scholarly journals Torsion of Hydrosalpinx with Concurrent Acute Cholecystitis: Case Report and Review of Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Preeti R. John ◽  
Amelia M. Pasley

Introduction.Isolated torsion of the Fallopian tube is an uncommon cause of acute lower abdominal pain and can occur in women of all age groups. Cholecystitis is a frequent cause of upper abdominal pain. We present an unusual case with the presence of these two distinct pathological entities occurring concurrently in the same patient, causing simultaneously occurring symptoms. To our knowledge, this is the first reported presentation of such a case.Methods.We describe a 34-year-old premenopausal woman who presented with right sided upper and lower abdominal pain and nausea. Abdominal ultrasound (US) revealed acute cholecystitis. Vaginal US was suggestive of right hydrosalpinx. Intravenous antibiotics were administered and consent was obtained for operative intervention. During laparoscopy, the right Fallopian tube with hydrosalpinx was noted to be twisted three times. The right ovary appeared normal. The gall bladder wall was thickened and inflamed. Laparoscopic right salpingectomy and cholecystectomy were performed.Results.Surgical pathology revealed hydrosalpinx with torsion and acute calculous cholecystitis. The patient had an uneventful postoperative course and was discharged home on the first postoperative day. Her symptoms resolved after the procedure.Conclusions.In women with abdominal pain, both gynecologic and nongynecologic etiologies should be considered in the differential diagnoses. Concurrent presence of symptomatic gynecologic and nongynecologic intra-abdominal pathology is rare. Isolated Fallopian tube torsion is rare and is associated most often with hydrosalpinx. Some torqued Fallopian tubes can be salvaged. Laparoscopy is useful in management of both Fallopian tube torsion and cholecystitis.

2020 ◽  
Vol 18 (6) ◽  
pp. 42-52
Author(s):  
Yu.O. Shulpekova ◽  
◽  
V.M. Nechaev ◽  
V.T. Ivashkin ◽  
◽  
...  

Acute or recurrent pain in the right upper part of the abdomen is a common cause for visits to physicians. Not less than two thirds of episodes of pain in this area are conditioned by biliary colic and acute cholecystitis. Other most common causes include diseases of the liver, pancreas, prepyloric and pyloric parts of the stomach and the beginning portion of the small intestine, the right kidney, and also subhepatic appendicitis. Some cases of developing pain are associated with the right lung affection and involvement of the diaphragmatic pleura, with heart diseases, involvement of the locomotor system and nerves. Taking into account a high prevalence of cholelithiasis in Russia – around 10–12% – we can conclude that episodes of biliary colic develop every year in 1 of 500–1000 individuals. In Russia, approximately half a million cholecystectomies are performed annually. The prevalence of gall stones among the paediatric population amounts to 2%. As distinct from adults, who in 80% of cases have an asymptomatic course of disease, pain episodes in children manifest themselves in 60–67% of cases. The diiagnosis of acute cholecystitis might meet with considerable difficulties; a scale for assessment of the likelihood of acute cholecystitis has been developed. Unlike in adults, in children a significantly large proportion of cases occur due to acalculous cholecystitis. Differentiating the causes of pain might be difficult, therefore, its character and concomitant symptoms should be thoroughly analysed, and the findings of additional examinations should also be taken into consideration (at the first step – assessment of haematological and biochemical parameters, urinalysis, electrocardiogram and abdominal ultrasonography). Key words: right upper abdominal pain, biliary colic, biliary dyskinesia, cholelithiasis


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Liang Qian ◽  
Xue Wang ◽  
Dingheng Li ◽  
Songyi Li ◽  
Jiashan Ding

Abstract Background Isolated fallopian tube torsion (IFTT) is a rare cause of gynecological acute abdomen, is easily misdiagnosed and often has a delay in diagnosis. IFTT with paraovarian cysts is most frequently reported in studies. Here, we reported a patient diagnosed with IFTT associated with a paraovarian cyst, and we conducted a literature review for IFTT, aiming to identify valuable information that will be helpful for diagnosis and treatment for fallopian tube torsions. Case presentation A 13-year-old girl presented with a 10-day history of right lower abdominal pain that worsened 2 days before presentation. On presentation, ultrasound showed a 5.8 * 5.5 cm hypoechoic cyst adjacent to the right ovary, and between the cyst and ovary, a tortuous thickened tube was visualized. Laparoscopy revealed a triple torsion of the right fallopian tube with a 6-cm paraovarian cyst, and tubal conservation surgery was performed. The postoperative course was uneventful. Histopathological diagnosis revealed serous papillary cystadenoma. Conclusion Paraovarian cystic dilatation often occurs in adolescence and can induce fallopian torsion when the size of the cyst reaches 5-cm. In our review, the median age of patients diagnosed with IFTT with paraovarian cysts was 15 years old, and the main clinical manifestation was emergency abdominal pain. The associated symptoms were variable, and vomiting was the most commonly associated symptom. Salpingectomy was the most common procedure performed; however, timely surgical intervention can effectively avoid salpingectomy.


