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International Journal of Gynecological... May 2019Extra-ovarian neoplasms incidentally discovered during cesarean section are very rare. Here we report a case of inflammatory myofibroblastic tumor found during cesarean...
Extra-ovarian neoplasms incidentally discovered during cesarean section are very rare. Here we report a case of inflammatory myofibroblastic tumor found during cesarean section of a 30-year-old, full-term woman, forming a mass in her cul-de-sac. Histology revealed an extensively decidualized spindle cell process, positive for anaplastic large cell lymphoma kinase (ALK) through immunohistochemistry and fluorescent in situ hybridization (FISH). To the best of our knowledge, this is the first presentation of inflammatory myofibroblastic tumor in this location without concurrent intrauterine component, that additionally demonstrates this degree of decidualization, mimicking ectopic decidua.
Topics: Adult; Anaplastic Lymphoma Kinase; Cesarean Section; Decidua; Diagnosis, Differential; Douglas' Pouch; Female; Humans; Immunohistochemistry; In Situ Hybridization, Fluorescence; Inflammation; Myofibroblasts; Neoplasms, Muscle Tissue; Pregnancy; Tomography, X-Ray Computed
PubMed: 29620583
DOI: 10.1097/PGP.0000000000000505 -
Surgical Endoscopy Dec 2017Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac/processus vaginalis has been widely performed for repair of inguinal hernia/hydrocele... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac/processus vaginalis has been widely performed for repair of inguinal hernia/hydrocele in children. However, a variety of surgical instruments and techniques were used, and significant differences existed among the SLPEC reports.
METHODS
A literature search was performed for all available studies concerning SLPEC for pediatric inguinal hernia/hydrocele in PubMed, Embase and Cochrane library. The surgical details and operative outcomes were pooled and analyzed with software StataSE 12.0.
RESULTS
49 studies fulfilled the predefined inclusion criteria of this review and 37 studies were finally included in the meta-analysis. The mean incidence of CPPV was 29.1% (range 5.73-43.0%). The average of mean operative time was 19.56 min (range 8.30-41.19 min) for unilateral SLPEC and 27.23 min (range 12.80-48.19 min) for bilateral SLPEC. The total incidence of injury, conversion, recurrence, hydrocele formation, knot reaction, severe pain, and scrotal swelling was 0.32% (range 0-3.24%), 0.05% (range 0-0.89%), 0.70% (range 0-15.5%), 0.23% (range 0-3.57%), 0.33% (range 0-3.33%), 0.05% (range 0-4.55%), and 0.03% (range 0-1.52%), respectively. There was no development of testicular atrophy. Subgroup analyses showed an inverse correlation between the injury incidence and adoption of assisted forceps, hydrodissection, and blunt puncture device, between the conversion rate and adoption of hydrodissection, between the recurrence/hydrocele incidence and adoption of assisted forceps, hydrodissection, nonabsorbable suture and the preventive measures to avoid ligating the unnecessary subcutaneous tissues, and between the rate of knot reaction and adoption of assisted forceps, hydrodissection, and the preventive measures.
CONCLUSIONS
SLPEC was a well-developed procedure for repair of pediatric inguinal hernia/hydrocele. Adoption of assisted forceps, hydrodissection, nonabsorbable suture, and the preventive measures to avoid ligating the unnecessary subcutaneous tissues could significantly reduce the intra- and postoperative complications.
Topics: Hernia, Inguinal; Herniorrhaphy; Humans; Laparoscopy; Male; Peritoneum; Testicular Hydrocele; Treatment Outcome
PubMed: 28389795
DOI: 10.1007/s00464-017-5491-3 -
Surgical Endoscopy Jul 2015TAPP inguinal hernia repair (IHR) entails the development of a peritoneal flap (PF) in order to reduce the hernia sac and create a preperitoneal space in which to place...
INTRODUCTION
TAPP inguinal hernia repair (IHR) entails the development of a peritoneal flap (PF) in order to reduce the hernia sac and create a preperitoneal space in which to place mesh. Many methods for closure of the PF exist including sutures, tacks, and staples. We hypothesized that patients who had PF closure with suture would have better short-term QOL outcomes.
METHODS AND PROCEDURES
A prospective institutional hernia-specific database was queried for all adult, TAPP IHRs from July 2012 to August 2013. Unilateral and bilateral patients were included and each hernia was analyzed separately. The main outcome of interest was quality of life (QOL) at two- and four-week follow-up, as measured by the Carolinas Comfort Scale.
RESULTS
There were 227 patients who underwent TAPP, with 99 bilateral and 128 unilateral IHR, for a total of 326 IHR. PF closure was performed using tacks in 45.1%, suture in 19.0%, and staples in 35.9%. Patient characteristics were statistically similar between the tack, suture, and staple group. There were 32.9% direct, 46.5% indirect, and 20.6% pantaloon hernias, which were not significantly different when compared by PF closure method. Post-operative complications and length of stay were same for the three groups. There were no hernia recurrences. Post-operative activity limitation at two weeks was significantly better in the suture group when compared to the stapled group (p = 0.005). Additionally, sutured PF closure had less early post-operative pain when compared to the tack group (p = 0.038).
