scholarly journals Vaginal Myomectomy for a Thirteen-Centimeter Anterior Myoma

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Bruno Deval ◽  
Pascal Rousset ◽  
Salma Kayani
Keyword(s):  
Abdominal Pain ◽  
Operative Technique ◽  
Surgical Procedure ◽  
Uterine Fibroids ◽  
Lower Abdominal Pain ◽  
Anterior Wall ◽  
Uterine Myoma ◽  
Vaginal Route ◽  
Preoperative Workup ◽  
Vaginal Myomectomy

Vaginal myomectomy is an uncommon but advantageous approach for large interstitial uterine fibroids. Myomectomy is performed via laparotomy and laparoscopy; however, in selected cases, vaginal myomectomy has been proven to be a safe and an effective surgical procedure. We report the case of a 38-year-old para one woman with complaints of chronic lower abdominal pain. Preoperative workup revealed a thirteen-centimeter interstitial uterine myoma in the anterior wall. Successful myomectomy was performed via the vaginal route. We will share the preoperative images, operative technique, and postoperative images.

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

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.

Midthoracic Punctate Midline Myelotomy for Treatment of Chronic, Intractable, Nonmalignant, Abdominal Visceral Pain: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (2) ◽  
pp. E183-E183 ◽  
Author(s):  
Tyler Ball ◽  
Zaid Aljuboori ◽  
Haring Nauta
Keyword(s):  
Abdominal Pain ◽  
Physical Examination ◽  
Surgical Procedure ◽  
Visceral Pain ◽  
Lower Abdominal Pain ◽  
Clinical History ◽  
Dorsal Column ◽  
Complete Relief ◽  
Patient Reported

Abstract Punctate midline myelotomy (PMM) is a surgical procedure that damages the ascending fibers of the postsynaptic dorsal column (PSDC) pathway to interrupt visceral pain transmission.1-3 It can offer relief to patients with chronic visceral pain conditions that are refractory to other treatments. Here, we present a surgical video of midthoracic PMM in a patient with chronic, intractable, nonmalignant visceral abdominal pain that failed over a decade of medical treatment. We choose T7-8 as the level for laminectomy in patients with pelvic or lower abdominal pain, because the postsynaptic pain fibers transmitting visceral pain sensation from the lower abdominal organs will invariably be caudal to this level. The patient developed immediate and complete relief of her visceral pain after the procedure, which was sustained through the 11-wk follow-up period to date and was able to be weaned off narcotics. Postoperatively, she remained full strength and had no impairment of light touch or proprioception of her lower extremities. Detailed physical examination showed a reduced vibratory sensation on the glabrous skin of her great toes. Regarding patient-reported sensory changes (not detected on physical examination), she reported some numbness on the insides of her feet that had resolved by 11-wk follow-up. She also reported some numbness of the vulva, but not of the vagina. However, by 11-wk follow-up, she reported this had resolved and she had normal sexual function. The only persistent sensation at 11-wk follow-up was slight tingling in her toes that was not bothersome to her.4 The patient presented in the following video consented to both the surgical procedure and the publication of her clinical history and operative video.

Hypovolaemic shock due to intra-abdominal haemorrhage from multiple uterine fibroids

2021 ◽  
Vol 14 (5) ◽  
pp. e241782
Author(s):  
Erika Takaki ◽  
Mayako Goto ◽  
Kensuke Hori ◽  
Kimihiko Ito
Keyword(s):  
Abdominal Pain ◽  
Preoperative Diagnosis ◽  
Surgical Intervention ◽  
Uterine Fibroids ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Abdominal Ct ◽  
Hypovolaemic Shock ◽  
Total Hysterectomy ◽  
Abdominal Bleeding

Intra-abdominal bleeding due to uterine fibroids is extremely rare, and preoperative diagnosis is difficult. Herein, we report a case of preoperatively diagnosed hypovolaemic shock due to intra-abdominal haemorrhage, in which fatal sequelae were prevented. A 46-year-old non-pregnant woman was brought to the hospital with a sudden-onset lower abdominal pain. On admission, she was in shock, and abdominal CT showed severe intra-abdominal haemorrhage. Since bleeding from uterine fibroids was suspected, an emergency simple total hysterectomy was performed, and her condition became stable after the operation. Intra-abdominal haemorrhage with hypovolaemic shock requires prompt surgical intervention. Although it occurs very rarely due to bleeding from uterine fibroids, imaging shows large fibroids; if the patient is not pregnant, bleeding from the fibroids should be considered.

Chronic lower abdominal pain is commonly associated with pelvic congestion syndrome

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

scholarly journals Pyometra: An Atypical Cause of Abdominal Pain

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.

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

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.

scholarly journals Roberts uterus: a rare congenital anomaly

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.

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

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.

ACE inhibitor induced visceral angioedema: an elusive diagnosis

2020 ◽  
Vol 13 (11) ◽  
pp. e236391 ◽  
Author(s):  
Metlapalli Venkata Sravanthi ◽  
Sharmil Suma Kumaran ◽  
Nishant Sharma ◽  
Bojana Milekic
Keyword(s):  
Adverse Effect ◽  
African American ◽  
Abdominal Pain ◽  
Ace Inhibitors ◽  
Ace Inhibitor ◽  
Lower Abdominal Pain ◽  
Supportive Treatment ◽  
Newly Diagnosed ◽  
Radiographic Findings ◽  
Missed Diagnosis

ACE inhibitors are widely used and well-tolerated drugs. Angioedema is a well-known adverse effect, which involves the viscera rarely. This is a case of a 44-year-old African-American man with newly diagnosed hypertension, who presented with lower abdominal pain and diarrhoea. Based on the clinical picture and radiographic findings, lisinopril-induced intestinal angioedema was diagnosed. He recovered with supportive treatment, and the lisinopril was permanently discontinued. The mechanism of angioedema is thought to be the inhibition of ACE-mediated degradation of bradykinin, which is a peptide responsible for vasodilation and increased vascular permeability. While the external angioedema is unmistakable, intestinal angioedema has a relatively non-specific presentation and chronology, often leading to missed diagnosis and unnecessary interventions. Most common symptoms are abdominal pain and diarrhoea. Characteristic radiographic findings include ‘doughnut sign’ and ‘stacked coin’ appearance. Treatment is supportive. ACE inhibitors should be discontinued to prevent a recurrence.

scholarly journals A rare cause of acute lower abdominal pain: Emphysematous cystitis

2014 ◽  
Vol 40 (1) ◽  
pp. 65-67 ◽  
Author(s):  
Tarkan Ergun ◽  
Halil Olcay Eldem ◽  
Hatice Lakadamyali
Keyword(s):  
Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Emphysematous Cystitis
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