Abdominal Cocoon With Intestinal Perforation: A Case Report

Introduction: Abdominal cocoon is a very rare abdominal disease. Abdominal cocoon mainly leads to intestinal obstruction, and abdominal cocoon with gastrointestinal perforation is rare.Case Presentation: We report a 63-year-old man who was admitted to our hospital with “persistent lower abdominal pain for one day”. Abdominal CT examination revealed a small amount of free gas in the abdominal cavity, ascites, and gastrointestinal perforation. An emergency operation was performed. During the operation, the end of the right lower abdominal ileum was found to be conglutinated and twisted into a mass, a local intestinal dilatation, and obstruction, local intestinal wall was black and gangrene, and fecal effusion flowed out. The adhesions were carefully separated, and the necrotic small intestine was removed. The operation process went smoothly, and the patient recovered well after the operation.Conclusion: The cases of intestinal perforation caused by the abdominal cocoon are very rare. In clinical work, when we encounter patients with gastrointestinal perforation, we need to carefully ask the history. When the patients had no digestive system diseases in the past, we need to consider the possibility of the abdominal cocoon with perforation.

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HETEROTOPIC PREGNANCY WITH INEVITABLE ABORTION (RIGHT ADNEXAL LIVE ECTOPIC AND COEXISTING INTRAUTERINE TRIPLETS WITH ABSENT FETAL CARDIAC ACTIVITY)

10.36106/ijsr/9522431 ◽

2021 ◽

pp. 58-59

Author(s):

Jayanta Sarkar ◽

Mini Sengupta

Keyword(s):

Ectopic Pregnancy ◽

Abdominal Cavity ◽

Lower Abdominal Pain ◽

Cardiac Activity ◽

Exploratory Laparotomy ◽

Sudden Onset ◽

Heterotopic Pregnancy ◽

Intrauterine Pregnancy ◽

Short Period ◽

The Right

Heterotopic pregnancy describes the occurrence of two or more pregnancies in different implantation sites simultaneously, intrauterine pregnancy coexists withectopic pregnancies (ampullary in 80%). A 27-year-old women (P ,L1) presented to the emergency department with a complaint of sudden onset of right-sided lower abdominal pain with 1+1 vaginal bleeding and had a short period of Amenorrhea. Ultrasonography demonstrated three intrauterine gestational sacwith foetal pole noted but Cardiac activity was absent . The right adnexa showed a heteroechoic area andmoderate amount of free uid was present in the lower abdominal cavity. Ectopic pregnancy was disturbed. An emergency exploratory laparotomy was performed under general anesthesia. Haemoperitoneum was found with a ruptured righttubal ectopic pregnancy as well. Both the ovaries appeared normaland a corpus luteal cyst was presentin right ovary. Right sided salpingectomy was performed with removal of the ectopic mass,heamostasis secured ,on table blood transfusion had been given.Suction evacuation had also been performed by manual vacuum aspirationon same sitting.Both the specimen send for histopathology. Histology conrmedGestational sac suggestive of an intra uterine pregnancy coexists with ectopic pregnancy. Left tube and both ovaries were found healthy. Episodes of PID also have a strong correlation with occurrence of ectopic gestation. Once diagnosis of heterotrophic pregnancy has been made the management is essentially surgical.

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Possibilities of CT in the diagnosis of complications of intestinal diverticulosis (clinical observation)

Medical Visualization ◽

10.24835/1607-0763-2019-3-54-65 ◽

2019 ◽

pp. 54-65

Author(s):

E. P. Korneva ◽

M. V. Rostovtsev ◽

N. V. Nudnov ◽

T. M. Rostovtseva ◽

E. V. Pronkina

Keyword(s):

Abdominal Pain ◽

Intestinal Obstruction ◽

Abdominal Cavity ◽

High Sensitivity ◽

Intestinal Wall ◽

Free Fluid ◽

Abdominal Organs ◽

Multiplanar Reformatting ◽

Detection And Diagnosis ◽

The Right

Purpose. To determine the possibility of MSCT in the detection and diagnosis of complications of diverticulosis.Materials and methods. MSCT was performed in the apparatus Aqullion Toshiba 64 with collimation of 0.5–1 mm with the multiphase contrast-enhanced and further multiplanar reformatting. The results of MSCT of abdominal organs in 2082 (100%) patients for 2016–2018 in GBUZ GKB im were analyzed. M.E. Zhadkevich, 841 (40%) – for emergency indications.Results. Intestinal diverticula was detected in 239 (11%) patients. CT-signs of diverticulitis were found in 36 (1.7%) subjects: 19 (0.9%) women aged 54 years to 91 years and 17 (0.8%) men aged 27 to 88 years. When admitted to the hospital, all patients (36 people – 100%) with CT signs of diverticulitis complained of severe abdominal pain: with localization in the left iliac and suprapubic areas of 22 (61%) patients, 2 (5.5%) – in the right iliac and suprapubic areas, the remaining 12 (33.5%) patients complained of abdominal pain without a clear localization. Localization of diverticulitis in the sigmoid colon occurred in 22 (61%) cases, in the descending part of the colon – in 13 (36%). In 1 (3%) observation diverticulitis was detected in the terminal part of the jejunum.The presence of perianth infiltrate took place – in 16 (44%) cases, with signs of abscedding – in 4 (11%), peritonitis was observed in 2 (5.5%) examined in combination with signs of intestinal obstruction. Perforation with the presence of a large amount of free gas was detected in 1 (3%) case, microperforation – in 12 (33.5%). A small amount of free fluid in the abdominal cavity was found in 18 (50%) patients. Conclusion. Timely diagnosis of complicated diverticular disease is crucial. MSCT has high sensitivity and specificity in the diagnosis of phlegmon and abscesses of the abdominal cavity, perforation of the intestinal wall, peritonitis, bleeding and intestinal obstruction.