CONCLUSIONS
Following TAPP IHR, suture closure of the PF significantly improves 2-week post-operative movement limitation compared to stapled and tacked PF closure. Continued randomized studies are needed to determine the best surgical hernia repair methods for ideal post-op QOL.
Topics: Female; Hernia, Inguinal; Herniorrhaphy; Humans; Laparoscopy; Male; Middle Aged; Peritoneum; Prospective Studies; Quality of Life; Surgical Mesh; Suture Techniques; Sutures
PubMed: 25294540
DOI: 10.1007/s00464-014-3857-3 -
Journal of Medical Case Reports Dec 2023Peritoneal cystic echinococcosis happens usually after traumatic rupture or after surgical treatment. Primary peritoneal cystic echinococcosis is a very rare case that...
BACKGROUND
Peritoneal cystic echinococcosis happens usually after traumatic rupture or after surgical treatment. Primary peritoneal cystic echinococcosis is a very rare case that constitutes a diagnostic and therapeutic challenge.
CASE REPORT
A 30-year-old Tunisian man was admitted for hypogastric pain since 4 months. He has a 10 cm hypogastric mass. Biological-tests were normal. A computed tomography Scan showed a cystic mass on the pelvis measuring 13 × 17 cm without echinococcosis cyst in the liver. The patient was operated and we found a cystic mass of 17 cm located on the Douglas cul-de-sac that suggest a pelvic hydatid cyst. We have performed an aspiration of the cyst confirms the diagnosis followed by injection of hypertonic solution, extarction of the germinal layer and a maximal reduction of the pericyst. The postoperative course was uneventful.
CONCLUSION
Trough our case, we try to focus on the diagnosis and therapeutic options of this rare entity that we should think of in front of a patient with isolated peritoneal cyst especially in endemic country.
Topics: Male; Humans; Adult; Peritoneum; Echinococcosis; Peritoneal Diseases; Abdominal Pain; Cysts
PubMed: 38093379
DOI: 10.1186/s13256-023-04289-y -
Archives of Gynecology and Obstetrics Apr 2009Omental pregnancy is a very rare form of ectopic pregnancy. A 29-year-old woman presented with severe abdominal pain. History of the patient revealed use of combined... (Review)
Review
Omental pregnancy is a very rare form of ectopic pregnancy. A 29-year-old woman presented with severe abdominal pain. History of the patient revealed use of combined oral contraceptive pills. There was no gestational sac in the endometrial cavity and no tubal ring in the adnexa, but free peritoneal fluid was detected at ultrasonography. Laparotomy was done according to pre-operative diagnosis of ruptured tubal pregnancy. Bilateral tubes and ovaries were intact; gestational sac was detected attached to the necrotic lower edge of omentum. Although 16 cases of omental pregnancy (mostly secondary) were reported in the literature, herein we describe a primary omental pregnancy without adnexal involvement.
Topics: Adult; Female; Humans; Laparotomy; Omentum; Pregnancy; Pregnancy, Ectopic
PubMed: 18665381
DOI: 10.1007/s00404-008-0730-4 -
Journal of Biomedical Engineering Oct 1983This paper, to the authors' best knowledge, presents the first attempt on the understanding of the biomechanics of hernial sac formation. First, a brief survey of the...
This paper, to the authors' best knowledge, presents the first attempt on the understanding of the biomechanics of hernial sac formation. First, a brief survey of the selected etiological factors and their related theories on hernia is given. Next, the results of some preliminary tensile tests conducted on normal and sac peritoneum are discussed. The third part of the paper is concerned with a theoretical model which incorporates both material and geometric nonlinearities by considering deformation of circular membrane under internal fluid pressure. The influence of the material properties of the peritoneal sac, its thickness and its initial radius of curvature, as well as the internal fluid pressure on the growth of the sac are illustrated. The existence of a critical value for a non-dimensional parameter is shown and it is proposed that the herniation process can be viewed as a biomechanically unstable phenomenon in the light of the present model.
Topics: Biomechanical Phenomena; Hernia, Inguinal; Humans; Mathematics; Models, Biological; Peritoneum
PubMed: 6632845
DOI: 10.1016/0141-5425(83)90009-2 -
Critical Reviews in Diagnostic Imaging 1988The pouch of Douglas (cul-de-sac) represents the caudal extension of the peritoneal cavity. It is the rectovaginal pouch in the female and the rectovesical pouch in the... (Review)
Review
The pouch of Douglas (cul-de-sac) represents the caudal extension of the peritoneal cavity. It is the rectovaginal pouch in the female and the rectovesical pouch in the male. The cul-de-sac is in a dependent position when either upright or supine; it is, therefore, a frequent location for seeded lesions. Abnormalities in the cul-de-sac include metastases, abscesses, and endometriosis. These lesions may be detected by multiple modalities, including barium enema, computed tomography, and ultrasound. Examples of numerous cul-de-sac lesions are presented as they appear with different imaging modalities.
