Laparoscopic excision of large omental cyst at department of pediatric surgery in Sanglah general hospital, Bali, Indonesia

Omental cyst is rare. All conditions most likely being of congenital or benign neoplastic lymphatic origin. Patients with Omental cysts usually present with abdominal distention and a painless abdominal mass. The most common physical finding of an omental cyst is a freely movable abdominal mass. The diagnostic procedure include CT scans. Complete excision by open or laparoscopically of the cysts is considered as the treatment of choice. Recurrence and malignant deterioration of omental cysts are rare. A case report of a large omental cyst which had been laparoscopically-treated using morcellator. Laparoscopic morcellation is a technique used in gynecological surgeries such as hysterectomy and myomectomy to remove uteri and uterine fibroids (leiomyomas) through a small abdominal incision. Authors present a case of 3 year old female with pre-operative assessment tumor intra-abdominal suspect abdominal cyst. Subsequently, laparoscopic resection of omental cyst with morcellator was performed. The histopathological report was omental cyst. Omental cysts are rare, but can be shown to have atypical abdominal symptoms and radiologic findings, so clinicians must keep in mind that omental cysts causing abdominal symptoms can be misdiagnosed as simple ovarian cysts of inflammation. Omental cysts can be removed safety laparoscopically with morcellator without bowel or vessel injury.

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Painless spontaneous haemoperitoneum secondary to a uterine leiomyoma/fibroid: unusual presentation of a life-threatening differential

BMJ Case Reports ◽

10.1136/bcr-2021-243465 ◽

2021 ◽

Vol 14 (10) ◽

pp. e243465

Author(s):

Chiamaka Maduanusi ◽

Sathiyaa Balachandran ◽

Sahathevan Sathiyathasan ◽

Kazal Omar

Keyword(s):

Uterine Leiomyoma ◽

Rare Complication ◽

Abdominal Mass ◽

Uterine Fibroids ◽

Reproductive Age ◽

Haemodynamic Instability ◽

Hypovolaemic Shock ◽

Important Differential Diagnosis ◽

Life Threatening ◽

Definitive Management

This is a case of a 47-year-old woman with a spontaneous haemoperitoneum secondary to uterine leiomyomas (fibroids), an important differential diagnosis in patients with uterine fibroids and hypovolaemic shock. Uterine fibroids are very common in women of reproductive age, yet little is taught about their potential to cause hypovolaemic shock. Although it is a rare complication, given the prevalence of fibroids, it is important to bear this life-threatening differential in mind to optimise the care for these women. Presentation typically involves abdominal pain, syncope, haemodynamic instability and an intra-abdominal mass. CT of the abdomen and pelvis can be helpful in identifying the source of the haemoperitoneum, but should not delay surgery, which is the definitive management.

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Axial torsion and gangrene of Meckel’s diverticulum: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1502079r ◽

2015 ◽

Vol 143 (1-2) ◽

pp. 79-82

Author(s):

Sasa Radovic ◽

Drago Albijanic ◽

Marko Albijanic ◽

Zoran Krstic

Keyword(s):

