Parasitic myoma developing at the port site after laparoscopic myomectomy; a case report

Parasitic myomas occur especially after laparoscopic myomectomy and its incidence increases due to the use of morcellators. Parasitic myomas can rarely occur at the port entry site, being more commonly seen on the intestines, the omentum, the ureter, the bladder, and the diaphragm in different periods after surgery, the average duration being 24 months. In this article, we present the case of parasitic myoma developing secondary to the port site in a 45-year-old nulliparous woman after the use of laparoscopic myomectomy and morcellation 8 years ago. The patient presented with complaints of pelvic pain and a palpable mass in the left trocar incision line, and an appearance compatible with multiple myomas in the subcutaneous tissue of the left trocar incision line. Besides, myomas were also observed in the mesentery of the rectosigmoid colon and at the uterus in the present study. Numerous and large myomas were observed in the uterus, in the mesentery of the rectosigmoid colon, on the left pelvic peritoneum, and under the skin corresponding to the port entrance. The pathological examination of the myomas excised was reported as leiomyoma. In this article, the diagnosis, the treatment, the possible risk factors, and the complications of myomas were discussed in the light of the literature.

THE INFORMATIVE VALUE OF PELVIC ULTRASONOGRAPHY IN RECURRENT EXTERNAL GENITAL ENDOMETRIOSIS

Background. In the structure of gynecological diseases, endometriosis ranks II after inflammatory diseases of the genitals and uterine myoma. The incidence of genital endometriosis is 92–94%, with an annual incidence ranging from 0,1% to 0,3%. The disease is characterized by tumor-like type of growth, affection of adjacent organs, and severe complications that lead to disability in patients. Aim. To study the informative value of ultrasound examination of the reproductive system organs in recurrent external genital endometriosis. Material and methods. Forty-eight patients with recurrent external genital endometriosis were examined. The mean age of the patients was (34,96±1,1) years. The history of endometriosis was in the range of (10,0±1,41) years (9–11). Recurrence rate averaged (2,02±0,44) years (1–4). The duration of remission averaged (6,1±0,84) years (1–15). All the patients underwent ultrasound examination with a transvaginal transducer. The length, width, anteroposterior uterine size, M-echo, and length and width of both ovaries were determined. Echographic features of endometrioid ovarian cysts and retrocervical endometrioid infiltrate were evaluated during ultrasound examination. The findings were compared with the echographic findings in women (n=20) with no history of endometriosis (comparison group). Results and discussion. Transvaginal ultrasonography in recurrent external genital endometriosis showed a significant increase in the echographic dimensions of uterine length (54,3±0,41) mm, width (47,9±0,13) mm, anteroposterior dimension (56,1±0,18) mm, endometrial thickness (6,6±0,09) mm, and increased echographic dimensions of both ovaries (p<0,05). Transvaginal ultrasound examination is informative in the diagnosis of endometrioid ovarian cysts. In 75,6% of patients, it manifests as a fluid mass with a heterogeneous suspension. In 75% of patients, retrocervical endometrioid infiltrate manifests as a heterogeneous, hypoechogenic, painful mass located behind the uterus. Conclusion. Transvaginal ultrasound is informative in the diagnosis of endometrioid ovarian cysts. Echographic diagnosis of endometrioid infiltrates of the vesicoureteral peritoneal fold, sacroiliac, broad uterine ligaments, and pelvic peritoneum presents difficulties, which justifies the necessity of laparoscopic diagnosis.

Short-Term Outcomes of Pelvic Peritoneum Reconstruction with Barbed Suture After Laparoscopic Rectal Resection for Rectal Cancer

Background: Laparoscopic rectal resection may cause various surgical complications including perineal hernia and adhesive small-bowel obstruction. Pelvic peritoneum reconstruction (PPR) could prevent those complications. The aim of the study is to evaluate the short-term clinical, technical and safety outcomes of PPR using the barbed suture in laparoscopic rectal resection. Methods: This is a retrospective cohort study conducted in Chengdu second’s people hospital. Between January 2014 and December 2019, a total of 402 patients who underwent curative surgery for rectal cancer in Chengdu Second People’s Hospital were enrolled in the study. Among them, 216 patients who underwent laparoscopic rectal resection with PPR were allocated into the experimental group, and 186 patients who underwent laparoscopic rectal resection without PPR were allocated into control group. All the patients received standard preoperative and postoperative treatments. Observational indicators (1) surgical and postoperative conditions; (2) postoperative pathological examination. (3) postoperative complications. The data were represented by X ± s. t-test and X2 test were used for counting data. Results (1) Surgery condition: all patients in the two groups underwent successful surgery without conversion to open surgery. There were no differences between the two groups in terms of surgical approach, resection margin, tumor size, postoperative T-stage, postoperative N-stage, positive lymph nodes, harvest lymph nodes, perineal wound infection, perineal hernia, postoperative pneumonia, postoperative hemorrhage, presacral fluid, or abscess. The operative time, blood loss, the incidence of anastomotic leakage, and small-bowel obstruction showed a significant difference between the two groups. Conclusion We hypothesized that pelvic peritoneum reconstruction with barbed suture could improve the efficiency of intracorporeal closure of the pelvic cavity after in laparoscopic rectal resection, which can significantly reduce postoperative perineal-related complications. Further, we expect that use of the barbed sutures will reduce intra-operative stress on the endoscopic surgeon.

