scholarly journals Isolated fallopian tube torsion in an adolescent: a diagnostic challenge

2020 ◽  
Vol 10 (1) ◽  
pp. 340
Author(s):  
Leonor Bivar ◽  
Ana Castro ◽  
Neusa Teixeira
Keyword(s):  
Abdominal Pain ◽  
Fallopian Tube ◽  
Transvaginal Ultrasound ◽  
Rare Event ◽  
Lower Abdominal Pain ◽  
Cystic Mass ◽  
Diagnostic Challenge ◽  
Ovarian Involvement ◽  
Delayed Intervention

Torsion of the fallopian tube without ovarian involvement is an extremely rare event and often difficult to diagnose, but noteworthy, cause of lower abdominal pain. The authors describe a case related to a 14- year-old adolescent with acute lower abdominal pain and vomiting presented to the gynaecological emergency department. Blood tests exhibited modest biochemical parameters of inflammation and a transvaginal ultrasound showed a left adnexal tubular cystic mass with normal ovarian appearance. A diagnostic laparoscopy revealed an isolated fallopian tube torsion. The tube was able to be untwisted with restoration of pelvic anatomy and the follow-up was uneventful. The authors describe a challenging diagnosis in an adolescent in which delayed intervention could compromise her reproductive future. Tubal torsion should however be kept in mind in the differential diagnosis of lower abdominal pain in women of all ages.

scholarly journals Torsion hematosalpinx concurrent with acute appendicitis

2021 ◽  
Vol 10 (10) ◽  
pp. 3973
Author(s):  
Vishwa G. Kanabar ◽  
Ravi N. Kotecha ◽  
Ramesh Thakan
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Fallopian Tube ◽  
Diagnostic Laparoscopy ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Acute Onset ◽  
Cystic Mass ◽  
Diagnostic Dilemma ◽  
Ovarian Pathology

Isolated fallopian tube torsion is very rare which is reported to be 1 in 1.5 million women. Fallopian tube torsion is commonly associated with hydrosalpinx, hematosalpinx or paratubal cysts such as hydatids of Morgagni. Fallopian tube torsion generally presents a diagnostic dilemma because symptoms and signs mimics ovarian torsion such as acute lower abdominal pain, vomiting, tenderness on palpation but ultrasound may show normal ipsilateral ovary. Right sided adnexal torsion may be difficult to differentiate from acute appendicitis clinically. In such cases ultrasound is helpful but diagnostic laparoscopy is gold standard. We encountered a rare case of torsion hematosalpinx concurrent with acute appendicitis. Patient was presented with acute onset severe lower abdominal pain associated with vomiting and tenderness in right iliac fossa. It was diagnosed as acute tip appendicitis and right adnexal cystic mass either hydrosalpinx/hematosalpinx in ultrasonography. Laparoscopy was done and it was found to be right sided torsion hematosalpinx along with inflamed tip of appendix. Right sided salpingectomy and appendicectomy was done laparoscopically. Fallopian tube torsion should be suspected and diagnostic laparoscopy should be considered in cases of acute onset lower abdominal pain in which ovarian pathology was not found in ultrasonography, that helps in earlier intervention and even in early cases fallopian tube can be salvaged.

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.

scholarly journals Erratum: Chronic Appendicitis: Diagnostic Dilemma in Female Patient for Recurrent Lower Abdominal Pain. J Shaheed Suhrawardy Med Coll Vol. 10 No. 1, June 2018 Page - 59-61

2019 ◽  
Vol 10 (2) ◽  
pp. 83-85
Author(s):  
Khairun Nahar ◽  
SM Amjad Hossain ◽  
Ashia Khatun
Keyword(s):  
Abdominal Pain ◽  
Female Patient ◽  
Lower Abdominal Pain ◽  
Clinical Feature ◽  
Pathology Report ◽  
Repeated Treatment ◽  
Diagnostic Dilemma ◽  
Chronic Appendicitis ◽  
Female Patients

