scholarly journals Syndrome of complete insensitivity to androgens of the 4-years-old child

2020 ◽  
Vol 10 (1) ◽  
pp. 89-94
Author(s):  
Vasily P. Gavrilyuk ◽  
Stanislav V. Kostin ◽  
Maria I. Statina ◽  
Dmitry A. Severinov ◽  
Elena O. Ageeva
Keyword(s):  
Vas Deferens ◽  
Surgical Intervention ◽  
Abdominal Cavity ◽  
Outpatient Basis ◽  
Female Reproductive System ◽  
Bilateral Inguinal Hernia ◽  
Pelvic Organs ◽  
Hernial Sac ◽  
Risk Of Malignancy ◽  
The Right

To demonstrate an interesting and rare case in the clinical practice of testicular feminization syndrome in a child, as an accidental finding when performing a planned surgical intervention. A mother with a child E., born in 2010 (at the time the child was 4 years old) was hospitalized with the mothers complaints about the presence of protrusions in both inguinal areas from birth, the mother denied cases of infringement. The child was examined on an outpatient basis and the next day a scheduled surgical intervention was prescribed hernia repair on both sides. At the opening of the hernial sac on the right, the contents were the testicle, 1.6 1.6 1.0 cm in size, with an appendage and vas deferens. Then an opening of the hernial sac was performed on the left, the contents of the hernial sac was also a testicle measuring 1.8 1.2 1.0 cm with an appendage and d. deference. Examination was performed: on an ultrasound of the pelvic organs the bladder is full, the effusion in the pelvis is up to 1215 mm high, the uterus and ovaries are not located at the time of the examination. In the abdominal cavity (in the iliac regions), ovarian testicles with mediastinum are located on both sides 19 11 mm on the right, 16 10 mm on the left. The clinical case that we have provided will be of interest to pediatric surgeons and geneticists in view of the unusual and complex clinical diagnosis of this condition. In the presence of a female phenotype, the child completely lacked the organs of the female reproductive system, this disease was detected only due to the presence of a concomitant pathology in the child, a bilateral inguinal hernia. The early diagnosis of STF is especially important given the risk of malignancy of the gonads in the post-pubertal period.

scholarly journals Diagnostic program and tactical approaches to treatment of patients with obturative colonic obstruction of tumor genesis

2012 ◽  
Vol 93 (3) ◽  
pp. 426-431
Author(s):  
I S Malkov ◽  
M M Toltoev
Keyword(s):  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Primary Anastomosis ◽  
Colonic Obstruction ◽  
Abdominal Cavity ◽  
Digital Rectal Examination ◽  
Postoperative Mortality ◽  
Diagnostic Procedures ◽  
Results Of Treatment ◽  
The Right

Aim. To determine the value of ultrasound investigations, colonoscopy and laparoscopy in the complex diagnosis of acute obturative colonic obstruction of tumor genesis and in selecting the optimal treatment strategy. Methods. Conducted was an anlysis of results of treatment of 112 patients with obturative colonic obstruction of tumor genesis. A set of diagnostic procedures was carried out for every admitted patient: digital rectal examination, radiography of the abdomen, ultrasound examination, fiber colonoscopy, and laboratory studies. Results. Based on the clinical and radiographic the diagnosis of obturative colonic obstruction was established in 64.3%, ultrasound investigation revealed the presence of bowel obstruction without specifying its location in 92% of the cases. Emergency colonoscopy was informative only in 55.5% of cases due to inadequate prior preparation of the colon. Using the developed methodology of preparing the colon, it was possible to perform colonoscopy up to the level of the tumor in 26 patients (92.9%) out of 28 patients. In the 32 cases minimal surgical intervention were performed by way of formation of an ileotransverse anastomosis by-pass, double-barreled ileostomy or colostomy. 80 patients underwent resection of the bowel with the tumor, including operations with the formation of a primary anastomosis, which were performed in 20 patients when the tumor was located in the right segments of the colon. In 22 patients an intraoperative colonic lavage was performed. Postoperative complications were recorded in 30 (26.8%) patients. Postoperative mortality was 24.1% (27 patients). Conclusion. Based on the radiographic and ultrasound investigations of the abdominal cavity it is possible to establish the presence of bowel obstruction without specifying the localization of the obstruction zone; in order to determine the cause of the obturative colonic obstruction it is necessary to perform an emergency colonoscopy with rigorous preparation of the colon according to the developed technique, while the volume of surgical intervention should be determined in each case individually.