Retroperitoneum parasitic leiomyoma: Dilemmatic diagnostic

HIGHLIGHTS1. Parasitic leimyoma was found in a 38 year-old woman with complaint of mass in lower abdomen and already done biopsy by laparotomy 4 months before.2. During operation, the tumor was detached from the uterus, located retroperitoneally as high as L4 – S1 vertebrae.3. The tumor had been confirmed intraoperatively and proven histopathologically as parasitic leimyoma.4. Retroperitoneal parasitic leiomyoma is of a rare type and it needs multidisciplinary examination and approaches to increase the quality of its management.ABSTRACTObjectives: To describe a retroperitoneum parasitic leiomyoma case: a dilemma in diagnosis and operation finding.Case Report: A 38 year-old woman with 3 children visited Ulin Hospital, Banjarmasin, Indonesia, with complaint of mass in lower abdomen and about 4 months before, she underwent biopsy by laparotomy which revealed leiomyoma. Parasitic leiomyoma is a rare type of leiomyoma with predilection area in broad ligament, pelvic peritoneum, pouch of douglas, and omentum. During operation, the tumor was detached from the uterus and located retroperitoneally as high as L4–S1. It had been confirmed intraoperatively and proven histopathologically as a leiomyoma.Conclusion: Retroperitoneal parasitic leiomyoma may cause a dilemma in the diagnosis. Multidiscipline examination and approaches may increase the quality of management.

Case report on an enigma of caesarean section: ‘scar endometriosis’

Endometriosis is described as a disease in which functional endometrial glands and stroma that commonly lines the uterus grows outdoor the uterus. The resulting cystic or solid tumoral masses due to endometriosis are named as endometrioma. They're normally seen within the ligaments of uterus, ovaries, pouch of Douglas and pelvic peritoneum however endometriosis has additionally been noted in nose, breast, lung, spleen, gastrointestinal tract, kidney, abdominal wall, however scar endometriomas are extremely uncommon and difficult to diagnose. This situation may be puzzled with different surgical conditions, however imaging strategies and FNAC can assist in diagnosing it better. Medical treatment is helpful in selected cases but wide excision is the treatment of choice.

The Impact of Complications on Short-Term Outcomes of Pelvic Peritoneum Reconstruction with Barbed Suture in Laparoscopic Rectal Resection for Rectal Cancer

Objective: This study aimed to evaluate the safety and short-term outcomes of pelvic peritoneum reconstruction with barbed sutures in laparoscopic rectal resection for rectal cancer. Methods: This is a retrospective cohort study conducted in Chengdu second’s people hospital. The clinicopathological data of 402 patients with rectal cancer admitted to our department hospital from January to December 2019 were collected. There was total of 402 patients, including 218 males and 174 females, with an average age of 68 years. Among them, 216 patients who underwent laparoscopic rectal resection with pelvic peritoneum reconstruction (PPR) were allocated into the PPR group, and 186 patients who underwent conventional laparoscopic rectal resection were allocated into a non-PPR group. All the patients received standard preoperative and postoperative treatments. Observational indicators (1) surgical and postoperative conditions; (2) postoperative pathological examination. (3) postoperative complications. Results (1) Surgery condition: all patients in the two groups underwent successful surgery without conversion to open surgery. There were no differences between the two groups in terms of surgical approach, resection margin, tumor size, postoperative T-stage, postoperative N-stage, positive lymph nodes, harvest lymph nodes, perineal wound infection, perineal hernia, postoperative pneumonia, postoperative hemorrhage, presacral fluid, or abscess. The operative time, blood loss, the incidence of anastomotic leakage, and small-bowel obstruction showed a significant difference between the two groups. Conclusion pelvic peritoneum reconstruction with barbed suture in laparoscopic rectal resection is safe and feasible for the treatment of rectal cancer, which can significantly reduce postoperative perineal-related complications.

Endometriosis of the Rectus Abdominis Muscle: A Rare Cause of Emergency Department Visit; Case Report

Introduction: Endometriosis affects approximately 10% of the reproductive age woman. Although the most common affected sites are ovaries, sacrouterine ligament, rectovaginal septum, and pelvic peritoneum, it can be located in any organ. Endometriosis of rectus abdominal muscle independent from the cesarean section incision is extremely rare. Case Presentation: A 31-years-old female was admitted to the emergency department with periodical abdominal pain and distension complaints. Ultrasonography and computed tomography revealed a heterogeneous mass in the rectus abdominis muscle. Surgical excision was performed. Histopathologic examination showed endometrial tissue with glandular and stromal elements within the muscularis propria. Conclusion: Endometriosis should be kept in mind in the differential diagnosis of atypical pain and mass of the abdominal wall in the emergency settings.

Alumnol in gynecology

The proposed method for the treatment of diseases of the uterus, its appendages and pelvic peritoneum consists in injecting into the uterus (its cavity) a solution of alumnol'a (alumnol 2.5, iodine tincture and purified alcohol 25.0 each). The idea of such a method of treatment, like very much in modern medicine, is not new, for example, for a very long time, for endometritis, injections into the uterine cavity of iodine tincture, an aqueous solution of zinc chloride, etc. have been used. The use of alumnol for this purpose is of a very recent origin.

About large cell growths on the peritoneum and ovaries during pregnancy

Some authors described nodular small thickenings and enlargements of the pelvic peritoneum during ectopic pregnancy, which were considered especially characteristic of peritoneal pregnancy. Schmorl, who thoroughly studied the peritoneum of the pelvic floor in a number of cases of normal intrauterine pregnancy, soon came to the conviction that these growths are all too often found in the latter and therefore do not constitute anything characteristic of an ectopic pregnancy.