Epigastric Pain ◽

Ileocecal Valve ◽

Postoperative Recovery ◽

Normal Appearance ◽

Abdominal Incision ◽

Surgical Exploration ◽

Axial Torsion ◽

Abdominal Symptoms ◽

Complete Physical Examination ◽

Midline Abdominal Incision

Introduction. Meckel?s diverticulum (MD) is the most prevalent congenital anomaly of small intestine. It develops due to the incomplete obliteration of omphalomesenterict duct which normally undergoes obliteration during the seventh week of gestation. In the majority of cases MD is asymptomatic but it may cause various complications, such as bleeding, intestinal obstruction and inflammation. Cases of umbilical sinuses, fistulas and neoplasms related with MD have been reported, but extremely rare gangrene due to its axial torsion, especially in children, as is the case of our patients. Case Outline. An 11-year-old boy admitted to hospital due to 24 hours epigastric pain, vomiting and malaise. After a complete physical examination, and appropriate pre-surgical laboratory and radiographic tests, surgical exploration was performed with a midline abdominal incision. On 60th cm proximal to the ileocecal valve we found a long and in a narrow based ganrenous MD with axial torsion and fibrotic cord extending from the tip of MD to the ileal mesentery. Surrounding ileum had normal appearance. A demarcation and subsequent resection of MD and the surrounding ileum was performed with endto- end ileal anastomosis. Postoperative recovery was successful and the patient was discharged after six days. Conclusion. Axial torsion of MD is presented with non-specific abdominal symptoms and difficult preoperative diagnosis. The choice of diagnosis and therapy is surgical exploration and resection of MD.

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A rare cause of small bowel diaphragm disease presenting with palpated abdominal mass

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz230 ◽

2019 ◽

Vol 2019 (8) ◽

Cited By ~ 1

Author(s):

Aghyad K Danial ◽

Ahmad Al-Mouakeh ◽

Yaman K Danial ◽

Ahmad A Nawlo ◽

Ahmad Khalil ◽

...

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Medical History ◽

Rare Complication ◽

Abdominal Mass ◽

Past Medical History ◽

Abdominal Symptoms ◽

Diaphragm Disease ◽

History Of ◽

Specific Symptoms

Abstract Small bowel diaphragm disease is a rare complication related to non-steroidal anti-inflammatory drug (NSAID) use. It presents with non-specific symptoms such as vomiting, abdominal pain, subacute bowel obstruction and occasionally as an acute abdominal condition. We report a case of diaphragm disease in a 33-year-old female who presented with vomiting, constipation and abdominal pain started 5 days earlier. Physical examination revealed palpated abdominal mass. The patient’s past medical history was remarkable for NSAID use. The patient was managed by surgical resection of involved intestine and diagnosis was confirmed by histological examination. Although there are few published cases of diaphragm disease in the medical literature, we recommend that this disease should be considered as one of the differential diagnoses when assessing patients presenting with non-specific abdominal symptoms with remarkable past medical history of NSAID use.

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Should Prophylactic Anticoagulation Be Considered with Large Uterine Leiomyoma? A Case Series and Literature Review

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/9803250 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6

Author(s):

Mohamed A. Satti ◽

Carmen Paredes Saenz ◽

Rubin Raju ◽

Sierra Cuthpert ◽

Abed Kanzy ◽

...

Keyword(s):

Literature Review ◽

Uterine Leiomyoma ◽

Medical Center ◽

Rare Complication ◽

Abdominal Mass ◽

Uterine Fibroids ◽

Case Series ◽

Thromboembolic Disease ◽

Uterine Leiomyomas ◽

Prophylactic Anticoagulation

Introduction. Uterine leiomyomas, also called uterine fibroids or myomas, are the most common pelvic tumors in women. They are very rarely the cause of acute complications. However, when complications occur they cause significant morbidity and mortality. Thromboembolic disease has been described as a rare complication of uterine leiomyomas. DVT is a serious illness, sometimes causing death due to acute PE.Cases. We report a case series of 3 patients with thromboembolic disease associated with uterine leiomyoma at Hurley Medical Center, Flint, Michigan, during 2015 and conduct a literature review on the topic. A literature search was conducted using Medline, PubMed, and PMC databases from 1966 to 2015.Conclusion. The uterine leiomyoma is a very rare cause of PE and only few cases have been reported. DVT secondary to uterine leiomyoma should be considered in a female presenting with abdominal mass and pelvic pressure, if there is no clear common cause for her symptoms. Thromboembolic disease secondary to large uterine leiomyoma should be treated with acute stabilization and then hysterectomy. Prophylactic anticoagulation would be beneficial for lowering the risk of VTE in patients with large uterine leiomyoma.

