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International Journal of Surgery Case... Jan 2023Primary peritoneal ectopic pregnancy is a rare condition that can be life-threatening. Herein, we report such a case which was managed by laparoscopy.
INTRODUCTION
Primary peritoneal ectopic pregnancy is a rare condition that can be life-threatening. Herein, we report such a case which was managed by laparoscopy.
PRESENTATION OF THE CASE
A 31-year-old G1P0 woman, who had a history of pelvic infection and primary infertility, presented with lower abdominal pain and mild vaginal spotting. Abdominal and bimanual pelvic examination revealed mild left pelvic tenderness. Her serum β-human chorionic gonadotropin (β-HCG) was 7247 IU. Transvaginal ultrasound demonstrated a mass measuring around 1.5 cm in diameter with a well-defined yolk sac adherent to the left ovary. A left fallopian tube ectopic pregnancy was suspected. Laparoscopy revealed that both fallopian tubes were normal and freely moving. Peritoneal ectopic pregnancy was seen behind the uterus which was removed laparoscopically. Histopathology confirmed the diagnosis. The patient had a smooth postoperative recovery.
DISCUSSION
Primary peritoneal pregnancy can be life-threatening. A thorough laparoscopic examination of the entire pelvis and abdomen should be done by an experienced surgeon when the location of the suspected ectopic pregnancy could not be identified.
CONCLUSION
Diagnostic laparoscopy for ectopic pregnancy should include the whole pelvis and the accessible part of the abdomen when the tubes and ovaries are normal.
PubMed: 36599251
DOI: 10.1016/j.ijscr.2022.107847 -
Hernia : the Journal of Hernias and... Apr 2021Repair of transverse incisional hernias is a surgical challenge with current methods of abdominal wall reconstruction. The peritoneal flap hernioplasty addresses this...
BACKGROUND
Repair of transverse incisional hernias is a surgical challenge with current methods of abdominal wall reconstruction. The peritoneal flap hernioplasty addresses this problem using flaps of hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space exploiting the retro-rectus space medially and the avascular plane between the internal and external oblique muscles laterally. The operative technique and long-term results of 80 consecutive cases with transverse incisional hernias undergoing repair with this method are reported.
METHODS
Patients undergoing elective peritoneal flap hernioplasty repair for transverse incisional hernias from Jan. 1, 2010 to Dec. 31, 2014 were identified from the Lothian Surgical Audit system, a prospectively-maintained computer database of all surgical procedures in the Edinburgh region of south-east Scotland. Patient demographics and clinical data were obtained from the hospital case-notes. Follow-up data were obtained in May 2019 from hospital records and telephone interview.
RESULTS
80 patients, (n = 53 male, 66%) were identified. Mean follow-up was 83 months (range 55-114 months) and mean postoperative stay was 6.4 days (range 1-23 days). Eleven repairs (14%) were for recurrent hernia. Mean mesh size applied (Optilene Elastic, 48 g/m, BBraun) was 747 cm (ranged 150-1500 cm). Redundant skin excision was performed in 54% of cases. Altogether, seven patients (8.8%) presented with postoperative complications: five superficial wound infections (6.3%), one symptomatic seroma (1.3%) and one recurrence (1.3%) within the follow-up period.
CONCLUSION
The peritoneal flap hernioplasty is associated with few complications and a very low recurrence rate. We propose this technique as the method of choice for reconstruction of transverse abdominal incisional hernias when primary fascial apposition is not possible.
Topics: Hernia, Ventral; Herniorrhaphy; Humans; Incisional Hernia; Male; Peritoneum; Postoperative Complications; Recurrence; Surgical Mesh
PubMed: 31813114
DOI: 10.1007/s10029-019-02099-0 -
International Journal of Gynecological... May 2023Recent studies have provided molecular confirmation that a subset of yolk sac tumors is somatically derived. Somatically derived yolk sac tumors are typically diagnosed...
Recent studies have provided molecular confirmation that a subset of yolk sac tumors is somatically derived. Somatically derived yolk sac tumors are typically diagnosed in older women and are often seen adjacent to epithelial proliferations (such as endometriosis or endometrioid carcinoma) with which they share mutations. Here, we present a case of a postmenopausal woman with a yolk sac tumor and endometriosis in the right ovary, endometriosis with glandular crowding and reactive changes in the left ovary, endometrial endometrioid carcinoma, and yolk sac tumor involving the serosa of the colon. Targeted next-generation sequencing of these five tumor components demonstrated identical mutations in PTEN (p.R130G), PIK3CA (p.G1049S), FGFR2 (p.S252W), and FBXW7 (p.R689Q), suggesting that all components arose from a common precursor. The endometrial endometrioid carcinoma harbored additional exclusive mutations involving PIK3CA (p.H1048R) and CTNNB1 (p.S37F).
