflow tract. It mostly remains unrecognized till adolescence and manifests as primary amenorrhoea with cyclic lower abdominal pain in background of appropriate Tanner staging secondary sex characterstics. Diagnosis is done by clinical examination and imaging, usually Magnetic Resonance Imaging. Early surgical management by vaginal or abdominal approaches improves the outcome. A 16 years, adolescent with appropriate Tanner staging secondary sex characteristics presented to gynecology (OPD) of Kathmandu Model Hospital with complaints of primary amenorrhoea and palpable abdominal mass of 24 weeks size with cyclic lower abdominal pain. Ultrasound showed features suggestive of hematometra. Under spinal anaesthesia, drainage and excision of the transverse vaginal septum was done followed by placement of vaginal mould post-operatively. We present here a case of primary amenorrhoea with pyometra secondary to transverse vaginal septum.

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Chronic lower abdominal pain is commonly associated with pelvic congestion syndrome

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-0036-1593045 ◽

2016 ◽

Vol 76 (10) ◽

Author(s):

A Jurga-Karwacka ◽

GM Karwacki ◽

FD Schwab ◽

A Schötzau ◽

C Zech ◽

...

Keyword(s):

Abdominal Pain ◽

Lower Abdominal Pain ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

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Pyometra: An Atypical Cause of Abdominal Pain

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211022481 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110224

Author(s):

Leonidas Walthall ◽

Marc Heincelman

Keyword(s):

Abdominal Pain ◽

Vaginal Discharge ◽

Elderly Women ◽

Lower Abdominal Pain ◽

Endometrial Biopsy ◽

Laboratory Evaluation ◽

Inpatient Service ◽

Gynecologic Malignancy ◽

Intravenous Contrast ◽

Lower Quadrant

Pyometra, a purulent infection of the uterus, is a rare cause of a very common complaint—abdominal pain. Risk factors include gynecologic malignancy and postmenopausal status. The classically described presentation includes abdominal pain, fever, and vaginal discharge. In this article, we present an atypical presentation of nonperforated pyometra in an 80-year-old female who was admitted to the internal medicine inpatient service. She initially presented with nonspecific subacute right lower quadrant abdominal pain. Physical examination did not demonstrate vaginal discharge. Laboratory evaluation failed to identify an underlying etiology. Computed tomography scan of the abdomen and pelvis with oral and intravenous contrast demonstrated a 6.5 × 6.1 cm cystic containing structure within the uterine fundus, concerning for a gynecologic malignancy. Pelvis ultrasound confirmed the mass. Endometrial biopsy did not reveal underlying malignancy, but instead showed frank pus, leading to the diagnosis of pyometra. This report illustrates that pyometra should be considered in the differential diagnosis of lower abdominal pain in elderly women.

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Successful treatment of recurrent volvulus in the afferent limb of the pouch following proctocolectomy for ulcerative colitis: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01007-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Michio Itabashi ◽

Yoshiko Bamba ◽

Hisako Aihara ◽

Kimitaka Tani ◽

Ryousuke Nakagawa ◽

...

Keyword(s):