Topics: Diagnosis, Differential; Douglas' Pouch; Female; Humans; Magnetic Resonance Imaging; Male; Peritoneal Neoplasms; Tomography, X-Ray Computed; Ultrasonography
PubMed: 3053046
DOI: No ID Found -
Urology Jun 2015To report our 5-year experience with a modified single-port, double-needle, minilaparoscopic technique for patent processus vaginalis with multiple peritoneal folds in... (Clinical Trial)
Clinical Trial
Application of a Laparoscopic, Single-port, Double-needle Technique for Pediatric Hydroceles With Multiple Peritoneal Folds: A Trial From a Single-center 5-Year Experience.
OBJECTIVE
To report our 5-year experience with a modified single-port, double-needle, minilaparoscopic technique for patent processus vaginalis with multiple peritoneal folds in the hydrocele sac orifice.
METHODS
A total of 125 consecutive cases of boys with unilateral pediatric hydrocele underwent minilaparoscopic repair between June 2008 and June 2013. The patients were divided into 2 groups. Group 1 consisted of 65 patients who underwent a 2-port laparoscopic procedure, during which a 3-mm grasping forceps was used to grasp the folds around the internal inguinal ring. Group 2 included 60 patients who received a modified single-port, double-needle, minilaparoscopic surgery. An Endo Close needle was used to spread the peritoneal folds and facilitate circular extraperitoneal suturing in group 2. The principal outcome factors were assessed between the groups.
RESULTS
A total of 151 minilaparoscopic procedures were performed in 125 patients (age range, 12-68 months; median, 21.5 months). In total, 26 extra procedures were performed for simultaneous repair of a potential contralateral patent processus vaginalis. No significant difference in operation time was noted between group 1 and group 2 (25.9 ± 6.4 vs 27.1 ± 5.5 minutes). The procedures were performed successfully without serious preoperative complications. During a median follow-up period of 18 months (range, 6-36 months), no postoperative hydrocele recurrence was encountered.
CONCLUSION
Our limited experience suggests that the modified single-port, double-needle, minilaparoscopic technique could be safe, effective, and more cosmetically appealing for the management of complicated pediatric hydroceles.
Topics: Child, Preschool; Humans; Infant; Laparoscopy; Male; Needles; Peritoneum; Testicular Hydrocele; Time Factors
PubMed: 26099890
DOI: 10.1016/j.urology.2015.01.053 -
Clinical Imaging Aug 2023The Kissing ovaries sign is a radiological sign seen in women with deep pelvic endometriosis. It refers to abutment of the ovaries within the cul-de-sac. The term...
The Kissing ovaries sign is a radiological sign seen in women with deep pelvic endometriosis. It refers to abutment of the ovaries within the cul-de-sac. The term kissing ovaries was first described by Ghezzi et al. (2005) and has been since used widely. When seen on imaging it indicates moderate to severe endometriosis with the ovaries tethered within abnormal pelvic soft tissue, which may warrant surgical management.
Topics: Female; Humans; Ovary; Endometriosis; Douglas' Pouch; Pelvis
PubMed: 37120923
DOI: 10.1016/j.clinimag.2023.04.012 -
International Urogynecology Journal and... Oct 2008The aim of this paper is to describe the efficacy and safety of a standardized technique of trans-vaginal entry into the peritoneal cavity for post-hysterectomy vault... (Comparative Study)
Comparative Study
The aim of this paper is to describe the efficacy and safety of a standardized technique of trans-vaginal entry into the peritoneal cavity for post-hysterectomy vault prolapse and determine how well the pre-operative pelvic examination predicted successful peritoneal entry. A retrospective review of patients undergoing post-hysterectomy trans-vaginal apical suspensions using a standardized technique of peritoneal entry was employed in this study. A subset of patients underwent a standardized pre-operative evaluation to predict what organ was behind the vaginal cuff and posterior cul-de-sac. Peritoneal entry was attempted in 280 patients, and successfully achieved in 223(80%). One cystotomy and one proctotomy (0.3%) occurred during attempted entry. Of those who underwent the standardized pre-operative evaluation, peritoneal entry was successful 86% of the time when small bowel was predicted to lie behind the vaginal cuff or posterior cul-de-sac. Peritoneal entry can be safely achieved in the majority of post-hysterectomy prolapse patients. Pre-operative examination assists in predicting successful peritoneal entry.
Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Hysterectomy; Middle Aged; Peritoneal Cavity; Postoperative Complications; Plastic Surgery Procedures; Reoperation; Retrospective Studies; Treatment Outcome; Uterine Prolapse; Vagina
PubMed: 18478174
DOI: 10.1007/s00192-008-0642-7