REPETITIVE OVARIAN TORSION AS WARNING SIGN OF SEROUS AND MUCINOUS CYSTADENOMA IN CHILDREN - REPORT OF TWO CASES

Cystadenomas are surface epithelial-stromal tumors. Although they are the most common type of ovarian tumor, seen mostly from late adolescent age, yet, they remain difficult to accurately diagnose clinically due to their diverse presentations similar to other diseases like functional cyst and appendicitis. We report the cases of two pediatric patients. The first one aged seventeen years and six months old with serous cystadenoma and the second patient aged seventeen years and three months old with mucinous cystadenoma, presenting with abdominal pain in the level of the right iliac fossa and abdominal pain in the inferior part of the abdomen respectively aiming to reveal some warning signs and particularities in diagnosis and management of female pediatric patients with ovarian cystadenomas. Conclusion: Recurrent ovarian torsion or recurrent cyst formation is a warning sign of mucinous cystadenoma and serous cystadenoma tumor requiring further investigations and treatment.

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Analysis of the risk of ovarian torsion in 49 consecutive pediatric patients treated at a single institution

World Journal of Pediatric Surgery ◽

10.1136/wjps-2018-000009 ◽

2019 ◽

Vol 2 (2) ◽

pp. e000009

Author(s):

Koshiro Sugita ◽

Takafumi Kawano ◽

Mukai Motoi ◽

Toshihiro Muraji ◽

Shun Onishi ◽

...

Keyword(s):

Abdominal Pain ◽

Pediatric Patients ◽

Clinical Symptoms ◽

White Cell Count ◽

Ovarian Torsion ◽

Imaging Findings ◽

Single Institution ◽

Exact Test ◽

Cystic Masses ◽

Ovarian Masses

PurposeAn early diagnosis of ovarian torsion is sometimes difficult due to variable clinical symptoms and non-specific imaging findings. We retrospectively reviewed patients with pediatric ovarian masses manifesting torsion.MethodsFifty-eight ovarian masses (55 episodes) in 49 non-neonatal patients treated from April 1984 to March 2017 were retrospectively analyzed. The Mann-Whitney U test and Fisher’s exact test were used for the statistical analysis.ResultsThe median age of these 55 episodes was 10.5 years old (range 1.0–23.0). Thirty-three patients presented with abdominal pain. Forty-five tumors and 13 cystic masses were resected and diagnosed pathologically (50 benign and 8 malignant). Torsion was identified in 15 cases (25.9%) at operation. The torsion masses were all benign, and 8 ovaries (53.3%) were successfully preserved. Comparing the torsion cases with the non-torsion cases, only the white cell count was significantly higher in the torsion cases (p=0.0133) and in the patients presented with abdominal pain (p=0.0068). The duration of abdominal pain was significantly shorter in ovary preserved cases than in oophorectomy cases.ConclusionThe white blood cell may be a helpful indicator of the presence of torsion as well as the need for surgery.

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Clinical Presentation of Ovarian Tumour

TAJ Journal of Teachers Association ◽

10.3329/taj.v28i1.39063 ◽

2018 ◽

Vol 28 (1) ◽

pp. 21-25

Author(s):

MS Nawrozy ◽

F Sultana ◽

AHM Kamal ◽

A Begum ◽

SF Tasmin ◽

...

Keyword(s):

Abdominal Pain ◽

Early Diagnosis ◽

Public Awareness ◽

Mucinous Cystadenoma ◽

Ovarian Tumour ◽

Serous Cystadenoma ◽

Malignant Tumours ◽

College Hospital ◽

Medical College ◽

Benign Tumours

Background: Clinical course of ovarian tumours are amazingly quite and the malignant ones are often inoperable by the time they are diagnosed. Aim of this study was to look into any probable way of early diagnosis of ovarian tumour.Methods: This study was carried out at the Department of Obstetrics & Gynaecology of Rangpur Medical College Hospital, Rangpur from July 2012 to June 2014. In this study, total 31 cases were included. The findings were described as percentage of total. In addition, χ2 test & Pearson’s correlation coefficient ‘r’ test were also used.Results: Age range of all the cases was between 16 and 65 years. Among the 31 cases, benign cases were 77.41% and malignant were 22.59%. The highest incidence of benign case was observed around 35 years of age and for the malignant cases was above 60 years. Patients commonly presented with abdominal lump (83.87%), abdominal pain (83.87%) and dyspepsia (74.19%). Other presentations were weight loss (22.58%), rapid enlargement of growth (16.13%), sense of heaviness of abdomen (9.67%) and abdominal enlargement (3.23%). Histologically serous cystadenoma was 38.71%, dermoid cyst 22.58%, mucinous cystadenoma 16.13%, poorly differentiated adenocarcinoma 12.90%, serous cyst adenocarcinoma 6.45% and immature teratoma was 3.23%.Conclusion: This sample is too small to draw any conclusion. Yet, as it was found, the incidence of benign tumours rises with increasing age up to 40 years and thereafter it declines. Whereas, the incidence of malignant tumours are very low before 40 years and thereafter it increases gradually. Also, public awareness may be developed regarding a female, specifically above 40 years of age, if complaints of abdominal lump, abdominal pain or dyspepsia should be evaluated properly; this may help in early diagnosis of many malignant ovarian tumours.TAJ 2015; 28(1): 21-25