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Mesothelial Cyst in a Young Female: Case report and literature review

International Journal of Case Reports ◽

10.28933/ijcr-2021-02-2005 ◽

2021 ◽

pp. 203

Author(s):

◽

Keyword(s):

Abdominal Mass ◽

Correct Diagnosis ◽

Young Female ◽

Cystic Mass ◽

Mesenteric Cyst ◽

Benign Tumors ◽

Presenting Symptoms ◽

Abdominal Symptoms ◽

Mesothelial Cyst ◽

Mesenteric Cysts

Mesenteric cysts are rare intra-abdominal benign tumors (1 in 100,000 cases in adults) with various clinical presentations. [1,2] They commonly originate from the small bowel mesentery, although a proportion has been found to originate from the mesocolon, and retroperitoneum. [1,3] The formation of mesenteric cysts depends on the histologic origin, where they could be classified into cysts of lymphatic origin, cysts of mesothelial origin, cysts of enteric origin, cysts of urogenital origin, dermoid cysts and pseudocysts. [4,5] Diagnosis is extremely difficult since. The Mesenteric cyst is usually asymptomatic, but if symptomatic, abdominal pain (82%), nausea and vomiting (45%), constipation (27%) are the most common presenting symptoms. [2,3] The clinical finding of abdominal mass is encountered in more than 61% of the patients. [2,3]. As this condition is very rare and its symptomatology can resemble any other abdominal diseases, diagnosis is extremely difficult and incorrect preoperative diagnosis is often made. Hence, performing physical examination and conducting radiological investigations such as ultrasonography (USG) and computed tomography (CT) are important in making a correct diagnosis. [2,3] As well as cases of mesothelial cysts, they are typically asymptomatic but occasionally, their symptoms are vague and non-specific. [6,7] As mentioned above, imaging modalities such as USG, CT and magnetic resonance imaging (MRI) are great in identifying the character, size, location, surrounding tissues and the wall and content of the cysts. [7] Surgery is the treatment of choice, as a complete resection with negative borders is curative and often prevents recurrence. [3] We report a case of a young female patient who presented with a vague abdominal symptoms and a large cystic mass in lower abdomen. After proper evaluation, surgical exploration revealed a large simple mesothelial cyst.

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PS01.090: LAPAROSCOPIC EXCISION OF A PARAESOPHAGEAL BRONCHOGENIC CYST IN A 9-YEAR-OLD MALE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.090 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 75-75

Author(s):

Satoshi Makita

Keyword(s):

Bronchogenic Cyst ◽

Conflicts Of Interest ◽

Incidental Finding ◽

Retrospective Chart Review ◽

Posterior Mediastinum ◽

Esophageal Wall ◽

Complete Excision ◽

Weighted Image ◽

Mediastinal Masses ◽

Laparoscopic Excision

Abstract Background Bronchogenic cyst is a malformation of the ventral foregut. It is ofen asymptomatic and discovered as an incidental finding. In children, it comprises approximately 6% of all mediastinal masses. However, paraesophageal bronchogenic cyst is a rare and has been reported only three cases in children. We report a case of a 9-year-old male with an asymptomatic paraesophageal bronchogenic cyst. Methods Retrospective chart review. Results A 9-year-old male was detected to have retrocardiac mass lesion (2.7 × 1.9 × 1.2 cm), which was detected incidentally on an abdominal computed tomography done for acute appendicitis. No enhancement was noticed after contrast administration. Magnetic resonance imaging revealed a well-circumscribed cyst adjacent to the esophagus just above the hiatus. T1-weighted image showed a low intensity mass and the T2-weighted image showed a high intensity mass. Endoscopic ultrasonography examination of the esophagus demonstrated a cystic mass, with low-echo density. The echo also showed disruption of the fourth layer of the esophageal wall. With these findings, esophageal duplication was suspected. A laparoscopic operation was performed via 4 ports plus one puncture. 5mm laparoscope (30°angle) was inserted in the umbilical port, three 5mm trocars were placed and 3mm grasping forceps was inserted. The cyst was identified in the intra-abdominal esophageal part. Lesion removal was performed with a coagulator hook. A complete excision of the cyst was achieved without perforating of the esophagus. The postoperative courses was uneventful with home discharging on day six. The pathological diagnosis was a bronchogenic cyst because of finding a ciliated respiratory epithelium and cartilage and mucus-secreting glands. Conclusion Paraesophageal bronchogenic cyst is rare. However, it should be considered in the differential diagnoses for mediastinal masses at any age. Laparoscopy is a safe and effective method to deal with masses of posterior mediastinum even in children. Disclosure All authors have declared no conflicts of interest.