2020 ◽  
Vol 20 (4) ◽  
pp. 1895-7
Author(s):  
Nnabuike Chibuoke Ngene ◽  
Ongombe Lunda

Background: It is uncommon to find ampullary tubal pregnancy in the second trimester. Methods: A 35-year-old G4P3 at 16 gestational weeks presented with a day history of sudden severe lower abdominal pain and no vaginal bleeding. The patient had a normal pulse of 82/minutes, haemoglobin concentration of 6.3 g/dl and ultrasonography showed an empty uterus with an alive fetus in the right adnexa. She was provisionally diagnosed to have an abdominal pregnancy. Results: The patient had an emergency laparotomy where 2.2 L of haemoperitoneum and a slow-leaking right ampullary tubal pregnancy were found. Right total salpingectomy was performed and she had an uncomplicated post-operative fol- low-up. Histology of the lesion confirmed tubal pregnancy. Conclusion: The growth of a pregnancy in the ampulla beyond the first trimester is possibly due to increased thickness and or distensibility of the fallopian tube. A tubal pregnancy may present with a normal pulse despite significant haemorrhage. Keywords: Abdominal pain; ampullary tubal ectopic pregnancy; Bezold–Jarish-like reflex.


2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Koji Nakamura ◽  
Kensuke Nakanishi ◽  
Satoshi Kubota ◽  
Ryoko Takahashi ◽  
Mari Tomiie ◽  
...  

Venous thrombophlebitis is an uncommon cause of fever and lower abdominal pain during the early postpartum period. It mostly occurs in the right ovarian vein, and computed tomography (CT) is useful for diagnosis. We present a case of thrombophlebitis of the renal capsular vein. A 27-year-old postpartum woman presented with right lower abdominal pain and fever unresponsive to antibiotics. Contrast CT showed a ring-enhancing mass in the right retroperitoneum, which was distinct from the right ovarian vein. Exploratory laparoscopy revealed a retroperitoneal hematoma and normal appendix. Reconstruction of CT images revealed that the mass was connected to the right renal capsular vein. Anticoagulation therapy improved the patient’s symptoms. Postpartum thrombophlebitis can occur at locations other than the ovarian vein, such as the renal capsular vein. If a retroperitoneal mass is discovered during puerperium, a thorough investigation of the mass’s continuity with surrounding vessels is essential to avoid unnecessary surgery.


2021 ◽  
Vol 19 (1) ◽  
pp. 76-80
Author(s):  
Grzegorz Pasternak ◽  
◽  
Dorota Bartusik-Aebisher ◽  
David Aebisher ◽  
Rafał Filip ◽  
...  

Introduction. Entero-bladder fistula (fistula entero-vesicalis) is a pathological connection between the lumen of the gastrointestinal tract and the bladder. Entero-bladder fistulas are not a common condition. The main reason for the formation of entero- bladder fistulas are intestinal diseases occurring within the intestinal loop adjacent to the bladder resulting in the formation of an abnormal channel, the connection between the above structures Aim. The aim is to present the causes of the fistulas can be divided into congenital and acquired (intestinal infection, cancer, Crohn’s disease, resulting from trauma and iatrogenic). Clinical manifestations of the biliary-bullous fistulae may be from the digestive or urinary tract. The most characteristic ailments are pneumaturia, fecuria, urge to urinate, frequent urination, lower abdominal pain, hematuria, urinary tract infection. Description of the case. The article discusses the case of a patient with Leśniowski-Crohn disease complicated with a bladder- fistula. The treatment of entero-bladder fistulas is primarily surgical, it consists in resection of the fistula together with resection of the affected intestine and bladder wall fragment. Conclusion. The test confirming the presence of an entero-bladder fistula is a test with oral administration of poppies, although it happens that the test result may be negative, especially in the case of a bladder-follicular fistula. Among the tests useful in the diagnosis of entero-bladder fistula include abdominal ultrasound, computed tomography, magnetic resonance imaging, endoscopic tests (colonoscopy or cystoscopy).


2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maria Alexandra Carranceja Villapol ◽  
Maria Princess L Kanapi