scholarly journals Incarcerated gallbladder in inguinal hernia: a case report and literature review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
János Tajti ◽  
József Pieler ◽  
Szabolcs Ábrahám ◽  
Zsolt Simonka ◽  
Attila Paszt ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Abdominal Cavity ◽  
Abdominal Ultrasound ◽  
Intestinal Loop ◽  
Emergency Case ◽  
Laboratory Findings ◽  
Midline Laparotomy ◽  
Reactive Protein ◽  
Hernial Sac ◽  
The Right

Abstract Background Treating hernias is one of the oldest challenges in surgery. The gallbladder as content in the case of abdominal hernias has only been reported in a few cases in the current literature. Cholecyst has only been described in the content of an inguinofemoral hernia in one case to date. Case presentation A 73-year-old female patient was admitted to the Emergency Department due to complaints in the right inguinal area, which had started 1 day earlier. The patient complained of cramp-like abdominal pain and nausea. Physical examination confirmed an apple-sized, irreducible hernia in the right inguinal region. Abdominal ultrasound confirmed an oedematous intestinal loop in a 70-mm-long hernial sac, with no circulation detected. Abdominal X-ray showed no signs of passage disorder. White blood cell count and C-reactive protein level were elevated, and hepatic enzymes were normal in the laboratory findings. Exploration was performed via an inguinal incision on the right side, an uncertain cystic structure was found in the hernial sac, and several small abnormal masses were palpated there. The abdominal cavity was explored from the middle midline laparotomy. During the exploration, the content of the hernial sac was found to be the fundus of the significantly ptotic, large gallbladder. Cholecystectomy and Bassini’s repair of the inguinal hernia were performed safely. Conclusions Following a review of the literature, it can be concluded that the finding of incarcerated gallbladder in the content of an inguinal hernia is a rare finding. No other similar emergency case and successful surgical intervention have been reported before.

scholarly journals Bochdalek hernia in adults: A case report

2018 ◽  
Vol 75 (6) ◽  
pp. 628-631
Author(s):  
Anita Ivosevic ◽  
Ivana Meta-Jevtovic ◽  
Vojislav Cupurdija ◽  
Ivan Cekerevac ◽  
Aleksandar Radunovic ◽  
...  
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Imaging Techniques ◽  
Main Bronchus ◽  
Abdominal Cavity ◽  
Proximal Part ◽  
Bochdalek Hernia ◽  
Hernia Sac ◽  
Hernial Sac ◽  
The Right

Introduction. Asymptomatic Bochdalek hernia in adults is a rarity. The aim of this paper is to present a rare case of Bochdalek hernia among adults and to point out to significance of clinical suspicion and important role of imaging techniques in reaching the exact diagnosis of this abnormality. Case report. A patient, aged 68 years, came to the Clinic of Pulmonology complaining of constant dyspnea, coughing and fatigue. Computed tomography (CT) findings were dominated by the large rear right diaphragmatic hernia with the hernial sac that reached the carina trachea and urged the principal bronchi. The stomach, duodenum and proximal part of jejunal winds, as well as a greater amount of omental and mesenteric adipose tissue were localized in hernial sac. Radiography of gastroduodenum showed: entry of the esophagus into the cardia was in the level of the right main bronchus. Stomach was mainly located in the chest (cardia, upper corpus half - to the level of the right main bronchus). Operation was indicated. First, we made right thoracotomy and the hernia sac was separated from the right lung and then we performed median laparotomy and the contents of the hernia sac were returned to the abdominal cavity; diaphragm defect was reconstructed with prolen mesh. Conclusion. We presented a rare case of right sided Bochdalek hernia which was discovered at late age and surgically treated with success.