Erratum: Chronic Appendicitis: Diagnostic Dilemma in Female Patient for Recurrent Lower Abdominal Pain J Shaheed Suhrawardy Med Coll Vol. 10 No. 1, June 2018 Page - 59-61 The author of this article brought attention to publishers that this is an original article an previous issue Vol. 10 No. 1, June 2018 Page - 59-61 it was published as a Case report. These error have been corrected to enhance credibility to readers and the article has been published in this issue of J Shaheed Suhrawardy Med Coll --------------------------------------------------------------------------------------------------------------------------------------------------------- Background: Many female patients presented to gynecologist with chronic lower abdominal pain, suspecting chronic PID or UTI, but found no improvement inspite of repeated treatment. It remains as diagnostic dilemma for gynaecologist. Proper diagnosis ultimately shows that it is a case of chronic appendicitis. The main purpose of this study was to evaluate the clinical feature of chronic appendicitis and its correlation with operative and histological findings & to create alertness of physicians and prevention of later complication. Methods: This cross-sectional study was carried out in female patients in private practice from January 2014 to December 2017.All patientswho complained frequent attacks of pain in their right lower abdomen were included in our study. The patient’s history, clinical and lab findings were closely evaluated. All the patients underwent appendectomy and all their appendices were histopathologically examined. Chronic appendicitis was ruled in with a positive pathology report confirming chronic inflammation. All the patients referred for their follow-up visits in a period of one year. Results: A total100 female patients were studied.66% patient were in age group 26 to35 years.87% patients were multiparous. Duration of pain varied from 2weeks to 2.5 years. Histopathology report confirmed chronic appendicitis in 96% cases. From them 94% cases expressed complete relief of pain following removal in the follow-up visit. Conclusion: Chronic appendicitis seems to be a cause of recurrent lower abdominal pain. The disease is easily cured by appendectomy. J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 83-85

scholarly journals ANTERIOR ABDOMINAL WALL ENDOMETRIOMA: A DIAGNOSTIC CHALLENGE

2016 ◽  
Vol 3 (2) ◽  
pp. 44-46
Author(s):  
Salamat Khan ◽  
Krishna Bhasyal ◽  
Bhusan Raj Timilsina
Keyword(s):  
Computed Tomography ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Lower Abdominal Pain ◽  
Radical Resection ◽  
Rectus Abdominis Muscle ◽  
Medical Sciences ◽  
Diagnostic Challenge ◽  
History Of

We are reporting a case of abdominal wall endometrioma (AWE) in a 32-year-old woman who had an 8 months history of lower abdominal pain and lump. The physical examination revealed an ill-defined mass without tenderness. Computed tomography (CT) showed an enhancing is odense mass at the level of umbilicus right to mid line in right rectus abdominis muscle. The patient was treated with a wide radical resection with a 1 cm margin. There was no postoperative complication. The histological examination confirmed endometriosis. The patient is now on regular follow-up and doing well without any recurrence, five months after her operation.Journal of Universal College of Medical Sciences (2015) Vol.03 No.02 Issue 10Page: 44-46 

scholarly journals Haematometra in one half of the uterus or rudimentary horn?

1970 ◽  
Vol 2 (1) ◽  
pp. 59-62
Author(s):  
Suniti Rawal ◽  
Josie Baral ◽  
Meeta Singh ◽  
Samira Khan ◽  
Beemba Shakya ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Key Words ◽  
Uterine Cavity ◽  
Lower Abdominal Pain ◽  
Rudimentary Horn ◽  
Unicornuate Uterus ◽  
Post Operative Period ◽  
Endometriotic Cyst

A unicornuate uterus with functioning and non communicating rudimentary horn is a rare Mullerian abnormality, difficult to diagnose at times usually low in the list of differential diagnosis for pelvic pain and dysmenorrhea. A 22 years P1 presented with severe lower abdominal pain and dysmenorrhoea, following laparotomy that was done for endometriotic cyst of left ovary 7 months back. Radiographic studies revealed the haematometra in the rudimentary horn with normal uterus, right ovary and the tube. Laparotomy with drainage of haematometra and excision of septum along with the reconstruction of uterine cavity was performed thus anatomizing it with the cavity of the rudimentary horn. Both the intra and the post operative period were uneventful. She was discharged on OCP along with the advice to follow up regularly. She is asymptomatic till date. Key words: Endometriosis, haematometra, rudimentary horn doi:10.3126/njog.v2i1.1480 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 59 - 62 May -June 2007

scholarly journals Conservative management of early uncomplicated appendicitis in children

2017 ◽  
Vol 4 (3) ◽  
pp. 1024 ◽  
Author(s):  
Sunil Kumar Maini ◽  
Neeraj Kumar Jain ◽  
Manjari Goel Jain ◽  
Vicky Khobragade
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Conservative Management ◽  
Medical Management ◽  
Surgical Intervention ◽  
Lower Abdominal Pain ◽  
Primary Treatment ◽  
Research Centre ◽  
Uncomplicated Appendicitis

