Preoperative hormonal therapy for a patient with appendiceal endometriosis

2021 ◽  
Vol 14 (11) ◽  
pp. e245667
Author(s):  
Keiko Shichiri ◽  
Kazuhiro Nishida ◽  
Alan Kawarai Lefor ◽  
Tadao Kubota
Keyword(s):  
Hormone Therapy ◽  
Hormonal Therapy ◽  
Preoperative Diagnosis ◽  
Lower Abdominal Pain ◽  
Gonadotropin Releasing Hormone ◽  
Optimal Management ◽  
Gonadotropin Releasing Hormone Agonist ◽  
Contrast Enhanced ◽  
Mucocele Of The Appendix ◽  
History Of

The optimal management of patients with appendiceal endometriosis has not been determined because of the difficulty of establishing a preoperative diagnosis. There are no reports of preoperative hormone therapy for a patient with appendiceal endometriosis. We report a patient who underwent resection of appendiceal endometriosis after hormone therapy. A 40-year-old woman with history of recurrent pelvic abscesses presented to the emergency department with lower abdominal pain. The recurrent pelvic abscesses were synchronised with her menstrual cycle. CT scan demonstrated a 25 mm contrast-enhanced luminal structure adjacent to the cecum, which was thought to be a mucocele of the appendix. Considering the recurrent symptoms during menstruation, endometriosis was suspected. Treatment with a gonadotropin-releasing hormone agonist was started for appendiceal endometriosis, which alleviated the symptoms. After 3 months, elective laparoscopic appendectomy was performed. Preoperative hormonal therapy is an option for patients with appendiceal endometriosis, especially when there is concern for dense adhesions.

Enterocolic lymphocytic phlebitis: a rare pathology in children

2021 ◽  
Vol 14 (8) ◽  
pp. e243826
Author(s):  
Omar Nasher ◽  
Naved Alizai
Keyword(s):  
Surgical Resection ◽  
Preoperative Diagnosis ◽  
Diagnostic Laparoscopy ◽  
Adult Population ◽  
Lower Abdominal Pain ◽  
Paediatric Population ◽  
Rare Clinical Entity ◽  
Clinical Challenge ◽  
History Of ◽  
Venous Vasculature

Enterocolic lymphocytic phlebitis (ELP) is a rare pathology, usually seen in the adult population. The condition affects the venous vasculature of the intestine sparing the arteries and lymphatics. It is commonly identified histologically after surgical resection making the preoperative diagnosis a clinical challenge. As the condition can lead to intestinal ischaemia and necrosis, surgical resection of the affected segment is the treatment of choice. We report the case of a 9-year-old girl who presented with a 2-day history of lower abdominal pain and anorexia. The initial diagnosis of appendicitis was made clinically and the patient underwent a diagnostic laparoscopy . The appendix was macroscopically normal and there were no other obvious intra-abdominal pathologies to account for her presenting complaints . The appendix was removed, as per the preoperative discussion and consent from parents. She recovered well and was discharged home the following day. The histological examination of the appendix demonstrated ELP. We describe this rare clinical entity in a child especially in view of the scarce published literature in the paediatric population.

scholarly journals A Case of Isolated Cecal Necrosis Preoperatively Diagnosed with Perforation of Cecum

Medicina ◽  
2019 ◽  
Vol 55 (1) ◽  
pp. 9 ◽  
Author(s):  
Atsushi Kohga ◽  
Kiyoshige Yajima ◽  
Takuya Okumura ◽  
Kimihiro Yamashita ◽  
Jun Isogaki ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Preoperative Diagnosis ◽  
Previous History ◽  
Lower Abdominal Pain ◽  
Rare Condition ◽  
Ileocecal Resection ◽  
Urgent Surgery ◽  
Ischemic Change ◽  
History Of ◽  
Laparoscopic Assisted

