Hemorrhagic ascites endometriosis could be a cause: a case report

Background Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”) is found outside the uterus, where it induces a chronic inflammatory reaction that may result in scar tissue. Endometriosis with massive ascites causing abdominal distension and other symptoms simulating malignancy has been described in the literature. Case presentation A case of a 27-year-old woman who presented to the Ascites Study Group Tropical Medicine department Ain Shams University in collaboration with the Egyption Club of Ascites (ECA) with increased central abdominal contour, shifting dullness, and hemorrhagic transudate hypocellular ascites with no malignant cells and bilateral ovarian cysts. A long stepwise approach was conducted to the patient, and after exclusion of other causes of hemorrhagic ascites, the patient was prepared for laparoscopy. The diagnosis of endometriosis was made. The patient was discharged on goserelin acetate subcutaneous injection every 28 days with good response, and she regularly follows up with our study group on scheduled visits monthly according to her clinical status. Conclusions Endometriosis could be a possible cause of massive hemorrhagic obscured ascites. The unexplained infertility should increase the probability of the endometriosis.

Incidence and Risk Factors for Postoperative Venous Thromboembolism in Patients with Endometrial Cancer: Systematic Review and Meta-analysis

Background: Venous Thromboembolism (VTE) is a leading reason of morbidity and mortality in endometrial cancer patients. There is no meta-analysis available on this topic so far. In order to identify relevant risk factors contributing to VTE and form strategies to prevent VTE, we conducted the present study to quantitatively analyze the data from studies with the incidence and risk factors among cases with endometrial cancer.Methods: PubMed, Embase and CNKI were searched for papers containing the key words “thromboembolism” “endometrial cancer” and their variants. Studies selection, data extraction, quality assessment of eligible studies were performed independently by two reviewers. Meta-analyses were conducted to determine postoperative VTE incidence rate and risk factors in endometrial cancer. Sensitivity analysis was used to verify the robustness of the results in the present study.Results: 8 studies were included in this meta-analysis totally. The pooled incidence rate for postoperative VTE was 7% (95% CI, 0.04 –0.09).The presence of age>60 (OR, 2.26), tumor size in uterine cavity(＞60mm) (OR, 5.68), tumor extension (CT/MRI) (OR, 5.59), FIGO stage (OR, 2.92), massive ascites (OR, 3.78), clear cell cancer (OR, 4.78) and CA125(＞35U/ml) (OR, 5.05) increase the likelihood of having postoperative VTE remarkably. Conclusions: The present study revealed that VTE is a prevalent complication in postoperative patients with endometrial cancer. The patients with the following risk factor including female elderly, large size of tumor, advanced endometrial cancer，massive ascites , elevated CA125 and special histology should be altered VTE occurrence.

Prenatal Sonographic Diagnosis and Clinical Management of Fetal Small Bowel Volvulus

Background The purpose of this research is to explore prenatal ultrasound features and clinical managements of fetal small bowel volvulus. At present, researchers mainly focus on the prenatal ultrasound features of fetal small bowel volvulus, and rarely summarize them in combination with the principles of clinical treatment. Methods 11 cases of fetal small bowel volvulus identified by prenatal ultrasound or neonatal surgery in our institution between January 2019 and January 2021 were included. General characteristics of pregnant women, features of prenatal ultrasound, clinical managements and prognosis of neonates were collected. Finally, prenatal ultrasound features and obstetric managements of fetal volvulus was summarized. Results At the first diagnosis, the whirlpool sign and intestinal dilatation were visualized in 11 cases. 3 cases underwent emergency caesarean because of the disappearance of dilated bowel peristalsis, massive ascites and fetal intrauterine hypoxia. The rest 8 cases were followed up by ultrasound, pregnancy outcomes were four regressed intrauterine spontaneously and delivered at term, two underwent emergency caesarean, one premature and one induced labor. 6 cases underwent neonatal surgery immediately after birth and received favorable outcomes.Conclusions Intestinal distention and the whirlpool sign are important ultrasonic features in the diagnosis of fetal small bowel volvulus. The disappearance of intestinal peristalsis of the volvulus segment, massive ascites and intrauterine hypoxia are the main basis for emergency prenatal clinical intervention.