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Primary Abdominal Cocoon with Right Intra-Abdominal Cryptorchidism: A Case Report

10.21203/rs.3.rs-877930/v1 ◽

2021 ◽

Author(s):

Jian Jiao ◽

Han Li ◽

Kangdi Dong ◽

Jin Liu ◽

Ronghua Zhang ◽

...

Keyword(s):

Small Intestine ◽

Abdominal Cavity ◽

Clinical Manifestations ◽

Testicular Tissue ◽

Seminiferous Tubules ◽

Abdominal Cocoon ◽

Chronic Inflammatory Cell ◽

Peritoneal Disease ◽

Preoperative Ct ◽

The Right

Abstract Background: Primary abdominal cocoon is a special peritoneal disease and easily cause misdiagnosis and mistreatment. Few cases have been reported primary abdominal cocoon with intra-abdominal cryptorchidism in the literature.Case presentation: We admitted one case of a 41-year-old male patient with primary abdominal cocoon and right intra-abdominal cryptorchidism. The main symptom of this patient was intermittent abdominal pain for more than one month, preoperative CT results showed that part of the small intestine folded into a mass, which was suspected of abdominal cocoon. Part of the small intestine was wrapped by fibrous membrane and the right testicle were observed in the abdominal cavity during the operation. Intestinal adhesion release and right cryptorchidectomy were performed successfully. Pathological results revealed that the membranous material was fibrous connective tissue with chronic inflammatory cell infiltration and no spermatogenic cells and sperm were observed in the seminiferous tubules of the testicular tissue. Conclusion: This article reports one case of primary abdominal cocoon with right intra-abdominal cryptorchidism. Primary abdominal cocoon lacks specific clinical manifestations, part of patients may have cryptorchidism and the diagnosis is difficult. We should improve the understanding of primary abdominal cocoon to better save the life of patient.

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

BMC Women s Health ◽

10.1186/s12905-021-01408-z ◽

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.

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

Surgical Case Reports ◽

10.1186/s40792-021-01232-5 ◽

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.

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Pyosalpinx due to Cronobacter sakazakii in an elderly woman

BMC Women s Health ◽

10.1186/s12905-021-01283-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Satoshi Ohira ◽

Eri Ikeda ◽

Kyosuke Kamijo ◽

Tomokuni Nagai ◽

Koji Tsunemi ◽

...

Keyword(s):

Abdominal Cavity ◽

Lower Abdominal Pain ◽

The Elderly ◽

Pathological Examination ◽

Milk Formula ◽

Adult Women ◽

Cronobacter Sakazakii ◽

Left Edge ◽

Powdered Milk ◽

First Case

Abstract Background Cronobacter sakazakii (C. sakazakii) is a bacterium known to cause severe neonatal infections in premature infants with the consumption of contaminated powdered milk formula. Adult infections are rare, and there have been no reports of pyosalpinx due to C. sakazakii to date. Case presentation We report a case of left pyosalpinx due to C. sakazakii in a sexually inactive postmenopausal woman. A 70-year-old woman presented to our hospital with left lower abdominal pain and fever. Abdominal computed tomography disclosed a cystic mass continuous with the left edge of the uterus. Urgent laparotomy revealed a ruptured left pyosalpinx with pus-like content. Left salpingo-oophorectomy, resection of the right tube, and washing of the abdominal cavity with saline were performed. Pathological examination of the left adnexa showed tubal tissue with acute inflammation and inflammatory exudate, which were compatible with pyosalpinx, and pus culture yielded C. sakazakii. Conclusions This is the first case report of pyosalpinx due to C. sakazakii. Cronobacter sakazakii infections in adult women might occur in the elderly, whose immunity has weakened. Further accumulation of cases of C. sakazakii infection is needed to clarify the etiology and behavior of C. sakazakii in adults.