Isolated cecal necrosis (ICN) is a rare condition which is developed under decreased mesenteric perfusion. Only a few dozen cases of ICN have been reported previously. The patient was a 59-year-old male with a previous history of atrial fibrillation. He presented to our emergency room with the chief complaint of lower abdominal pain. Computed tomography imaging revealed a dilated cecum and presence of free air. With a preoperative diagnosis of perforation of the cecum; an urgent surgery was conducted. Intraoperative findings revealed an ischemic change of the cecum and a laparoscopic-assisted ileocecal resection was performed. The pathological findings showed transmural ischemic change on the anti-mesenteric side of the cecum, and the diagnosis of ICN was achieved. Preoperative diagnosis of ICN is difficult because of its non-specific radiological features. In patients with right lower abdominal pain, ICN should be considered as a differential diagnosis especially if the patient has a comorbidity causing hypotension attack.

scholarly journals Adult Colo-Colic Intussusception Induced By a Lipoma Masquerading As a Sigmoid Polyp on Colonoscopy: A Case Report

2013 ◽  
Vol 5 (1) ◽  
pp. 72-74
Author(s):  
Junaid Nabi ◽  
SM Quamrul Akhter ◽  
Mohammad Abdullah Al Mamun ◽  
Nelema Jahan ◽  
Md Mamunur Rahman
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Preoperative Diagnosis ◽  
Anal Verge ◽  
Lower Abdominal Pain ◽  
Histological Evaluation ◽  
Midline Incision ◽  
History Of ◽  
Specific Symptoms ◽  
Satisfactory Recovery

Intussusception in adults is rare, accounting for only 5% of all cases of intussusceptions and only 1% of bowel obstruction. Preoperative diagnosis is often difficult due to non specific symptoms and subacute nature. This case report was a per-operatively diagnosed adult colo-colic intussusception induced by a lipoma which mimicked a sigmoid polyp on colonoscopy. A 40-year-old Bengali woman was admitted with two weeks history of colicky lower abdominal pain. Ultrasound abdomen was unremarkable. Colonoscopy revealed a moderately enlarged sigmoid polyp at 25 cm from the anal verge. A midline incision laparotomy was performed only to reveal a colo-colic intussusception. The intussusception was reduced and the patient underwent a segmental resection of the involved bowel. Histological evaluation confirmed the diagnosis of lipoma of the colon. The patient however satisfactory recovery and remains well six months after surgery. DOI: http://dx.doi.org/10.3329/jssmc.v5i1.16226 J Shaheed Suhrawardy Med Coll, 2013;5(1):72-74

Fertility-Sparing Treatment of Early Endometrial Cancer and Complex Atypical Hyperplasia in Young Women of Childbearing Potential

2015 ◽  
Vol 25 (6) ◽  
pp. 1010-1014 ◽  
Author(s):  
Stanislav Mikhailovich Pronin ◽  
Olga Valerievna Novikova ◽  
Julia Yurievna Andreeva ◽  
Elena Grigorievna Novikova
Keyword(s):  
Endometrial Cancer ◽  
Young Women ◽  
Hormonal Therapy ◽  
Endometrial Hyperplasia ◽  
Endometrial Adenocarcinoma ◽  
Gonadotropin Releasing Hormone ◽  
Atypical Hyperplasia ◽  
Childbearing Potential ◽  
Atypical Endometrial Hyperplasia ◽  
Gonadotropin Releasing Hormone Agonist