Dysgenetic male pseudohermaphroditism

2012 ◽  
Vol 153 (8) ◽  
pp. 303-307 ◽  
Author(s):  
László Ságodi ◽  
Janka Jakab ◽  
Ákos Kiss ◽  
Erzsébet Ladányi ◽  
Erzsébet Balogh ◽  
...  
Keyword(s):  
Gonadal Dysgenesis ◽  
Surgical Intervention ◽  
Abdominal Cavity ◽  
Testicular Tissue ◽  
Male Pseudohermaphroditism ◽  
Histological Evaluation ◽  
Surgical Removal ◽  
Pelvic Magnetic Resonance Imaging ◽  
The Right

The authors report a case of a dysgenetic male pseudohermaphroditism with a 45,X/46,XY karyotype in a mosaic form, which was diagnosed in an infant. The one-week-old infant was evaluated because of proximal hypospadias and retention of the right testis. The results of hormonal tests were the followings: serum FSH 5.2 mU/ml; LH: 2.0 mU/ml; testosterone: 144.3 ng/dl; androstendione: 0.42 µg/l; 17-hydroxyprogesterone: 1.12 ng/ml. Chromosomal analysis revealed 45,X/46,XY karyotype. Fluorescent in vitro hybridization showed that 51% of the lymphocytes had the Y chromosome and the SRY gene. Analysis of the SRY showed no deletion in the AZF a,b,c regions. Pelvic magnetic resonance imaging indicated the presence of vagina between the bladder and the rectum, and it showed a mass measuring 15×8 mm in the right inguinal canal as well as an oval gonadal mass with a size of 13×7 mm in the left scrotum. During surgical intervention, performed at the age of one, the right gonad was removed and biopsy of the scrotal testis was performed. Histological examination revealed dysgenetic testis in both sides. The authors emphasize the necessity of cytogenetic and endocrinological investigations of newborns with perineoscrotal hypospadia and bilateral or unilateral maldescent testes immediately after birth. Surgical removal of the dysgenetic testicular tissue located in the abdominal cavity and its histological evaluation provides separation of mixed gonadal dysgenesis, dysgenetic male pseudohermaphroditism, bilateral gonadal dysgenesis and ovotestis in the 45,X/46,XY mosaic cases. An accurate evaluation is necessary for a correct sex assignment and for surgical intervention to prevent neoplastic degeneration of the dysgenetic gonad. Orv. Hetil., 2012, 153, 303–307.

scholarly journals CLINICAL CASE OF APPENDIX MUCOCELL, COMPLICATED BY PERFORATION AND THE FORMATION OF RETROPERITONEAL SPACE PHLEGMON

2020 ◽  
pp. 110-114
Author(s):  
О. А. Povch ◽  
Е. N. Shepetko ◽  
О. V. Коvalchuk ◽  
R. О. Leleta ◽  
S. О. Rebenkov
Keyword(s):  
Preoperative Diagnosis ◽  
Surgical Intervention ◽  
Clinical Symptoms ◽  
Abdominal Cavity ◽  
Retroperitoneal Space ◽  
Medical Attention ◽  
Timely Manner ◽  
Gradual Improvement ◽  
Mucocele Of The Appendix ◽  
The Right

Summary. The aim. To analyze the anamnestic data, clinical symptoms, preoperative diagnosis, features of surgical intervention and the results of histological examination in a patient with mucocele of the appendix (MA), complicated by necrosis and perforation of the wall and formation of retroperitoneal space phlegmon (FRS). Material and methods. An analysis of the case of MA, which was complicated by the atypical course and the development of retroperitoneal space phlegmon, which was diagnosed after multispiral computered tomography of the abdominal cavity (MSCT AC). Results. The patient, despite periodic atypical complaints of discomfort in the right iliac region, did not seek medical attention and was not examined. Operated urgently after performing MSCT AC. Intraoperatively, a rupture of the MA was diagnosed with formation of FRS, which significantly complicated the course of the operation and the course of the postoperative period. Appendectomy, drainage of the abdominal cavity and retroperitoneal space were performed. Gradual improvement and recovery. Conclusions: The acute situation resulting from the rupture of the MA, led to a complex operation. Performing MSCT AC at the prehospital stage makes it possible to diagnose the problem and perform the operation in a timely manner, without waiting for serious complications.