Background: Right lower abdominal pain management in children is a challenging task for the surgeon. Most of the time right lower abdominal pain ends up in acute appendicitis. For long time appendicetomy was the treatment of choice. However surgical intervention has its own disadvantages such as pain, scarring, adhesions, hernia development and venous thrombosis disease. Anxiety and fear of surgery were also two difficulties in obtaining consent for surgery. Parents often request and insist for medical management. Their unwillingness for surgical intervention was the most important reason for medical management of uncomplicated acute appendicitis.Methods: Our prospective observational study was conducted in the Department of General Surgery, R.K.D.F. Medical College and Research Centre, Bhopal, Madhya Pradesh, India during period of January 2014 to January 2016 and follow up was done till December 2016. Our target group was children under 16 years. A total of 92 children with complaint of right lower abdominal pain attended the hospital for treatment. Routine investigations including ultrasonography of abdomen were performed for all the patients. Out of 92 patients diagnosis of acute appendicitis was made in 74 patients, Surgery was performed in 32 patients, while remaining 42 patients were treated conservatively and the results were analyzed.Results: In this study of 92 patients of pain in right iliac fossa below 16 years, 74 (80.43%) were diagnosed as acute appendicitis. 32 (43.24%) Patients were operated earlier. 42 (56.75%) Patient were treated conservatively. Out of 42 patients, 12 (16.21%) patients were operated within 1 year, 30 (40.54%) Patients didn’t require any surgical intervention during 1 year follow up. In present study, significant role of antibiotic was found in conservative management of acute appendicitis in children. So it can be concluded that conservative management of acute appendicitis in children can be attempted under observation.Conclusions: Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. Appendicectomy should be done but conservative management of acute appendicitis in children can be attempted under observation.

scholarly journals Chronic Appendicitis: Diagnostic Dilemma in Female Patient for Recurrent Lower Abdominal Pain

2018 ◽  
Vol 10 (1) ◽  
pp. 59-65
Author(s):  
Khairun Nahar ◽  
SM Amjad Hossain ◽  
Ashia Khatun
Keyword(s):  
Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Clinical Feature ◽  
Complete Relief ◽  
Pathology Report ◽  
Repeated Treatment ◽  
Diagnostic Dilemma ◽  
Chronic Appendicitis ◽  
Female Patients

Background: Many female patients presented to gynecologist with chronic lower abdominal pain, suspecting chronic PID or UTI, but found no improvement inspite of repeated treatment. It remains as diagnostic dilemma for gynaecologist. Proper diagnosis ultimately shows that it is a case of chronic appendicitis. The main purpose of this study was to evaluate the clinical feature of chronic appendicitis and its correlation with operative and histological findings & to create alertness of physicians and prevention of later complication.Methods: This cross-sectional study was carried out in female patients in private practice from January 2014 to December 2017.All patientswho complained frequent attacks of pain in their right lower abdomen were included in our study. The patient’s history, clinical and lab findings were closely evaluated. All the patients underwent appendectomy and all their appendices were histopathologically examined. Chronic appendicitis was ruled in with a positive pathology report confirming chronic inflammation. All the patients referred for their follow-up visits in a period of one year.Results: A total100 female patients were studied.66% patient were in age group 26 to35 years.87% patients were multiparous. Duration of pain varied from 2weeks to 2.5 years. Histopathology report confirmed chronic appendicitis in 96% cases. From them 94% cases expressed complete relief of pain following removal in the follow-up visit.Conclusion: Chronic appendicitis seems to be a cause of recurrent lower abdominal pain. The disease is easily cured by appendectomy.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 59-61

scholarly journals Accuracy of Five Different Diagnostic Techniques in Mild-to-Moderate Pelvic Inflammatory Disease

2002 ◽  
Vol 10 (4) ◽  
pp. 171-180 ◽  
Author(s):  
Hernando Gaitán ◽  
Edith Angel ◽  
Rodrigo Diaz ◽  
Arturo Parada ◽  
Lilia Sanchez ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pelvic Inflammatory Disease ◽  
Clinical Diagnosis ◽  
Inflammatory Disease ◽  
Performance Test ◽  
Transvaginal Ultrasound ◽  
Lower Abdominal Pain ◽  
Endometrial Biopsy ◽  
Diagnostic Methods ◽  
Cross Sectional