Topics: Endometriosis; Ovarian Neoplasms; Endodermal Sinus Tumor; Carcinoma, Endometrioid; Peritoneal Neoplasms; Humans; Female; Middle Aged
PubMed: 35639393
DOI: 10.1097/PGP.0000000000000889 -
Annals of Medicine and Surgery (2012) Jan 2021Spontaneous uterine rupture before onset of labour is extremely rare. This is even more so in the second trimester of pregnancy, in nulliparous women and in the absence...
INTRODUCTION
Spontaneous uterine rupture before onset of labour is extremely rare. This is even more so in the second trimester of pregnancy, in nulliparous women and in the absence of myometrial surgery. The initial presentation of this potentially catastrophic event may be non-specific, with upper or lower abdominal discomfort, vague gastrointestinal or urinary symptoms preceding rapid deterioration.
DISCUSSION
This case report demonstrates that a high index of suspicion, rapid diagnosis aided by imaging modalities and immediate surgical intervention are crucial steps in successful management. A postulated etiology in our patient is that of an upper scar from a previous uterine curettage with abnormal placentation predisposing to spontaneous rupture.
PRESENTATION OF CASE
A case of spontaneous uterine rupture at 16 week's gestation in a multiparous, 32 year old patient with no history of myometrial surgery. She had presented with lower abdominal discomfort, progressing to severe pain with hypotension and tachycardia. An urgent ultrasound pelvis showed a live fetus, free intra-peritoneal fluid with blood clots. An emergency laparotomy performed revealed 2 L of hemoperitoneum, with the fetus intact in the amniotic sac. The uterine fundal rupture was successfully repaired.
CONCLUSION
Despite the gestation, in women presenting with symptoms and signs suggestive of acute abdomen and hemodynamic instability, prompt resuscitation must be instituted, and a high index of suspicion for rupture must be suspected.
PubMed: 33425347
DOI: 10.1016/j.amsu.2020.12.020 -
Journal of Laparoendoscopic & Advanced... Apr 2017Laparoscopic inguinal hernia repair in children is in evolution. Multiple methods of passing the suture around the peritoneum at the level of the internal inguinal ring...
INTRODUCTION
Laparoscopic inguinal hernia repair in children is in evolution. Multiple methods of passing the suture around the peritoneum at the level of the internal inguinal ring exist. Cauterization of the peritoneum at the internal ring is thought to increase scarring and decrease recurrence. We have employed a sutureless, cautery only, laparoscopic single port repair of inguinal hernias and patent processus vaginalis (PPV) in girls.
METHODS
After institutional ethical review was obtained, a retrospective review of sutureless laparoscopic inguinal hernia repairs in girls by 4 surgeons at separate institutions was performed. Patient demographics, intraoperative findings, and postoperative outcomes were recorded and analyzed. The technique involves an umbilical 30° camera and either a separate 3 mm stab incision in the midclavicular line or a 3 mm Maryland grasper placed next to the camera, and the distal most portion of the hernia sac is grasped and pulled into the abdomen and cauterized obliterating the sac.
RESULTS
Eighty inguinal hernias were repaired using this technique in 67 girls between July 2009 and September 2015. The ages and weights ranged from 1 month to 16 years and from 2 to 69 kg, respectively. There was one conversion to open approach because an incarcerated ovary was too close to the ring. A single umbilical incision was utilized in 85%. Fifty-seven percent patients had hernias on the right whereas 42% had hernias on the left. Of the patients with presumed unilateral hernias, 22 patients were found to have PPV and were treated through the same incisions, 17/22 were found during a contralateral hernia surgery and 5/22 were found incidentally during appendectomy. Average operative time for unilateral and bilateral hernias was 22 minutes (5-38 minutes) and 31 minutes (11-65 minutes), respectively. No patient required a hospital stay because of the hernia repair. At an average of 25 months follow-up (1.6-75 months), there were no recurrences. The only complication was a single lateral port site hernia on a 2 kg, former 24 week postmenstrual age girl before adapting the technique to single-site surgery for all.
CONCLUSIONS
Laparoscopic sutureless inguinal hernia repair is safe and effective in girls of all ages. The single-site modification allows for superior cosmetic result and lower complication profile. The Burnia allows for adequate treatment of unilateral and bilateral inguinal hernias with a single incision in the umbilicus.
Topics: Adolescent; Appendectomy; Cautery; Child; Child, Preschool; Cicatrix; Female; Hernia, Inguinal; Herniorrhaphy; Humans; Infant; Inguinal Canal; Laparoscopy; Length of Stay; Operative Time; Peritoneum; Recurrence; Retrospective Studies; Treatment Outcome; Umbilicus
PubMed: 28358588
DOI: 10.1089/lap.2016.0234 -
Cureus Oct 2023This is the first reported case of lesser sac empyema secondary to a foreign body perforation in the posterior stomach. Although PubMed and Google Scholar...