Peritoneal Chlamydia trachomatis Infection as a Cause of Ascites: A Diagnosis Not to Be Missed

Ascites is a common complication of several conditions, but it is rare in cases of <i>Chlamydia trachomatis</i> infection. We report a 36-year-old patient presenting with abdominal swelling for a week prior to hospitalization. An extensive workup excluded liver or heart disease and malignancy. A computed tomography scan demonstrated massive ascites and severe thickening of peritoneal reflections. Laboratory tests showed low serum-ascites albumin gradient, high total protein, and low adenosine. Diagnostic laparoscopy revealed inflammatory signs of both fallopian tubes. The histopathological results from peritoneal biopsy were consistent with lymphoid proliferation with reactive lymphoplasmacytic infiltrate. A gynecological investigation showed a positive DNA for <i>C. trachomatis</i> in the cervical swab. After treatment with doxycycline, there was a complete resolution of ascites.

Colon perforation as a complication of COVID-19: a case report

Background Coagulopathy induced by COVID-19 has received much attention. Arterial and venous thrombosis of multiple organs due to COVID-19-related coagulopathy is associated with a poor outcome. Case presentation A 67-year-female was transferred to our hospital in need of intensive care for severe COVID-19 pneumonia. On day 7 after admission, despite the treatments, her respiratory and hemodynamic status deteriorated. Computed tomography revealed massive ascites and free air as well as wall defects of the transverse colon. An emergency laparotomy was undertaken in the intensive-care unit, and 17 cm of the transverse colon was resected. Histopathological findings revealed two perforation sites of 25 and 7 mm in diameter, necrosis of the intestinal mucosa around the perforation sites, and the microcirculatory thrombosis in the mesentery vessels which was suspected of having been induced by COVID-19-related coagulopathy. Conclusions The case highlights the risk of intestinal ischemia and perforation induced by COVID-19 coagulopathy. Physicians treating COVID-19 should recognize the risk and evaluate patients carefully.

Role of Ambulatory Laparoscopy in Diagnosis of Ascites with Unknown Etiology

Background: Ascites could be caused by many underlying diseases, mainly portal hypertension, malignancy, and heart failure. Other etiologies include tuberculosis and pancreatitis. Difficulties in confirming the cause of ascites have been seen in many clinical settings. Ambulatory laparoscopy is one of powerful tools to rule out many etiologies of ascites despite being invasive in its nature. This case report would like to show one case of peritoneal TB presenting with ascites. Patient has undergone many laboratory workups in search of ascites origin. Literature study is done to look for evidence about timing and role of laparoscopy in ascites work-up. Case illustration: A-26-year-old P2 woman came to hospital with a history of vaginal delivery 22 days before admission presenting with massive ascites. No obstetric complication was found. Transvaginal ultrasound revealed normal postpartum uterus and ovaries, surrounded with ascites. Both the liver and kidneys were found normal on ultrasound. Abdominal CT scan with contrast showed massive ascites with thickened omentum. ADA was 36 IU/L. We decided to perform diagnostic laparoscopy and biopsy for histopathology. We found massive yellowish ascites and hyperaemic tubal enlargement with thickening of the peritoneum. Pathology examination proved the appearance of chronic salpingitis and granulomatous peritonitis consistent with tuberculosis peritonitis. Conclusion: Laparoscopy as a minimal invasive tool can diagnose ascites with unknown etiology patients after failure to prove diagnosis from clinical laboratory and radiological examination. It is one best alternative to diagnose peritoneal TB presenting with ascites with its superiority in visualizing abdominal cavity and obtaining specimens for histology with lower risk of morbidity.

Sterile cerebrospinal fluid ascites, hydrothorax and hydrocele as a complication of ventriculoperitoneal shunting in an elderly patient

An 89-year-old man with a history of multiple abdominal surgeries and ventriculoperitoneal (VP) shunt placement for normal pressure hydrocephalus presented for intractable abdominal bloating and scrotal swelling, for which imaging revealed massive ascites, bilateral hydrocele and small bilateral pleural effusions. Cardiac, hepatic and renal workup were insignificant. Culture and cytology of ascitic fluid were negative for infection or malignancy. Aetiology of the ascites as secondary to Cerebrospinal fluid (CSF) from the VP shunt was confirmed via ligation of the shunt. Sterile CSF ascites, hydrothorax and hydrocele are rare complications of VP shunt for hydrocephalus and are mostly presented in paediatric patients. We report the first known case of concurrent CSF ascites, hydrothorax and hydrocele in an elderly patient. We examine the difficulty of shunt replacement as a diagnostic and treatment modality in this age group and propose the use of reversible shunt ligation as a diagnostic modality.