Right Iliac Fossa Mass (Suspected Ileocecal Tuberculosis)

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.

Download Full-text

Abdominal apoplexy during pregnancy

BMJ Case Reports ◽

10.1136/bcr-2020-235946 ◽

2020 ◽

Vol 13 (10) ◽

pp. e235946

Author(s):

Jasmeet Kumari ◽

Rosemary Harkin

Keyword(s):

Iliac Fossa ◽

Unknown Origin ◽

Breech Presentation ◽

Sudden Onset ◽

Left Iliac Fossa ◽

Safe Delivery ◽

Uterine Contractions ◽

Early Labour ◽

Increased Risk ◽

High Index Of Suspicion

We report a case of idiopathic spontaneous intraperitoneal haemorrhage (ISIH) in a 31-year-old patient at 37 weeks gestation in her second pregnancy. The patient presented to the labour ward with abdominal pain and uterine contractions. The initial complain was of sudden onset, severe sharp pain in left iliac fossa. She started having uterine contractions within 30 min of her presentation. Examination confirmed early labour with a footling breech presentation. Urgent caesarean section was performed that confirmed peritoneal bleeding of unknown origin with safe delivery of the baby. Mother and baby were safely discharged on day 5. ‘Abdominal apoplexy’ (ISIH), is a rare obstetric emergency with increased risk of fetal and maternal morbidity and mortality. With various clinical presentations as a possibility, diagnosis is challenging. High index of suspicion with prompt management of suspected cases can be pivotal life saving measure for the fetus and mother.

Download Full-text

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.

Download Full-text

Cystic papillary adenoma of the seminal vesicle

BMC Urology ◽

10.1186/s12894-021-00830-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

B. Heijkoop ◽

D. Bolton ◽

D. Katz ◽

Andrew Ryan ◽

J. Epstein ◽

...

Keyword(s):

Seminal Vesicle ◽

Rare Case ◽

Groin Pain ◽

Iliac Fossa ◽

Papillary Adenoma ◽

Rare Entity ◽

Macroscopic Haematuria ◽

Case Presentation ◽

Adjacent Organ ◽

Epithelial Tumours

Abstract Background Primary Seminal Vesicle (SV) tumours are a rare entity, with most SV masses representing invasion of the SV by malignancy originating in an adjacent organ, most often the prostate. Previously reported primary SV epithelial tumours have included adenocarcinoma and cystadenoma, with limited prior reports of inracystic papillary structures. Case presentation A 35-year-old male presented with azoospermia, intermittent macroscopic haematuria, and mild right iliac fossa and groin pain. A papillary appearing seminal vesicle mass was found on imaging and seminal vesicoscopy. The mass was robotically excised with diagnosis of benign cystic papillary adenoma made. Conclusion In this manuscript we describe a rare case of a benign cystic papillary adenoma of the seminal vesicle, a unique histological entity differentiated from cystadenoma of the Seminal Vesicle by its papillary component.

Download Full-text

Giant sigmoid diverticulitis mimicking acute appendicitis

Annals of The Royal College of Surgeons of England ◽

10.1308/147870811x591008 ◽

2011 ◽

Vol 93 (6) ◽

pp. e89-e90 ◽

Cited By ~ 2

Author(s):

M Anderton ◽

B Griffiths ◽

G Ferguson

Keyword(s):

Computed Tomography ◽

Iliac Fossa ◽

Treatment Options ◽

Sigmoid Diverticulitis ◽

Acute Presentation ◽

Rare Manifestation ◽

Giant Sigmoid Diverticulum ◽

Right Iliac Fossa Pain ◽

Colonic Diverticula

Giant colonic diverticula are a rare manifestation of diverticular disease and there are fewer than 150 cases described in the literature. They may have an acute or chronic presentation or may remain asymptomatic and be found incidentally. As the majority (over 80%) of giant diverticula are located in the sigmoid colon, they usually present with left-sided symptoms but due to the variable location of the sigmoid loop, right-sided symptoms are possible. We describe the acute presentation of an inflamed giant sigmoid diverticulum with right iliac fossa pain. We discuss both the treatment options for this interesting condition and also the important role of computed tomography in the diagnosis and management of abdominal pain in elderly patients.

Download Full-text