Late presentation of extrauterine adenomyomas after laparoscopic morcellation at hysterectomy: a case report

Abstract Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.

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Ovarian Hilus Cell Hyperplasia and Sertoli-Leydig Cell Tumor in a Patient with Postmenopausal Virilization: a Rare Case Report

Aegean Journal of Obstetrics and Gynecology ◽

10.46328/aejog.v3i3.99 ◽

2021 ◽

Vol 3 (3) ◽

pp. 83-86

Author(s):

Begum Ertan ◽

Eyüphan Ozgozen ◽

Orkun Ilgen ◽

Göksenil Bulbul ◽

Bahadır Saatli ◽

...

Keyword(s):

Case Report ◽

Leydig Cell ◽

Transvaginal Ultrasound ◽

Laparoscopic Hysterectomy ◽

Cystic Mass ◽

Leydig Cell Tumor ◽

Cell Tumor ◽

Plasma Testosterone ◽

Cell Hyperplasia ◽

The Right

Objective; We present a case report regarding a 71-year-old woman with postmenopausal virilization caused by ovarian hilus cell hyperplasia and Sertoli-Leydig cell tumor who was suffered from hair loss, clitoromegaly and hirsutism. Case Report; The patient’s plasma testosterone levels were high. In the MRI examination, a nodular formation of 20x26mm in size was observed in the right ovary. At the transvaginal ultrasound, a cystic mass of 28x28mm was seen in the right ovary. Then we performed a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The final pathology showed a poorly differentiated Sertoli Leydig cell tumor at the right ovary and hilus cell hyperplasia at the left ovary. Sertoli-Leydig cell tumors, which are relatively less common, are extremely rare to be seen in the postmenopausal period. Conclusion; What distinguishes this case from others is that Sertoli-Leydig cell tumor and hilus cell hyperplasia may cause virilization symptoms together, in addition to its prevalence in advanced age.

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Acute intrauterine device migration appendicitis with cecal appendix obstruction: Case report and literature review

Annals of Mediterranean Surgery ◽

10.22307/2603.8706.2020.02.002 ◽

2020 ◽

Vol 3 (2) ◽

Author(s):

Oscar Mauricio Poveda Ortiz

Keyword(s):

Case Report ◽

Iliac Fossa ◽

Intrauterine Device ◽

Abdominal Cavity ◽

Uterine Perforation ◽

Uterine Anomalies ◽

Surgical Extraction ◽

And Migration ◽

The Moment ◽

The Right

Introduction The intrauterine device is a planning method widely used in the world, however, it is not without complications, one of these is uterine perforation and migration of the IUD to the abdominal cavity, which although it is rare, has serious clinical repercussions and its study has been studied. relationship with the adequate or not insertion of the device, the size and configuration of the uterus, uterine anomalies or surgeries and the moment of insertion after delivery. Case report We present the case of a 36-year-old female patient with a 12-hour history of pain in the mesogastrium that radiates to the right iliac fossa of 9/10 weight intensity, associated with fever measured at 38.9º. He underwent diagnostic laparoscopy with a finding of acute appendicitis secondary to lumen obstruction by the IUD, so an appendectomy was performed. Conclusions The appropriate treatment when this complication occurs is surgical extraction either laparoscopically or laparotomy to reduce the risk of associated complications.

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Neuroendocrine Neoplasm in Cecal Appendix: A Case Report

Amadeus International Multidisciplinary Journal ◽

10.14295/aimj.v4i7.84 ◽

2019 ◽

Vol 4 (7) ◽

pp. 118-126

Author(s):

Pedro Walisson Gomes Feitosa ◽

Andrezza Lobo Rodrigues ◽

Esther Barbosa Gonçalves Felix ◽

Maria Stella Batista de Freitas Neta ◽

Sávio Samuel Feitosa Machado

Keyword(s):

Case Report ◽

Surgical Approach ◽

Iliac Fossa ◽

Neuroendocrine Neoplasm ◽

Neuroendocrine Neoplasms ◽

Histopathological Analysis ◽

High Mitotic Activity ◽

Precise Diagnosis ◽

The Right ◽

A Site

Although neuroendocrine neoplasms are relatively uncommon entities, the appendix is a site with relatively frequent emergence of this pathology and its precise diagnosis and clinical management have been a challenge for practitioners. This paper aims to present and discuss a case report of neuroendocrine neoplasia in the appendix of a patient with acute abdomen who underwent appendectomy. A 46-year-old man referred to the Emergency Department complaining of abdominal pain in the right iliac fossa and signs of peritoneal irritation. After diagnosis of acute appendicitis, the patient underwent appendectomy. In a macroscopic analysis, an area of 1.9 cm long, hardened, irregular and yellowish shapes was noted in the distal third of the appendix. Histopathological analysis showed neoplasia consisting of invasive islands of monotonous rounded epithelioid cells, large areas of necrosis, high mitotic activity, neural and angiolymphatic invasion and extension to adipose tissue compatible with invasion of the mesoappendix. Circumferential resection was compromised, suggesting the persistence of neoplasia in the patient even after the surgical approach, which would probably recommend the need for surgical approach. Therefore, the importance of sending collected materials for anatomopathological analysis is emphasized, since it helps in the clinical evaluation, in the etiological diagnosis, guides the medical conduct in the evolution of the case, as well as assisting in family mourning in cases of mortality.Keywords: Neuroendocrine tumor, Appendix, Histopathological analysis.