Successful treatment of conversion chemotherapy for initially unresectable synchronous colorectal liver metastasis

2020 ◽  
Author(s):  
Lungwani Muungo
Keyword(s):  
Liver Metastasis ◽  
Colorectal Liver Metastasis ◽  
Surgical Intervention ◽  
Liver Volume ◽  
Sigmoid Colon Cancer ◽  
Remnant Liver ◽  
Future Remnant Liver ◽  
The Right ◽  
Synchronous Colorectal Liver Metastasis ◽  
Right Hepatic Vein

A 72-year-old woman with a sigmoid colon cancer anda synchronous colorectal liver metastasis (CRLM), whichinvolved the right hepatic vein (RHV) and the inferiorvena cava (IVC), was referred to our hospital. Themetastatic lesion was diagnosed as initially unresectablebecause of its invasion into the confluence of theRHV and IVC. After she had undergone laparoscopicsigmoidectomy for the original tumor, she consequentlyhad 3 courses of modified 5-fluorouracil, leucovorin,and oxaliplatin (mFOLFOX6) plus cetuximab. Computedtomography revealed a partial response, and theconfluence of the RHV and IVC got free from cancerinvasion. After 3 additional courses of mFOLFOX6 pluscetuximab, preoperative percutaneous transhepaticportal vein embolization (PTPE) was performed tosecure the future remnant liver volume. Finally, a righthemihepatectomy was performed. The postoperativecourse was uneventful. The patient was dischargedfrom the hospital on postoperative day 13. She hadneither local recurrence nor distant metastasis 18 moafter the last surgical intervention. This multidisciplinarystrategy, consisting of conversion chemotherapy usingFOLFOX plus cetuximab and PTPE, could contributein facilitating curative hepatic resection for initiallyunresectable CRLM.Key words: Initially unresectable; Colorectal liver metastasis;Conversion chemotherapy; Cetuximab; Percutaneoustranshepatic portal vein embolization

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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammed Nagdi Zaki ◽  
Aafia Mohammed Farooq Gheewale ◽  
Nada Ibrahim ◽  
Ibrahim Abd Elrahman
Keyword(s):  
Case Report ◽  
Transvaginal Ultrasound ◽  
Iliac Fossa ◽  
Abdominal Cavity ◽  
Laparoscopic Hysterectomy ◽  
Pathology Report ◽  
Presacral Space ◽  
Gnrh Analogue ◽  
Power Morcellation ◽  
The Right

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.

scholarly journals Right-sided Bochdalek hernia in an adult with hepatic malformation and intestinal malrotation

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Naoki Enomoto ◽  
Kazuhiko Yamada ◽  
Daiki Kato ◽  
Shusuke Yagi ◽  
Hitomi Wake ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Abdominal Cavity ◽  
Three Dimensional ◽  
Simulation Software ◽  
3D Simulation ◽  
Diaphragmatic Defect ◽  
Intestinal Malrotation ◽  
Intestinal Loop ◽  
Bochdalek Hernia ◽  
The Right