Ulcerative Colitis ◽

Abdominal Pain ◽

Lower Abdominal Pain ◽

Anterior Wall ◽

Middle Part ◽

Presacral Space ◽

Previous Surgery ◽

Afferent Limb ◽

Radiographic Findings ◽

Oral Side

Abstract Background Pouch volvulus after proctocolectomy for ulcerative colitis is a very rare postoperative complication. The common site of pouch volvulus has been reported to be the ileal pouch–anal anastomosis and the middle part of the pouch, but no reports on pouch volvulus in the afferent limb of the pouch have been observed. Here, we report the case of a patient with afferent limb volvulus who underwent afferent limbpexy, but required reoperation 7 months later. Case presentation A 38-year-old man with refractory ulcerative colitis had undergone open proctocolectomy 10 years ago at another hospital. He had been aware of lower abdominal pain and bowel movement difficulty for 2 years. After repeated bowel obstruction, he was referred to our hospital for surgery. Based on the radiographic findings, we diagnosed a pouch volvulus and performed an operation. Laparoscopically, counterclockwise rotation of the afferent limb of the pouch was recognized. Moreover, the ileal mesentery was adhered and fixed to the presacral space 20 cm from the oral side of the pouch. The antimesenteric side of the afferent limb was fixed using interrupted stiches on the left peritoneal wall of the pelvis. He was discharged uneventfully 18 days after surgery, and defecation improved immediately. However, he was readmitted 7 months after surgery with the same abdominal pain and defecation difficulty. A similar finding was found and diagnosed as recurrent volvulus. Therefore, we performed a laparoscopic surgery. The same volvulus as in the previous surgery was confirmed. The site fixed during the previous surgery showed scars, but the afferent limb was free. The dilated ileum that contained the volvulus was excised only on the oral side of the pouch and an intraluminal anastomosis was performed on the anterior wall of the pouch. He had a good postoperative course and was discharged. Conclusion Proper diagnosis of volvulus based on the characteristic imaging findings is important. In principle, bilateral row fixation of the rotated ileum is the basic procedure for volvulus. However, fixation with this technique is sometimes difficult. Therefore, this procedure is one of the useful options for the fixation of difficult or recurrent cases.

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Solitary fibrous tumor of the greater omentum: case report and review of literature

Surgical Case Reports ◽

10.1186/s40792-021-01176-w ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Karim M. Eltawil ◽

Carly Whalen ◽

Bryce Knapp

Keyword(s):

Solitary Fibrous Tumor ◽

Management Strategy ◽

Abdominal Mass ◽

Lower Abdominal Pain ◽

Greater Omentum ◽

Team Approach ◽

Review Of Literature ◽

Case Presentation ◽

Multidisciplinary Team Approach ◽

Fibrous Tumor

Abstract Background Solitary fibrous tumor (SFT) is a rare neoplasm of mesenchymal origin occurring most often in the visceral pleura, however, it has been described in almost every anatomic location of the human body. While most SFTs have a benign behavior, they can potentially be locally aggressive and demonstrate a malignant behavior. Case presentation A 63 year-old male patient presented with lower abdominal pain and nausea and was noted on CT to have a large, heterogeneous lower abdominal mass with no evidence of metastatic disease. A surgical resection was performed and the mass appeared to be connected to the greater omentum with a vascular pedicle. It was not invading any intra-abdominal or pelvic organs. Pathology revealed an SFT of omental origin. The mitotic count was less than 4 per 10 high-power fields and all pathologic characteristics did not meet the criteria for a malignant SFT. Conclusions We report an extremely rare case of SFT originating from the greater omentum. A multidisciplinary team approach was followed to plan the patient’s management strategy.

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Spontaneous Perinephric Urinoma Secondary to Drug Induced Acute Interstitial Nephritis: A Case Report

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0041-1723924 ◽

2021 ◽

Author(s):

Rajesh Kumar Varatharajaperumal ◽

Rupa Renganathan ◽

V Mangalakumar ◽

Sriman Rajasekaran ◽

Venkatesh Kasi Arunachalam

Keyword(s):

Abdominal Pain ◽

Interstitial Nephritis ◽

Lower Abdominal Pain ◽

Acute Interstitial Nephritis ◽

Computed Tomography Scan ◽

Drug Induced ◽

Significant Deterioration ◽

Loin Pain ◽

Tomography Scan ◽

Collecting System

AbstractUrinoma is defined as the extravasation of urine from any part of the urinary collecting system, which causes lipolysis of the surrounding fat, resulting in an encapsulated collection. The most common cause of urinoma is the direct obstruction of the urinary system. The other etiologies include trauma and postinstrumentation/surgery. Parenchymal cause for spontaneous urinoma is exceedingly rare. We present a case of a 30-year-old gentleman who presented with lower abdominal pain and was treated with a Diclofenac injection. The pain got better temporarily, but he presented again with right loin pain after 3 days. His computed tomography scan images revealed bilateral perinephric urinoma. As there was significant deterioration of renal function, he underwent a renal biopsy. The histopathology was reported as acute interstitial nephritis (AIN). Drug-induced AIN is very rarely presented with acute loin or abdominal pain due to spontaneous perinephric urinoma, as it was seen in our case.