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The Sensitivity, Specificity and Accuracy of Warning Signs in Predicting Severe Dengue, the Severe Dengue Prevalence and Its Associated Factors

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15092018 ◽

2018 ◽

Vol 15 (9) ◽

pp. 2018 ◽

Cited By ~ 6

Author(s):

Mohd Ahmad ◽

Mohd Ibrahim ◽

Zeehaida Mohamed ◽

Nabilah Ismail ◽

Muhammad Abdullah ◽

...

Keyword(s):

Abdominal Pain ◽

Associated Factors ◽

Warning Signs ◽

Severe Dengue ◽

Warning Sign ◽

Cross Sectional ◽

Predictive Values ◽

Persistent Vomiting ◽

Mucosal Bleeding ◽

Sensitivity Specificity

Objectives: To study Malaysian dengue clinical practice guideline (CPG) warning signs (WS) in predicting severe dengue (SD) and its associated factors among confirmed cases presented to a teaching hospital in north-eastern Malaysia in 2014. Methods: A cross-sectional study was performed in February 2015 using secondary data acquired from the hospital records. There were 2607 confirmed dengue cases presented to Hospital Universiti Sains Malaysia (HUSM) in 2014. Seven hundred patients were selected after proportionate stratified random sampling conducted according to the number of cases in 12 different months in 2014. Data were collected and analysed using SPSS version 22.0. Results: Severe dengue outcomes represented 4.9% of cases. The prevalence of any of WS in SD was 91.2%. The most common WSs prior to SD were persistent vomiting (55.9%), and abdominal pain/tenderness (52.9%). The most sensitive warning sign in detecting SD was abdominal pain (59%). Specificity of individual WS were generally good, especially of clinical fluid accumulation (99%), hepatomegaly (98%) and mucosal bleeding (93%). Factors associated with SD were persistent vomiting (Adjusted odds ratio (aOR)): 2.41), mucosal bleeding (aOR: 4.73) and haematocrit rise with rapid platelet drop (aOR: 2.74). Conclusion: A focus on sensitivity, specificity, predictive values and association of a number of particular WS should be emphasized in order to better predict severe dengue outcomes.

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Rare case of torsion of giant ovarian mass post-colonoscopy

Journal of Surgical Case Reports ◽

10.1093/jscr/rjab070 ◽

2021 ◽

Vol 2021 (3) ◽

Author(s):

Irene A T Ng ◽

Jolene S M Wong ◽

Jermaine Wong ◽

Claramae S Chia ◽

Chin-Ann J Ong

Keyword(s):

Abdominal Pain ◽

Ovarian Cyst ◽

Frozen Section ◽

Lower Abdominal Pain ◽

Exploratory Laparotomy ◽

Serous Cystadenoma ◽

Ovarian Torsion ◽

Ovarian Mass ◽

Large Ovarian Cyst ◽

The Right

ABSTRACT We present an unprecedented case of torsion of a large ovarian cyst following colonoscopy. A 43-year-old female was found to have a 20 × 13 × 19 cm pelviabdominal mass possibly arising from the right ovary. Endoscopic evaluation was performed prior to planned resection of the ovarian mass. The patient experienced progressive lower abdominal pain after the procedure with a computed topography finding of torsion. She underwent exploratory laparotomy, right salpingo-oophorectomy with intra-operative frozen section and omentectomy. Final histology revealed features of benign serous cystadenoma with extensive haemorrhagic infarction in keeping with torsion. To our knowledge, this is the first reported case of torsion of a large ovarian cyst after colonoscopy. We propose a postulated mechanism of this patient’s ovarian torsion and urge clinicians to be cognizant of acute ovarian torsion as a cause of severe abdominal pain following endoscopy.

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To study cardiac manifestations in patients presenting with dengue infection and to find out the correlation of cardiac manifestations to warning signs of dengue

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20171003 ◽

2017 ◽

Vol 4 (2) ◽

pp. 323 ◽

Cited By ~ 3

Author(s):

Rakesh Kumar Yadav ◽

Sujit Kumar

Keyword(s):