Abstract Introduction: This is the case of a pregnant woman on her 3rd trimester who was diagnosed with primary hyperparathyroidism. Since there are two patients involved, the potential complications that can be brought about by the diagnostic tests and the treatment had to be weighed against the benefits. Case: The patient is SA, a 34-year old female on her 29th week of pregnancy, admitted due to a month history of abdominal pain described as intermittent, crampy, generalized, non-radiating, and mild-to-moderately severe in intensity. She was advised to do tests but did not comply. In the interim, there was recurrence of symptoms but with resolution. However, the crampy abdominal pain recurred, now localized at the right upper quadrant and epigastric areas, radiating to the right upper back, moderate in intensity, and with associated nausea and vomiting, leading to admission. She was first managed under OB-Gynecology, given hydration, pain management and Betamethasone. She was also referred to Cardiology for blood pressure control, and Surgery for evaluation of the abdominal pain. Due to an increasing trend of her blood glucose, she was referred to Endocrinology and started on insulin. Mild bilateral nephrocalcinoses seen in an abdominal ultrasound prompted work-up showing an elevated serum ionized calcium at 1.88 meq/L (n 1.12-1.32 meq/L), elevated intact PTH at 451.13 pg/ml (n <67.9 pg/ml), and low Vitamin D at 10.96 ng/ml (n >30ng/ml). Parathyroid ultrasound showed nonthyroidal tissue measuring 0.4 x 0.6 cm at the right inferior area. Saline hydration and diuresis with Furosemide were started to manage the hypercalcemia. A multi-disciplinary meeting was held to discuss the options for management and risks involved. The goal was to deliver the baby in stable condition possibly to term, while keeping maternal calcium levels and blood pressure normal. However on her 30th week of gestation, she had persistent elevated blood pressure and underwent emergency caesarian section. After delivery, the patient was advised against breastfeeding for adequate management of her hypercalcemia. She was started on Cinacalcet, Calcitonin, and Ibandronic Acid. A Parathyroid Sestamibi Scan done showed a parathyroid adenoma on the right inferior lobe, and she underwent right inferior parathyroidectomy, with left thyroidectomy and isthmusectomy. Findings showed a right inferior parathyroid adenoma and a benign follicular nodule on the left thyroid. She was started on Calcium Carbonate and Calcitriol, and discharged stable. Conclusions: This case shows that when two lives are at stake every step of the management, whether diagnostic or therapeutic, must be communicated well to the patient and to the other members of the team. It is ultimately a choice made by the expectant mother but through the proper guidance and updated knowledge of the team, combined with a good clinical eye especially in the treatment of pregnant women.


PEDIATRICS ◽  
1975 ◽  
Vol 56 (1) ◽  
pp. 127-129
Author(s):  
Seymour Katz ◽  
Irwin Katzka ◽  
Keith Schneider ◽  
Mervin Silverberg

Recent advances in flexible fiberoptic endoscopy have permitted direct visualization of segments of the gastrointestinal tract hitherto considered inaccessible. Preoperative diagnoses of diseases of these areas are subject to the vagaries of roentgen interpretation. The following case report illustrates the value of the colonoscope in distinguishing intralumenal ileal neoplastic disease from an inflammatory process (e.g., ileitis, appendiceal abscess). CASE REPORT W. M., a 15-year-old white youth, was referred for eveluation of intermittent lower abdominal pain of six weeks' duration. Prior to his admission, he experienced cramping abdominal pain, fever, cough, emesis, and diarrhea. This gradually abated, leaving a residuum of recurrent abdominal pain which was relieved partially with fiexion of the right thigh.


2021 ◽  
Vol 14 (1) ◽  
pp. e232797
Author(s):  
Clemmie Stebbings ◽  
Ahmed Latif ◽  
Janakan Gnananandan

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.


2018 ◽  
Vol 8 (2) ◽  
pp. 23-25
Author(s):  
Hasna Hena ◽  
Shamim Ara ◽  
Hosna Ara Perven ◽  
Dilruba Siddiqua ◽  
Fatema Johora ◽  
...  

Context: Problems with the fallopian tubes can lead to infertility. Disease can be defined and measured only in terms of deviation from normal structure. Detailed morphological and histological knowledge is essential for the diagnosis and management of fallopian tube disease. Objectives: To identify the outer diameter of the infundibulum and its changes with advancing age. Study Design: Cross sectional descriptive type of study. Period and place: Department of anatomy, Dhaka Medical College from July 2008 to June 2009. Materials: Present study was performed on post mortem fallopian tubes of 60 Bangladeshi female. Among them lowest age was 12 years and highest age was 50 years. Methods: Samples were divided into three differential age groups: Group A (10-13 years), Group B (14-45 years), Group C (46-50 years). All samples were studied morphologically and histologically. Results: The mean outer diameter of the infundibulum of the right and left fallopian tubes ranged from 0.80±0.01 to 1.03±0.22 mm. The difference between all the groups were statistically significant (p < 0.001). Conclusion: There was change in outer diameter of the infundibulum of fallopian tubes of left and right in relation to age. Update Dent. Coll. j: 2018; 8 (2): 23-25


2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094618
Author(s):  
Xia Zhang ◽  
Biaohu Liu ◽  
Xiangming Zhu ◽  
Guobing Hu

A pelvic accessory spleen is uncommon and most patients with this condition are asymptomatic. Ureteral calculus is a common disease and can cause acute abdominal pain. We report a 51‐year‐old male patient who presented at our hospital with acute right lower abdominal pain and gross hematuria. A large mass on the right side of the pelvis was detected on an ultrasound examination, as well as a calculus in the lower segment of the right ureter. Computed tomography angiography showed the presence of a long vascular pedicle with an artery originating from the splenic artery and a vein that joined with the splenic vein. Laparoscopy was carried out and it showed a solid mass covered with omentum on the right lower abdomen. The mass was then removed surgically. Histopathological examination of the resected specimens confirmed splenic tissue. We speculate that the accessory spleen and ureteral calculus caused right lower abdominal pain in our case. However, the ureteral calculus might have played a much more important role in causing acute right lower abdominal pain than the accessory spleen.


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