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Roberts uterus: a rare congenital anomaly

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175304 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5657

Author(s):

Nagendra Sardeshpande ◽

Pratima Chipalkatti ◽

Jainesh Doctor

Keyword(s):

Congenital Anomaly ◽

Abdominal Pain ◽

Adnexal Mass ◽

Lower Abdominal Pain ◽

Uterine Horn ◽

Transabdominal Ultrasound ◽

Septate Uterus ◽

Bicornuate Uterus ◽

Rare Congenital Anomaly ◽

Hysteroscopic Resection

A 23-year-old girl presented with severe cyclical lower abdominal pain during menstruation since menarche, which had increased since the last 4 years. Transabdominal ultrasound showed adnexal mass with no internal vascularity; MRI reported it as bicornuate uterus with one non-communicating right uterine horn with haematometra. On hysteroscopy there was evidence of septate uterus communicating only to the left ostia. Ultrasonography-guided hysteroscopic resection of septa with drainage of haematometra was done. Patient is presently asymptomatic.

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Fuke Qianjin Combined with Antibiotic Therapy for Pelvic Inflammatory Disease: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/5372839 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Yu Chen ◽

Shaobin Wei ◽

Li Huang ◽

Mei Luo ◽

Yang Wu ◽

...

Keyword(s):

Abdominal Pain ◽

Pelvic Inflammatory Disease ◽

Inflammatory Disease ◽

Meta Analysis ◽

Lower Abdominal Pain ◽

Effective Rate ◽

Chinese Patent ◽

Meta Analyses

Background. Pelvic inflammatory disease (PID) without timely and proper treatment can cause long-term sequelae; meanwhile, patients will be confronted with the antimicrobial resistance and side effects. Chinese patent medicine as a supplement is used to treat PID with satisfactory clinical efficacy. This study evaluated the efficacy and safety of Fuke Qianjin (FKQJ) combined with antibiotics in the treatment of PID. Methods. Eight electronic databases and other resources were searched to make a collection of the randomized controlled trials (RCTs) from 1990 to 2019. The RCTs contrasting the effect of FKQJ combined with antibiotics regimens and antibiotics alone in reproductive women with PID were included. The antibiotics regimens are all recommended by the guidelines. Two reviewers independently screened the studies, extracted the data, and assessed the methodological quality of the included studies. Then, the meta-analyses were performed by RevMan 5. 3 software if appropriate. Results. Twenty-three RCTs (2527 women) were included in this review. The evidence showed that FKQJ combined with antibiotics improved the markedly effective rate compared to antibiotics alone group (RR = 1.38, 95% CI 1.27 to 1.49, I2 = 42%), shortened the improvement time of low abdominal pain (MD = −1.11, 95% CI −1.39 to −0.84, I2 = 38%), and increased the rate of lower abdominal pain improvement (RR = 1.35, 95% CI 1.19 to 1.55, I2 = 0). The implementation of adjuvant reduced the recurrent rate compared with antibiotics alone (RR = 0.27, 95% CI 0.13 to 0.56, I2 = 0%). Conclusions. Based on available evidence, FKQJ combined with antibiotics therapy have certain outcomes on increasing the markedly effective rate, decreasing the recurrent rate compared with antibiotics alone group. This therapy appears to improve lower abdominal pain and curtail the relief time. Due to the low quality and the risk of bias, any high-quality evidence or longer follow-up period should be advisable and necessary in the future.

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