Abdominal Pain ◽

Sinus Bradycardia ◽

Statistical Significance ◽

Dengue Infection ◽

Warning Signs ◽

Warning Sign ◽

Ecg Changes ◽

Medical College ◽

Cardiac Abnormalities ◽

Cardiac Manifestations

Background: This study was done to observe the presence of Electrocardiographic (ECG) changes in patients presenting with dengue infection and to evaluate whether there were any related clinical cardiac manifestations and to find out the correlation of cardiac manifestations to warning signs of dengue.Methods: The study was conducted at MLN Medical College, Allahabad in the Department of Medicine between July 2016 to December 2016. One hundred consecutive patients aged 18 years or more with positive dengue serology were interviewed and examined. ECG was done for all patients. The data was analyzed using statistical significance tests.Results: Thirty-six patients had no warning signs, 64 patients had warning signs, out of which 43 patients had two or more warning signs while 21 patients had single warning sign. Most common warning sign in this study was abdominal pain (50%) and Vomiting (45 %) while hepatomegaly was the least common warning sign. The most common cardiac abnormalities noted were rhythm abnormalities of which the commonest was sinus bradycardia, found in 60 percent. There was statistically significant correlation between cardiac manifestations and all the warning signs except lethargy/restlessness and hepatomegaly.Conclusions: The most common cardiac manifestations noted were transient rhythm abnormalities, of which sinus bradycardia was the commonest. There was no evidence of myocarditis in any of the patients. There was statistically significant correlation between cardiac manifestations and all the warning signs except lethargy/restlessness and hepatomegaly.

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Lockdown dilemma: ingestion of magnetic beads presenting as right iliac fossa pain and subacute small bowel obstruction

BMJ Case Reports ◽

10.1136/bcr-2020-236429 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236429

Author(s):

Bankole Oyewole ◽

Anu Sandhya ◽

Ian Maheswaran ◽

Timothy Campbell-Smith

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Magnetic Beads ◽

Iliac Fossa ◽

Serous Fluid ◽

Magnetic Resonance Scan ◽

History Of ◽

Right Iliac Fossa Pain ◽

Multiple Episodes ◽

Safety Netting

A 13-year-old girl presented with a 3-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She presented again 6 days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment. Intraoperative findings revealed 200 mL of serous fluid in the pelvis, normal-looking appendix, dilated stomach and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

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Sigmoid Volvulus in 16-year-old Boy with an Associated Anomalous Congenital Band

The American Surgeon ◽

10.1177/000313481307901114 ◽

2013 ◽

Vol 79 (11) ◽

pp. 1140-1141 ◽

Cited By ~ 4

Author(s):

Ann A. Albert ◽

Tracy L. Nolan ◽

Bryan C. Weidner

Keyword(s):

Abdominal Pain ◽

African American Male ◽

Pediatric Patients ◽

Primary Anastomosis ◽

Exploratory Laparotomy ◽

Sigmoid Volvulus ◽

Sudden Onset ◽

Contrast Enema ◽

Pediatric Age Group ◽

History Of

Sigmoid volvulus, a condition generally seen in debilitated elderly patients, is extremely rare in the pediatric age group. Frequent predisposing conditions that accompany pediatric sigmoid volvulus include intestinal malrotation, omphalomesenteric abnormalities, Hirschsprung's disease, imperforate anus and chronic constipation. A 16-year-old previously healthy African American male presented with a 12 hour history of sudden onset abdominal pain and intractable vomiting. CTwas consistent with sigmoid volvulus. A contrast enema did not reduce the volvulus, but it was colonoscopically reduced. Patient condition initially improved after colonoscopy, but he again became distended with abdominal pain, so he was taken to the operating room. On exploratory laparotomy, a band was discovered where the mesenteries of the sigmoid and small bowel adhered and created a narrow fixation point around which the sigmoid twisted. A sigmoidectomy with primary anastomosis was performed. The diagnosis of sigmoid volvulus may be more difficult in children, with barium enema being the most consistently helpful. Seventy percent of cases do not involve an associated congenital problem, suggesting that some pediatric patients may have congenital redundancy of the sigmoid colon and elongation of its mesentery. The congenital band found in our patient was another potential anatomic factor that led to sigmoid volvulus. Pediatric surgeons, accustomed to unusual problems in children, may thus encounter a condition generally found in the debilitated elderly patient.

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Ovarian Torsion in a 5-Year Old: A Case Report and Review

Case Reports in Emergency Medicine ◽

10.1155/2012/679121 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Matthew F. Ryan ◽

Bobby K. Desai

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Case Report ◽

Urinary Tract ◽

Clinical Suspicion ◽

Ovarian Torsion ◽

Surgical Emergencies ◽

High Clinical Suspicion ◽

Tract Infections ◽

Prompt Diagnosis

Ovarian torsion represents a true surgical emergency. Prompt diagnosis is essential to ovarian salvage, and high clinical suspicion is important in this regard. Confounding the diagnosis in general are more commonly encountered abdominal complaints in the Emergency Department (ED) such as constipation, diarrhea, and urinary tract infections and more common surgical emergencies such as appendicitis. Prompt diagnosis can be further complicated in low-risk populations such as young children. Herein, we describe the case of a 5-year-old girl with a seemingly benign presentation of abdominal pain who was diagnosed in the ED and treated for acute ovarian torsion after two prior clinic visits. A brief discussion of evaluation, treatment, and management of ovarian torsion follows.

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