Objective:To evaluate the clinical diagnosis of pelvic inflammatory disease (PID) compared with the diagnosis of PID made by laparoscopy, endometrial biopsy, transvaginal ultrasound, and cervical and endometrial cultures.Study design:A diagnostic performance test study was carried out by cross-sectional analysis in 61 women. A group presenting PID (n= 31) was compared with a group (n= 30) presenting another cause for non-specific lower abdominal pain (NSLAP). Diagnosis provided by an evaluated method was compared with a standard diagnosis (by surgical findings, histopathology, and microbiology). The pathologist was unaware of the visual findings and presumptive diagnoses given by other methods.Results:All clinical and laboratory PID criteria showed low discrimination capacity. Adnexal tenderness showed the greatest sensitivity. Clinical diagnosis had 87% sensitivity, while laparoscopy had 81% sensitivity and 100% specificity; transvaginal ultrasound had 30% sensitivity and 67% specificity; and endometrial culture had 83% sensitivity and 26% specificity.Conclusions:Clinical criteria represent the best diagnostic method for discriminating PID. Laparoscopy showed the best specificity and is thus useful in those cases having an atypical clinical course for discarding abdominal pain when caused by another factor. The other diagnostic methods might have limited use.

scholarly journals Herlyn-Werner-Wunderlich Syndrome: Comparison of Two Cases

2020 ◽  
Vol 17 (19) ◽  
pp. 7173
Author(s):  
Mateusz Kozłowski ◽  
Katarzyna Nowak ◽  
Dominika Boboryko ◽  
Sebastian Kwiatkowski ◽  
Aneta Cymbaluk-Płoska
Keyword(s):  
Abdominal Pain ◽  
Clinical Symptoms ◽  
Transvaginal Ultrasound ◽  
Lower Abdominal Pain ◽  
Clinical Situation ◽  
Uterus Didelphys ◽  
History Of ◽  
Rare Malformation ◽  
Obstructed Hemivagina

Background: Herlyn-Werner-Wunderlich Syndrome is a rare malformation syndrome characterized by uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis. Symptoms appear most often after menarche and are secondary to hematocolpos. We compare clinical symptoms, diagnosis and treatment of two patients, a 13-year-old and a 17-year-old. Case report: Despite the non-uniform clinical symptoms, it should be noted that in both patients, the 13-year-old and the 17-year-old, hematocolpos, which was probably the cause of lower abdominal pain, was diagnosed with ultrasound. The diagnosis was complemented by laparoscopy, which determined the diagnosis of malformation of uterus didelphys with obstructed hemivagina. The patients had a history of kidney agenesis, which, after gynecological diagnosis, turned out to be ipsilateral. In the 13-year-old, agenesis was diagnosed by uroscintigraphy, while in the 17-year-old it was diagnosed by urography. Incision and drainage of the residual vagina was performed in the course of therapeutic management. In both cases, the clinical situation required a repeated widening of the orifice. Conclusions: Lower abdominal pain accompanying hematocolpos suggested Herlyn-Werner-Wunderlich Syndrome (HWWS) as the cause of symptoms. 3D transvaginal ultrasound enabled the determination of a congenital uterine defect with high probability, although inconclusive cases required confirmation by laparoscopy. Incision of the blocked vagina and drainage of hematocolpos were the key components of treatment. The treatment of HWWS is a multi-step process.

scholarly journals Pediatric Ovarian Torsion: A Diagnostic Challenge in COVID-19 Times

2020 ◽  
Vol 18 (2) ◽  
pp. 120-123
Author(s):  
R. Chanchlani ◽  
M. Jangid ◽  
R. Ahmad ◽  
P. Sharma
Keyword(s):  
Abdominal Pain ◽  
Surgical Intervention ◽  
Lower Abdominal Pain ◽  
Exploratory Laparotomy ◽  
Ovarian Torsion ◽  
Diagnosis And Treatment ◽  
Diagnostic Challenge ◽  
Delay In Diagnosis ◽  
Functional Loss ◽  
Early Surgical Intervention

Ovarian torsion is a rare gynecological emergency in children and an early surgical intervention is needed to salvage the ovary. Herein, we present a case of eight year old girl who presented with complaints of lower abdominal pain during ongoing COVID-19 pandemic. She was diagnosed as a case of ovarian torsion on right side. She underwent exploratory laparotomy and ovarian cystectomy was performed. Delay in diagnosis and treatment of ovarian torsion may have grave consequences, resulting in functional loss of the ovary.

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