Abstract Background Bochdalek hernia is a common congenital diaphragmatic defect that usually manifests with cardiopulmonary insufficiency in neonates. It is very rare in adults, and symptomatic cases are mostly left-sided. Diaphragmatic defects generally warrant immediate surgical intervention to reduce the risk of incarceration or strangulation of the displaced viscera. Case presentation A 47-year-old woman presented with dyspnea on exertion. Computed tomography revealed that a large part of the intestinal loop with superior mesenteric vessels and the right kidney were displaced into the right thoracic cavity. Preoperative three-dimensional (3D) simulation software visualized detailed anatomy of displaced viscera and the precise location and size of the diaphragmatic defect. She underwent elective surgery after concomitant pulmonary hypertension was stabilized preoperatively. The laparotomic approach was adopted. Malformation of the liver and the presence of intestinal malrotation were confirmed during the operation. The distal part of the duodenum, jejunum, ileum, colon, and right kidney were reduced into the abdominal cavity consecutively. A large-sized oval defect was closed with monofilament polypropylene mesh. No complications occurred postoperatively. Conclusion Symptomatic right-sided Bochdalek hernia in adults is exceedingly rare and is frequently accompanied by various visceral anomalies. Accurate diagnosis and appropriate surgical repair are crucial to prevent possible incarceration or strangulation. The preoperative 3D simulation provided comprehensive information on anatomy and concomitant anomalies and helped surgeons plan the operation meticulously and perform procedures safely.

Nursing the uroabdomen patient

2021 ◽  
Vol 12 (3) ◽  
pp. 131-138
Author(s):  
Sam McGaw
Keyword(s):  
Metabolic Acidosis ◽  
Urinary Tract ◽  
Diagnostic Imaging ◽  
Urinary Diversion ◽  
Nursing Care ◽  
Postoperative Care ◽  
Surgical Intervention ◽  
Urinary Catheter ◽  
Abdominal Cavity ◽  
Patient Presentation

Uroabdomen, the presence of urine in the abdominal cavity, commonly occurs in dogs and cats, particularly following a trauma. Initial stabilisation of the patient is essential to treat the multisystemic effects of electrolyte and metabolic derangements, including hyperkalaemia, azotaemia and metabolic acidosis. Diagnosis is confirmed by comparing laboratory analysis of abdominal fluid and serum. Urinary diversion is required, often via placement of a urinary catheter, to prevent continuing urine accumulation. Once haemodynamically stable, diagnostic imaging may be performed to confirm the location of the urinary tract rupture, with several modes of imaging available. Surgical intervention may be necessary to repair the urinary leak, this is dependent on the location and severity of the trauma to the urinary tract. Registered veterinary nurses play an important role in the management of the uroabdomen patient, from initial triage and stabilisation, to assisting with imaging, anaesthetic monitoring and postoperative care. This article will discuss the aetiology of the uroabdomen, patient presentation and how to effectively treat the critical patient. Nursing care is vital for ensuring patient welfare and identifying complications that may arise.

scholarly journals Minilaparotomy a Good Option in Specific Cases: A Case Report of Bilateral Ovarian Germ Cell Tumor

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
D. Bolla ◽  
N. Deseö ◽  
A. Sturm ◽  
A. Schöning ◽  
C. Leimgruber
Keyword(s):  
Acute Abdominal Pain ◽  
Adnexal Mass ◽  
Past History ◽  
Ovarian Tissue ◽  
Abdominal Cavity ◽  
Operating Time ◽  
Expectant Management ◽  
Small Incision ◽  
Risk Of Rupture ◽  
The Right

Mature cystic teratomas (MCTs) of the ovary represent 44% of ovarian neoplasmas. The surgical approach is important in young women especially for the cosmetic results. Nowadays most of the ovarian surgeries can be performed laparoscopically. An alternative between laparoscopy and laparotomy is the minilaparotomy (ML) which can be an interesting option, thanks to the small incision. We report a 39-year-old woman who was referred to our hospital with acute abdominal pain. In her past history the patient had an uncomplicated delivery. During pregnancy a 6 cm bilateral MCT was diagnosed and expectant management was followed. A left-sided ovarial torsion was postulated, and laparoscopic detorsion was performed. To avoid a rupture of the left MCT, the operation was interrupted. To remove the cyst, a ML was done two weeks later. A left-sided salpingo-oophorectomy was performed due to a large cyst including the entire ovary. On the other side, the right dermoid cyst was entirely removed. The advantage of a ML is not only shorter operating time with less learning curve compared to laparoscopy but also the possibility to extract the adnexal mass from the abdominal cavity with lower risk of rupture and in addition the possibility to preserve more ovarian tissue.

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