ObjectiveTo evaluate oncologic and reproductive outcome with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist in women with grade 1 endometrial carcinoma, and the levonorgestrel monotherapy in women with complex atypical hyperplasia.Materials/MethodsA prospective study was conducted. We analyzed the clinical characteristics of 70 patients younger than 42 years (mean age, 33 years) with a diagnosis of complex atypical endometrial hyperplasia (AEH) or grade 1 endometrial adenocarcinoma who were treated with hormonal therapy at the Division of Gynecologic Oncology of P.A. Hertsen Moscow Cancer Research Institute from February 2009 to December 2012. Patients with complex AEH received monotherapy with levonorgestrel-releasing intrauterine system (Mirena, Shering, Finland; 52 mg). Patients with a diagnosis of grade 1 endometrial cancer were treated with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist (Zoladex; AstraZeneca UK Limited, UK; 3.6-mg depot). All the patients received hormonal therapy for a minimum of 6 months. Pretreatment evaluation consisted of transabdominal and transvaginal ultrasound in grayscale, color Doppler ultrasound, contrast-enhanced magnetic resonance imaging,cervical hysteroscopy, Pipelle endometrial biopsy, and morphological and immunohistochemical characteristics of the tissue.ResultsSeventy patients were included in study analyses. Twenty three (72%) of 32 patients with adenocarcinoma and 35 (92%) of 38 patients with AEH had complete remission, defined as the absence of any carcinoma or hyperplasia on endometrial sampling specimens. Among these cases, 2 patients with adenocarcinoma and 1 patient with AEH had recurrence after their complete response. Nine patients had persistent disease. Eight patients had 10 conceptions, resulting in 8 live births.ConclusionsThe suggested conservative treatment strategy can be considered as a valid therapeutic option for young women of childbearing potential with atypical endometrial hyperplasia and grade 1 endometrial adenocarcinoma who wish to preserve their fertility and thus may be recommended as an alternative to hysterectomy. Close follow-up during and after the treatment period is strictly required.

Risk of Cardiovascular Ischemic Events After Surgical Castration and Gonadotropin-Releasing Hormone Agonist Therapy for Prostate Cancer: A Nationwide Cohort Study

2017 ◽  
Vol 35 (32) ◽  
pp. 3697-3705 ◽  
Author(s):  
Dong-Yi Chen ◽  
Lai-Chu See ◽  
Jia-Rou Liu ◽  
Cheng-Keng Chuang ◽  
See-Tong Pang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Gonadotropin Releasing Hormone ◽  
Androgen Deprivation ◽  
Releasing Hormone ◽  
Gonadotropin Releasing Hormone Agonist ◽  
Bilateral Orchiectomy ◽  
History Of ◽  
Ischemic Events

Purpose Our aim was to determine whether cardiovascular (CV) risk in patients with prostate cancer (PCa) differs between those who receive androgen-deprivation therapy by surgical castration and those who receive gonadotropin-releasing hormone agonist (GnRHa) therapy. Patients and Methods By using the Taiwan National Health Insurance Research Database, we analyzed data from 14,715 patients with PCa diagnosed from January 1, 1997, through December 31, 2011. The patients were treated with bilateral orchiectomy or GnRHa therapy. We used inverse probability of treatment weighting with propensity scores to adjust for the imbalance in covariate baseline values between these two groups. Cox regression models were used to identify risk factors for myocardial infarction (MI), ischemic stroke (IS), and cardiac-related complications. Results Overall, 3,578 patients with PCa (24.3%) underwent bilateral orchiectomy and 11,137 patients (75.7%) received GnRHa therapy. Both groups had a similar risk of CV ischemic events (ie, MI or IS; hazard ratio, 1.16; 95% CI, 0.97 to 1.38) during a median follow-up time of 3.3 years. However, during the first 1.5 years of follow-up, there were higher CV ischemic events in the orchiectomy group than in the GnRHa group (hazard ratio, 1.40; 95% CI, 1.04 to 1.88), particularly in patients who were ≥ 65 years of age, had hypertension, had a Charlson comorbidity index score ≥ 3, and had a previous history of MI, IS, or coronary heart disease. Conclusion Compared with bilateral orchiectomy, use of GnRHa does not increase the risk of CV ischemic events in patients with PCa. Nonetheless, orchiectomy is associated with higher rates of CV ischemic events in older patients and those with a history of CV comorbidities within 1.5 years of initiating androgen-deprivation therapy. These findings can help clinicians decide on the optimal castration strategy for individual patients.

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