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Recurrent abdominal liposarcoma presenting with intestinal obstruction

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz188 ◽

2019 ◽

Vol 2019 (6) ◽

Author(s):

Belal S Abufkhaida ◽

Barah K Alsalameh

Keyword(s):

Intestinal Obstruction ◽

Local Recurrence Rate ◽

Slow Growth ◽

Abdominal Mass ◽

Rare Entity ◽

Complete Excision ◽

Retroperitoneal Liposarcoma ◽

Large Size ◽

High Local Recurrence Rate ◽

Mechanical Intestinal Obstruction

Abstract Liposarcoma is the most common retroperitoneal sarcoma and mesenchymal tumor in the abdomen. Usually, it presents with vague symptoms due to its large size and slow growth at the time of diagnosis. Liposarcoma is associated with a high local recurrence rate according to its histology, size and growth rate. Up till now, surgical resection is the only effective treatment for primary and recurrent abdominal liposarcoma. Secondary mesenteric liposarcoma is an extremely rare entity and so far a small number of cases have been reported in the literature. In this article, we present a rare case of a 63-year-old female patient who was diagnosed with mesenteric liposarcoma after 3 years of complete excision of retroperitoneal liposarcoma, presenting primarily as abdominal mass causing mechanical intestinal obstruction.

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Clinicopathologic Features of Uterine Fibroids in a Private Gynecologic Setting in Calabar, Nigeria

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz127.001 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S138-S138

Author(s):

Ima-Obong Ekanem ◽

Odudu Ekanem ◽

Chinweoke Ekanem

Keyword(s):

Abdominal Mass ◽

Uterine Fibroids ◽

Abdominal Hysterectomy ◽

Medical Centre ◽

Medical Attention ◽

Traditional Health ◽

Clinical Presentations ◽

Pathologic Features ◽

Health Practitioners ◽

Microscopic Findings

Abstract Introduction Uterine fibroid is a common gynecologic problem among adult females in Nigeria with variable clinical presentations. Unfortunately, these patients often seek medical attention very late after having consulted nonorthodox and/or traditional health practitioners. Objectives To assess the clinical outcome of patients diagnosed with uterine fibroids and review the pathologic features of specimens obtained from such patients managed over a 48-months period at Davis Medical Centre, a specialist gynecologic private health facility in Calabar, Nigeria. Methods This retrospective study was conducted at Davis Medical Centre, located in a semirural community in Calabar Municipality. It involved the extraction of data from case notes of patients and review of laboratory reports and H&E-stained histopathologic slides of surgical specimens removed from patients who presented with abdominal mass/swelling, heavy menstrual bleeding, abdominal pain, and inability to get pregnant having excluded other causes of infertility and ultrasonographic features suggestive of leiomyoma. Results A total of 82 patients aged between 26 and 54 years (mean age 36 ± 2 SD) were seen, giving an annual rate of about 20 cases yearly in the 4-year period (2015-2018) studied. Forty-eight (58.5%) had giant uterine fibroids with uterine size between 16 and 28 weeks. Myomectomy was the mainstay of treatment in 93.9% while 6.1% had abdominal hysterectomy. Histologically, the number of fibroid nodules ranged from 1 to 60 nodules with the largest weighing 4,097 g. All had the typical whorled grayish-tan gross appearance of leiomyoma uteri with a large proportion histologically showing degenerative changes of the hyaline type (39%) and few having features suggestive of adenomyosis. Conclusion Despite the grotesque, unusual macroscopic and characteristic microscopic findings, timely and careful surgical intervention can remedy the reproductive outcome and save lives of the affected patients when seen and managed by an experienced specialist gynecologist.