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

Case Reports in Obstetrics and Gynecology ◽

10.1155/2012/589568 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 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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Extraovarian primary seromucinous cystadenoma masquerading as mesenteric cyst

BMJ Case Reports ◽

10.1136/bcr-2020-240414 ◽

2021 ◽

Vol 14 (5) ◽

pp. e240414

Author(s):

Kishor R J ◽

Bhuvaneshwari Harikrishnan ◽

Naveen Alexander ◽

Veena Bheeman

Keyword(s):

Lower Abdominal Pain ◽

Interesting Case ◽

Mesenteric Cyst ◽

Lumbar Region ◽

Normal Limits ◽

Mesenteric Border ◽

Contrast Enhanced ◽

Laparoscopic Excision ◽

Abdominal Examination ◽

The Right

We report an interesting case of extraovarian, primary seromucinous cystadenoma, which presented as a mesenteric cyst. A 31-year-old woman came with complaints of lower abdominal pain for 2 years, which is intermittent and aggravated during the menstrual cycle. On examination, her vitals were within normal limits; per abdominal examination revealed 7×7 cm mass in the right lumbar and right hypochondrium with well-defined margins. A Contrast-enhanced whole abdomen done showed a thin-walled of cyst of size 7×8×9 cm in the right lumbar region abutting and replacing the mesenteric border of ascending colon suggesting of mesenteric cyst. Patient underwent laparoscopic excision of mesenteric cyst. Histopathology revealed seromucinous cystadenoma without ovarian stroma.

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Comparative study of inflammatory response and adhesions formation after fixation of different meshes for inguinal hernia repair in rabbits

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502005000500002 ◽

2005 ◽

Vol 20 (5) ◽

pp. 347-352 ◽

Cited By ~ 30

Author(s):

Alberto Goldenberg ◽

Jacques Matone ◽

Wagner Marcondes ◽

Fernando Augusto Mardiros Herbella ◽

José Francisco de Mattos Farah

Keyword(s):

Inflammatory Response ◽

Abdominal Wall ◽

Peritoneal Cavity ◽

Abdominal Cavity ◽

Mesh Fixation ◽

Rabbit Model ◽

Laparoscopic Approach ◽

Preperitoneal Space ◽

Similar Amount ◽

The Right

PURPOSE: Compare, in a rabbit model, the inflammatory response and adhesions formation following surgical fixation of polypropilene and Vypro mesh in the inguinal preperitoneal space. METHODS: Fourteen male New Zealand rabbits, weighing between 2.000 to 2.500 g were used. A midline incision was made and the peritoneal cavity was exposed. The 2,0X1,0 cm polypropylene mesh was fixed in the left flank and secured to the margins with 3-0 prolene in a separate pattern. In the right flank, a 2,0X1,0 cm Vypro II mesh was sewn in the same way. After the post surgical period, the animals were again anesthetized and underwent laparoscopic approach, in order to identify and evaluate adhesions degree. Both fixed prosthesis were excised bilaterally with the abdominal wall segment, including peritoneum, aponeurosis and muscle and sent to a pathologist RESULTS: Operative time ranged from 15 to 25 minutes and no difficulties in applying the mesh were found. From the 14 polypropylene meshes fixed to the intact peritoneum, 11 had adhesions to the abdominal cavity (78,6%). Concerning Vypro mesh, 12 animals developed adhesions from the 14 with mesh fixation (85,7%). Histological examination of tissues harvested revealed fibroblasts, collagen, macrophages and lymphocytes between the threads of the mesh. CONCLUSION: Polypropylene and Vypro mesh, when implanted in the peritoneal cavity of rabbits provoke similar amount of adhesions. Vypro mesh tissues had higher fibrosis resulting in better mesh incorporation to the abdominal wall.

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Acute Abdomen due to Mutual Tangle of Two Small Paratubal Cysts

Case Reports in Obstetrics and Gynecology ◽

10.1155/2018/2351809 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Hiroharu Kobayashi ◽

Shinichi Shibuya ◽

Kentaro Iga ◽

Keiichiro Kato ◽

Airi Kato ◽

...

Keyword(s):

Acute Abdomen ◽

Histopathological Examination ◽

Lower Abdominal Pain ◽

Cystic Teratoma ◽

Cystic Mass ◽

Mature Cystic Teratoma ◽

Contrast Enhanced ◽

The Right ◽

Enhanced Computed Tomography ◽

Paratubal Cyst

A 30-year-old woman (gravida 0) visited our hospital with a complaint of right lower abdominal pain. Transvaginal ultrasonography revealed a 5-cm swollen right ovary, which was suspected to be a mature cystic teratoma. Pelvic examination revealed moderate pain. Contrast-enhanced computed tomography showed a 44-mm cystic mass containing fat and calcified material in the right pelvis. Since torsion was suspected, emergent laparoscopic surgery was performed. Intraoperative findings were a swollen right ovary without torsion or congestion. Two small pedunculated 1- and 2-cm diameter paratubal cysts that grew from almost the same place of the ampulla of the right fallopian tube were observed. The thin stalk of the 1-cm paratubal cyst was entangled around the stalk of the 2-cm paratubal cyst, with its head congested. Through a small abdominal laparoscopic incision, the tumor of the right ovary and the two paratubal cysts were excised. Histopathological examination revealed that the right ovarian tumor was a mature cystic teratoma, and the two paratubal cysts had no malignancy. This case showed that only a 2-cm tumor with congestion caused the acute abdomen.

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