MRI in Pregnancy and Precision Medicine: A Review from Literature

Magnetic resonance imaging (MRI) offers excellent spatial and contrast resolution for evaluating a wide variety of pathologies, without exposing patients to ionizing radiations. Additionally, MRI offers reproducible diagnostic imaging results that are not operator-dependent, a major advantage over ultrasound. MRI is commonly used in pregnant women to evaluate, most frequently, acute abdominal and pelvic pain or placental abnormalities, as well as neurological or fetal abnormalities, infections, or neoplasms. However, to date, our knowledge about MRI safety during pregnancy, especially about the administration of gadolinium-based contrast agents, which are able to cross the placental barrier, is still limited, raising concerns about possible negative effects on both the mother and the health of the fetus. Contrast agents that are unable to cross the placenta in a way that is safe for the fetus are desirable. In recent years, some preclinical studies, carried out in rodent models, have evaluated the role of long circulating liposomal nanoparticle-based blood-pool gadolinium contrast agents that do not penetrate the placental barrier due to their size and therefore do not expose the fetus to the contrast agent during pregnancy, preserving it from any hypothetical risks. Hence, we performed a literature review focusing on contrast and non-contrast MRI use during pregnancy.

Rectovaginal Fistula on Migration of an Intrauterine Device: A Case Report and Literature Review

Intrauterine devices (IUDs) are effective methods of contraception widely used worldwide because of their efficacy, low cost, and reversibility. Although overall well-tolerated, they may, however, cause uterine perforation, a rare but serious complication that can endanger adjacent abdominal organs. We report the case of a 50-year-old woman who consulted a gastroenterologist three years ago for the detection of blood in her feces on a screening test (Hémoccult°). Colonoscopy and abdominopelvic imaging discovered a displaced IUD embedded in the recto-sigmoidal wall. A wait-and-see approach was proposed at that time because of the absence of symptoms. Three years later, she developed abdominal and pelvic pain. On a second laparoscopic surgery procedure, we removed the IUD. Intraoperatively, a rectovaginal fistula was also discovered and sutured in different anatomical planes. Based on a comprehensive review of the literature, the management of this case is confronted with guidelines available for this rare condition.

Absence of Infrarenal Portion of the Inferior Vena Cava With Acute Lower Extremities Venous Thrombosis: A Case Report

A lack of congenital Inferior Vena Cava (IVC) is an uncommon malformation that has been identified in combination with idiopathic Deep Venous Thrombosis (DVT), exclusively. It may not even be revealed during the lifetime. A 63-year-old female was accepted with three months of abdominal and pelvic pain and localized edema on the right flank. During this admission, she was examined and recognized for deep vein thrombosis (DVT). Ct scan images showed a lack of the Inferior Vena Cava with enormous thrombosis collaterals of the superficial vein in the abdomen. In this case report, we report a woman with side pain who has an absence of the IVC.

Influence of COVID-19 confinement measures on appendectomies in Germany—a claims data analysis of 9797 patients

Purpose COVID-19 pandemic had multiple influences on the social, industrial, and medical situation in all affected countries. Measures of obligatory medical confinement were suspensions of scheduled non-emergent surgical procedures and outpatients’ clinics as well as overall access restrictions to hospitals and medical practices. The aim of this retrospective study was to assess if the obligatory confinement (lockdown) had an effect on the number of appendectomies (during and after the period of lockdown). Methods This retrospective study was based on anonymized nationwide administrative claims data of the German Local General Sickness Fund (AOK). Patients admitted for diseases of the appendix (ICD-10: K35-K38) or abdominal and pelvic pain (ICD-10: R10) who underwent an appendectomy (OPS: 5-470) were included. The study period included 6 weeks of German lockdown (16 March–26 April 2020) as well as 6 weeks before (03 February–15 March 2020) and after (27 April–07 June 2020). These periods were compared to the respective one in 2018 and 2019. Results The overall number of appendectomies was significantly reduced during the lockdown time in 2020 compared to that in 2018 and 2019. This decrease affects only appendectomies due to acute simple (ICD-10: K35.30, K35.8) and non-acute appendicitis (ICD-10: K36-K38, R10). Numbers for appendectomies in acute complex appendicitis remained unchanged. Female patients and in the age group 1–18 years showed the strongest decrease in number of cases. Conclusion The lockdown in Germany resulted in a decreased number of appendectomies. This affected mainly appendectomies in simple acute and non-acute appendicitis, but not complicated acute appendicitis. The study gives no evidence that the confinement measures resulted in a deterioration of medical care for appendicitis.