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Specificities of transplantation of kidneys procured from donors with situs inversus totalis: A case report and review of the literature

Vojnosanitetski pregled ◽

10.2298/vsp131010036p ◽

2015 ◽

Vol 72 (1) ◽

pp. 63-67 ◽

Cited By ~ 1

Author(s):

Milica Petrovic ◽

Violeta Rabrenovic ◽

Dusica Stamenkovic ◽

Neven Vavic ◽

Zoran Kovacevic ◽

...

Keyword(s):

Kidney Transplantation ◽

Case Report ◽

Situs Inversus ◽

Iliac Fossa ◽

Preoperative Evaluation ◽

Situs Inversus Totalis ◽

Mirror Image ◽

Image Reversal ◽

The Right

Introduction. Situs inversus totalis (SIT) represents a total vertical transposition of the thoracic and abdominal organs which are arranged in a mirror image reversal of the normal positioning 1. We presented a successful pre-dialysis kidney transplantation from a living sibling donor with SIT and the longest donor follow-up period, along with analysis of the reviewed literature. Case report. The pair for pre-dialysis kidney transplantation included a 68-year-old mother and 34-year-old daughter at low immunological risk. Comorbidities evidenced in kidney donors with previously diagnosed SIT, included moderate arterial hypertension and borderline blood glucose level. Explantation of the left donor kidney and its placement into the right iliac fossa of the recipient were performed in the course of the surgical procedure. A month after nephrectomy, second degree renal failure was noticed in the donor. A 20-month follow-up of the donor?s kidney and graft in the recipient proved that their functions were excellent. Conclusion. In donors with previously diagnosed SIT the multidisciplinary approach, preoperative evaluation of the patient and detection of possible vascular anomalies are required to provide maximum safety for the donor.

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Interventional Treatment of Lymphatic Leakage Post Appendectomy: Case Report

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.288 ◽

2019 ◽

Vol 7 (9) ◽

pp. 1512-1515

Author(s):

Nguyen Ngoc Cuong ◽

Nguyen Thai Binh ◽

Phan Nhan Hien ◽

Nguyen Hoang ◽

Le Tuan Linh ◽

...

Keyword(s):

Case Report ◽

Female Patient ◽

Clinical Case ◽

Iliac Fossa ◽

Chylous Ascites ◽

Percutaneous Intervention ◽

Interventional Treatment ◽

Lymphatic Complications ◽

The Right ◽

Intranodal Lymphangiography

BACKGROUND: Postoperative lymphatic complications are not common, and lymphatic leakage complication post appendectomy (LLCPC) is even rarer. However, the number of this operation is high so LLCPC can occur. CASE REPORT: Here, we report a female patient post appendectomy with severe chylous ascites. This patient underwent six operations. A leakage point at the right iliac-fossa, which was embolized successfully after two sessions, was spotted during intranodal lymphangiography. After 6 months, the ascites were significantly reduced while some lymphatic aneurysms still existed in the lumbar-retroperitoneal region. CONCLUSIONS: Basing the knowledge of this clinical case and literature, we have concluded that lymphatic leakage can be diagnosed and embolized by percutaneous intervention.

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Idiopathic Omental Infarction Mimic Acute Appendicitis: A Case Report

Surgical Case Reports ◽

10.31487/j.scr.2020.12.07 ◽

2020 ◽

pp. 1-3

Author(s):

Hamad Almakinzy ◽

Bandar Idress ◽

Hamad Almakinzy

Keyword(s):

Case Report ◽

Acute Appendicitis ◽

Acute Abdomen ◽

Inflammatory Markers ◽

Iliac Fossa ◽

Young Patients ◽

Acute Onset ◽

First Case ◽

Laparoscopy Surgery ◽

The Right

Idiopathic Omental Infarct (IOI) is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Since first case was described by Elitelin 1899, more than 300 cases have been published [1]. It can mimic serious surgical pathology. It occurs in <1% of appendicitis cases [2]. It’s challenge to diagnose, as features may mimic acute appendicitis and therefore in young patients, may only be discovered intra-operative. Here, we present a case of omental infarct in 26-year-old gentleman with no significant medical or surgical background who present with acute onset of right iliac fossa (RIF) pain. Examination revealed tenderness over the right iliac fossa and was having localized rebound. His inflammatory markers were high. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day.