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A New Laparoscopic Morcellator Using an Actuated Wire Mesh and Bag

Journal of Medical Devices ◽

10.1115/1.4026294 ◽

2014 ◽

Vol 8 (1) ◽

Cited By ~ 9

Author(s):

Alexander Isakov ◽

Kimberly M. Murdaugh ◽

William C. Burke ◽

Sloan Zimmerman ◽

Ellen Roche ◽

...

Keyword(s):

Initial Conditions ◽

Uterine Fibroids ◽

Animal Tissue ◽

The Body ◽

Wire Mesh ◽

Minimal Risk ◽

Abdominal Incision ◽

New Device ◽

Bipolar Energy ◽

Tissue Manipulation

Laparoscopic morcellation is a technique used in gynecological surgeries such as hysterectomy and myomectomy to remove uteri and uterine fibroids (leiomyomas) through a small abdominal incision. Current morcellators use blades or bipolar energy to cut tissue into small pieces that are then removed through laparoscopic ports in a piecewise manner. These existing approaches have several limitations; (1) they are time consuming as the tissue must be manually moved over the devices during the cutting step and removal is piecewise, (2) they can lead to accidental damage to surrounding healthy tissue inside the body and (3) they do not provide safe containment of tissue during the morcellation process which can lead to seeding (spreading and regrowth) of benign or potentially cancerous tissue. This paper describes a laparoscopic morcellator that overcomes these limitations through a new design that is based on an enclosed, motor-actuated mesh that applies only an inward-directed cutting force to the tissue after it has been loaded into the protective mesh and bag. The deterministic design approach that led to this concept is presented along with the detailed electromechanical design. The prototype is tested on soft vegetables and an animal model to demonstrate successful morcellation and how the device would be compatible with current clinical practice. Results show that the time required to morcellate with the new device for a set of tests on animal tissue is relatively uniform across samples with widely varying parameters. Including tissue manipulation and extraction time, the new device is shown to have an improvement in terms of speed over current morcellators. The mean time for cutting animal tissue ranging from 100 g to 360 g was 30 s with small variations due to initial conditions. The time for cutting is expected to remain approximately constant as tissue size increases. There is also minimal risk of the protective bag ripping due to the inward-cutting action of the mesh, thereby potentially significantly reducing the risk of seeding during clinical procedures; thus, further increasing patient safety. Finally, this design may be applicable to other procedures involving removal of tissue in nongynecologic surgeries, such as full or partial kidney or spleen removal.

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High levels of ca125 in a patient with large uterine fibroid.

Hellenic Journal of Obstetrics and Gynecology ◽

10.33574/hjog.2102 ◽

2020 ◽

Vol 19 (4) ◽

pp. 167-170

Author(s):

Konstantinos Zacharis ◽

Konstantinos Dafopoulos

Keyword(s):

Abdominal Mass ◽

Female Genital Tract ◽

Uterine Fibroids ◽

Reproductive Age ◽

Benign Tumors ◽

Caucasian Woman ◽

Cancer Antigen 125 ◽

Cancer Antigen ◽

Present Case Report ◽

Female Genital

Uterine leiomyomas, also known as uterine fibroids, are the most common benign tumors of the female genital tract and affect 60 to 80% of women at their reproductive age. Although elevated tumor markers may be measured in benign gynaecological diseases, the association of uterine fibroids with increased levels of serum cancer antigen 125 (CA125) has not been proven to date. In the present case report we present a rare case of a 21-year-old Caucasian woman attended to our outpatient department with hypermenorrhea and pelvic discomfort that was treated for an enlarged intra-abdominal mass with an abnormally high CA-12 (777.3 U/mL).

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