Laparoscopy as A Diagnostic Tool in Abdominal Problems

Laparoscopy has been used for decades now in the treatment of various abdominal pathologies in general surgery, urology, gynecology and pediatric surgery. The use of laparoscopy in establishing the diagnosis when other modalities have failed is also well known. The aim of this study was to assess the uses of laparoscopy as a diagnostic tool in various abdominal problems in Mosul City hospitals and its benefits in achieving the accurate diagnosis. Between the year 2009 and 2019, Laparoscopy was used as a diagnostic tool in Mosul City hospitals for 200 patients with various abdominal problems The patients were classified into five categories including abdominal trauma, acute and chronic abdominal and pelvic pain, cirrhosis and hepatitis, malignancies and intra-abdominal testes.

Influence of COVID-19 confinement measures on appendectomies in Germany - administrative claims data analysis of 9,797 patients

Purpose: COVID 19 pandemic had multiple influences on the social, industrial and medical situation in all affected countries. Measures of obligatory medical confinement were suspensions of scheduled non-emergent surgical procedures and outpatients clinics as well as overall access restrictions to hospitals and medical practices. The aim of this retrospective study was to assess if the obligatory confinement (lockdown) had an effect on the number of appendectomies (during and after the period of lockdown). Methods: This retrospective study was based on anonymized nationwide administrative claims data of the German Local General Sickness Fund (AOK). Patients admitted for disease of the appendix (ICD-10: K35-K38) or abdominal and pelvic pain (ICD-10: R10) who undergone an appendectomy (OPS: 5-470) were included. The study period included six weeks of German lockdown (16.03.-26.04.2020) as well as six weeks before (03.02.-15.03.2020) and after (27.04.-07.06.2020). These periods were compared to the respective in 2019. Results: Overall number of appendectomies was significantly reduced during the lockdown time in 2020 compared to 2019. This decrease affects only appendectomies due to acute simple and non-acute appendicitis. Numbers for appendectomies in acute complex appendicitis remained unchanged. Female patients and in the age group 1-18 years showed the strongest decrease in number of cases. Conclusion: The lockdown in Germany resulted in a decreased number of appendectomies. This affected mainly appendectomies in simple acute and non-acute appendicitis, but not complicated acute appendicitis. The study gives no evidence, that the confinement measures resulted in a deterioration of medical care for appendicitis.

Paediatric ovarian torsion: a case report and review of literature

Ovarian torsion is a surgical emergency, can result in ovarian loss, intra-abdominal infection and even death. Paediatric ovarian torsion is a rare condition, requires high clinical suspicion and prompt diagnosis. Diagnosis is a challenge since signs and symptoms are similar to those of other causes of acute abdominal pain such as appendicitis, gastroenteritis, urinary tract infection, renal colic or other conditions of acute abdominal and pelvic pain. Here, authors describe a case of a 4-year-old girl with a presentation of acute abdominal pain, treated empirically elsewhere. After investigations, a provisional diagnosis of ovarian torsion was made and patient was taken up for surgery. Intraoperatively, ovary was found to be necrosed. Detorsion was tried but ovary was unsalvageable. Right sided salpingectomy with oophorectomy was performed. Conservative surgery by laparoscopic detorsion can be tried in cases of ischemia but if necrosis has already set in, then salpingo-oophorectomy has to be performed.