This is the first reported case of lesser sac empyema secondary to a foreign body perforation in the posterior stomach. Although PubMed and Google Scholar search reports cases of lesser sac empyema alone and foreign body penetrations, there are currently no reported cases of a lesser sac abscess secondary to a foreign body. Patients with a lesser sac empyema present atypically with an insidious onset. The lesser sac should be examined in patients with peritonitis without a clear source. A 48-year-old female presented to the emergency department with acute onset epigastric pain. The patient was tender in the epigastrium and left upper quadrant with associated guarding. The patient had elevated white cell count and C-reactive protein, with a computed tomography scan identifying a foreign body posterior gastric wall perforation. The patient was managed with endoscopic drainage of the lesser sac empyema and surgical washout of the abdomen. Foreign bodies are investigated using different imaging modalities, with computed tomography being able to further evaluate the size, shape, and complications. Intra-abdominal collections can be managed through three different methods: percutaneous drainage, endoscopic drainage, and surgery. Patients with peritonitis would require a laparoscopic or open surgical washout of the abdomen and inspection of the lesser sac would be necessary if no obvious source is identified. Foreign body ingestion requires careful history taking and assessment. Patients with lesser sac empyema present atypically, and this can lead to delayed surgical referral and management. Contained intra-abdominal collections can be drained percutaneously or endoscopically.
PubMed: 38021889
DOI: 10.7759/cureus.47186 -
SAGE Open Medical Case Reports 2022Congenital peritoneal encapsulation is a rare entity characterized by an accessory peritoneal membrane that forms during embryonic development. Congenital peritoneal...
Congenital peritoneal encapsulation is a rare entity characterized by an accessory peritoneal membrane that forms during embryonic development. Congenital peritoneal encapsulation is generally asymptomatic but can cause intermittent, colicky abdominal pain related to subacute small bowel obstruction. Diagnosis is made incidentally or upon surgical exploration for chronic abdominal complaints as preoperative imaging is typically nonspecific. We report a case of a 49-year-old male with epigastric abdominal pain, constipation, and superior mesenteric vein thrombosis on imaging. Upon exploratory laparotomy, the small bowel was covered by an accessory peritoneal sac consistent with congenital peritoneal encapsulation. The accessory sac was excised completely, and the patient recovered well. Although rarely causing significant gastrointestinal symptoms, congenital peritoneal encapsulation is an anomaly that requires surgical intervention.
PubMed: 36274860
DOI: 10.1177/2050313X221132436 -
Journal of Minimally Invasive Gynecology 2017To assess the potential role of peritoneal and omental biopsies in women undergoing risk-reducing salpingo-oopherectomy (RRSO) for prophylactic management of hereditary... (Observational Study)
Observational Study
STUDY OBJECTIVE
To assess the potential role of peritoneal and omental biopsies in women undergoing risk-reducing salpingo-oopherectomy (RRSO) for prophylactic management of hereditary breast/ovarian cancer (HBOC) syndromes.
DESIGN
A retrospective observational cohort (Canadian Task Force classification II.1).
SETTING
An academic gynecology practice.
PATIENTS
All women who underwent RRSO for a high-risk BRCA1/2 mutation or deletion at a single institution between January 2003 and June 2016.
INTERVENTIONS
After obtaining institutional review board approval, patient demographics, types of surgical intervention, histopathology reports, and outcomes were abstracted. Bilateral fallopian tubes were histologically evaluated using the "sectioning and extensively examining of the fimbriated end" protocol. Descriptive statistics were used to summarize findings.
MEASUREMENTS AND MAIN RESULTS
Seventy women underwent RRSO within the study window; 60% (n = 42) carried a high-risk mutation in BRCA1, 37.1% (n = 26) carried a high-risk mutation in BRCA2, and 2.9% (n = 2) had a high-risk BRCA deletion identified by BRAC analysis rearrangement testing (BART). Serous tubal intraepithelial carcinomas were identified in the distal fallopian tube of 3 subjects. In addition to RRSO, subjects underwent pelvic washings (n = 58, 82.9%), omental biopsy (n = 44, 62.9%), peritoneal biopsies of the bilateral paracolic gutters (n = 51, 72.9%), anterior and posterior cul-de-sac (n = 53, 75.7%), and rectosigmoid mesentery (n = 11, 15.7%). Rare atypical cells favoring reactive cells were identified in pelvic washings of 1 subject (1.7%) with histologically normal fallopian tubes. No evidence of atypical mesothelial proliferations or carcinoma was identified in any omental or peritoneal biopsies. The mean duration of follow-up was 32.5 ± 24.7 months. At the last contact, 3 women (4.3%) had died of metastatic breast cancer, whereas another 3 (4.3%) had been diagnosed with a recurrence of their breast cancer. All other subjects were alive and well (n = 64, 91.4%).