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Mirrored Appearance of Complete Common Mesentery Discovered on CT Scan for Crohn's Disease

European Journal of Case Reports in Internal Medicine ◽

10.12890/2021_002721 ◽

2021 ◽

Author(s):

Odette Ndikumana ◽

Fatima Zahra Badi ◽

Oumar Djidda ◽

Mouna Sabiri ◽

Samia Elmanjra ◽

...

Keyword(s):

Small Intestine ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Iliac Fossa ◽

Abdominal Cavity ◽

Mirror Image ◽

Wall Thickening ◽

Rectosigmoid Junction ◽

History Of ◽

The Right

Incomplete 90° intestinal rotation in a clockwise direction results in complete common mesentery being placed in a mirror image to and with a similar appearance to complete common mesentery. This rotation places the colon in the right half of the abdominal cavity and the small intestine in the left half of the abdominal cavity. We report the case of a 19-year-old patient with a history of cerebral palsy secondary to meningitis who presented with melaena and inflammatory anaemia. CT enterography was performed which showed regular, non-stenosing circumferential wall thickening of the sigmoid colon and rectosigmoid junction compatible with Crohn's disease, which was confirmed by pathophysiology. It also revealed transposition of the colon to the right hemi-abdomen and the small intestine to the left hemi-abdomen, the caecum to the right iliac fossa, and the third portion of the duodenum to the left of the mesenteric vessels.

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Parasitic Myomas: Case Report and Literature Review

Surgical Case Reports ◽

10.31487/j.scr.2020.09.06 ◽

2020 ◽

pp. 1-3

Author(s):

Sonia Soto-Schutte ◽

Fernado Mendoza-Moreno ◽

Javier Mínguez-García ◽

Enrique Ovejero-Merino ◽

...

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Transvaginal Ultrasound ◽

Abdominal Cavity ◽

Definitive Diagnosis ◽

Retroperitoneal Tumor ◽

Correct Identification ◽

Uterine Myomas ◽

The Past ◽

Ct And Mri

Parasitic myomas are an infrequent type of myomas that appear in abdominal cavity. The incidence of this pathology has increased over the past years. There has been many hypothesis about the pathogenesis. One of the most recent ones is in relation to the start of laparoscopic morcellation at myomectomy or hysterectomy to treat uterine myomas due to the small fragments that can be detached during the procedure and that implant themselves in the abdominal cavity. Parasitic myomas, in most cases, are asymptomatic, but it can cause an unspecific abdominal pain, menstrual disturbances, dyspareunia and other gynecological symptoms. Physical exploration in patients is often also normal. The correct identification of parasitic myoma by image tests, such as transvaginal ultrasound, CT or MRI, is still complicated because it is difficult to diagnose due to the unspecific radiological characteristics that show up. CT and MRI give information about the location that could be useful during the surgery. Usually the diagnosis is an accidental finding during an abdominal surgery done for another reason and the histology of the piece is what gives the definitive diagnosis. We present a case of a 32-year-old woman, asymptomatic, after a transvaginal ultrasound is diagnosed a retroperitoneal tumor. The tumor was removed by laparoscopic surgery and the patient had a favourable recovery. The histopathology of the tumor was a parasitic myoma.

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Subhepatic caecum and appendix - a rare variant in an adult male cadaver

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401707 ◽

2013 ◽

Vol 02 (02) ◽

pp. 093-096

Author(s):

P. Savithri

Keyword(s):

Iliac Fossa ◽

Abdominal Cavity ◽

Intestinal Loop ◽

Diagnostic Challenge ◽

Inferior Surface ◽

Male Cadaver ◽

Hypochondriac Region ◽

Right Lobe ◽

The Right ◽

Symptoms And Signs

AbstractIn unusual cases of malrotation or incomplete rotation of caecum , the appendix is not located in the lower right quadrant. When the caecum is high [subhepatic caecum] the appendix is located in the right hypochondriac region and the pain in these cases is located there, not in the lower right quadrant. In this position , the symptoms and signs of acute appendicitis may mimic acute cholecystitis, diagnosis in such cases is a great diagnostic challenge. The author observed this less frequent anomaly in a middle aged male cadaver. After opening the abdomen while tracing peritoneal reflections abnormality was identified. The caecum and appendix were present in relation with inferior surface of liver. Embryologically, the caecal swelling appears as a small conical dilation of the caudal limb of primitive intestinal loop and it is the last part of the gut to reenter the abdominal cavity. It is temporarily located in the right upper quadrant directly below the right lobe of liver. From here it descends into the right iliac fossa. The failure to descend leads to subhepatic caecum.

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