CONCLUSION
The routine use of peritoneal and omental biopsies for women undergoing RRSO does not appear to improve detection of occult malignancy.
Topics: Adult; Aged; BRCA1 Protein; BRCA2 Protein; Biopsy; Breast Neoplasms; Cystadenocarcinoma, Serous; Diagnostic Tests, Routine; Fallopian Tube Neoplasms; Fallopian Tubes; Female; Genes, BRCA1; Genes, BRCA2; Humans; Middle Aged; Mutation; Neoplasm Metastasis; Neoplasm Recurrence, Local; Omentum; Ovarian Neoplasms; Peritoneum; Retrospective Studies; Risk Factors; Salpingo-oophorectomy
PubMed: 28285055
DOI: 10.1016/j.jmig.2017.03.001 -
PloS One 2019Deep infiltrating endometriosis (DIE) is defined as an endometriotic lesion penetrating to a depth of >5 mm and is associated with pelvic pain, but the underlying...
PURPOSE
Deep infiltrating endometriosis (DIE) is defined as an endometriotic lesion penetrating to a depth of >5 mm and is associated with pelvic pain, but the underlying mechanisms are unclear. Our objective is to investigate whether plasminogen activator inhibitor-1 expression (PAI-1) in endometriotic tissues is increased in women with DIE.
METHODS
In this blinded in vitro study, immunohistochemistry and Histoscore were used to examine the expression of PAI-1 in glandular epithelium (GECs) and stroma (SCs) in a total of 62 women: deep infiltrating uterosacral/rectovaginal endometriosis (DIE; n = 13), ovarian endometrioma (OMA; n = 14), superficial peritoneal uterosacral/cul-de-sac endometriosis (SUP; n = 23), uterine (eutopic) endometrium from women with endometriosis (UE; n = 6), and non-endometriosis eutopic endometrium (UC; n = 6). The following patient characteristics were also collected: age, American Fertility Society stage, hormonal suppression, phase of menstrual cycle, dysmenorrhea score and deep dyspareunia score.
RESULTS
PAI-1 expression in GECs and SCs of the DIE group was significantly higher than that of SUP group (p = 0.01, p = 0.01, respectively) and UE group (p = 0.03, p = 0.04, respectively). Interestingly, increased PAI-1 expression in GECs and SCs was also significantly correlated with increased dysmenorrhea (r = 0.38, p = 0.01; r = 0.34, p = 0.02, respectively).
CONCLUSIONS
We found higher expression of PAI-1 in DIE, and an association between PAI-1 and worse dysmenorrhea.
Topics: Adult; Dysmenorrhea; Endometriosis; Epithelial Cells; Female; Humans; Immunohistochemistry; Middle Aged; Peritoneal Diseases; Plasminogen Activator Inhibitor 1; Rectal Diseases; Stromal Cells; Uterine Diseases; Vaginal Diseases; Young Adult
PubMed: 31315131
DOI: 10.1371/journal.pone.0219064 -
Minimally Invasive Surgery 2021Totally extraperitoneal herniorrhaphy (TEP) is a therapeutic challenge because of its complex anatomical location in inguinal region. The aim of this study was to...
BACKGROUND
Totally extraperitoneal herniorrhaphy (TEP) is a therapeutic challenge because of its complex anatomical location in inguinal region. The aim of this study was to describe the related surgical anatomy through laparoscopic observation and share the lessons learned from a review of 250 primary inguinal hernia repair procedures performed at our hospital from January 2013 to November 2019. . There were 245 men and 5 women (median age: 63.2 years). Right hernia (60.2%) was the most common site. Indirect hernia (60.5%) was the most common abnormality. The classification of type II (65.0%) was the most common form. Surgical techniques comprised retromuscular approach using cauterized dissection, management of variations of arcuate line, Retzius space and Bogros space dissection, hernia sac reduction, and mesh positioning.
RESULTS
The incidence of peritoneum injury was in 27 (10.1%). No epigastric vessels were injured. There were 8 (3%) hematoma and 18 (6.8%) seroma. No mesh infection, chronic pain, and recurrence were found after follow-up of an average of 35 months.
CONCLUSION
A good understanding of the anatomically complex nature in the inguinal region can make it easier and safer to learn the TEP approach. Early and midterm outcomes after TEP are satisfactory.
PubMed: 33976937
DOI: 10.1155/2021/5524986