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Orphanet Journal of Rare Diseases Mar 2024This study investigated the clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients. Our...
PURPOSE
This study investigated the clinicopathological features and surgical procedures of adnexal masses with abdominal pain in pediatric and adolescent patients. Our objective was to better define the clinical presentation of adnexal torsion and to distinguish characteristics of those with torsion and those with an alternate diagnosis.
METHODS
Retrospective cohort study of 212 pediatric and adolescent patients was performed who admitted for abdominal pain and presenting with an adnexal mass between March 2012 to December 2019.Medical records were reviewed for age at operation, including presentation of symptoms and signs; the levels of tumor markers; imaging examinations; pathologic findings; the size of masses; treatment; and outcome. Data management and descriptive analyses were performed using SPSS 26.0.
RESULTS
The median age of the patients was 14.5 ± 3.6 years at the operation. 126 (59.4%, 126/212) patients presented with an abrupt onset of abdominal pain. A total of 82.1% (174/212) of the participants underwent adnexal conservative surgery. 179 (84.5%, 179/212) patients underwent laparoscopic surgery with an average tumor size of 7.7 ± 3.4 cm, while 33 patients ( 15.6%, 33/212) underwent laparotomy. Rupture of mass and ectopic pregnancy accounted for 7.5% (16/212) and 0.9%(2/212), respectively. Torsion was responsible for 36.8% (78/212) of all patients. Among the patients with torsion, the symptom of nausea and vomiting was more common among girls without torsion (P < 0.0001). 88.5% of the girls with torsion had acute onset of abdominal pain, while 92.3% had persistent pain that could not be relieved or occurred repeatedly, which significantly higher than that in the patients without torsion (P < 0.001). 69.2% of patients with torsion had fixed pain sites, compared with 42.2% in patients without torsion (P < 0.001). 88.5% of girls with torsion had an ovarian cyst/mass ≥ 5 cm, compared with 75.0% in girls without torsion (P = 0.038). 66.7% of girls underwent ovary-preserving surgery, compared with 92.2% in patients without torsion. The most common pathologic types were mature teratoma and simple cyst, accounting for 29.4% and 25.6%, respectively. The multivariate analyses confirmed that mass size greater than 5 cm (OR 4.134, 95% CI: 1.349-12.669,P = 0.013), acute onset pain (OR 24.150,95%CI: 8.398-69.444,P = 0.000), persistent or recurrent pain (OR 15.911,95%CI: 6.164-41.075,P = 0.000) were significantly associated with increased risk of torsion.
CONCLUSIONS
Torsion which is a relatively rare event in the pediatric population was not an uncommon condition and responsible for more than one third of all pediatric and adolescent patients presented with adnexal masses and abdominal pain. Pain assessment in children and adolescents is important to distinguish characteristics of those with torsion and those with an alternate diagnosis.Thus, pediatric and adolescent patients particularly with a pelvic mass size greater than 5 cm, acute onset pain, persistent or recurrent pain have a benign cause and not missing the devastating condition that needs emergent attention. Thus, a strategy of earlier and liberal use of Diagnostic Laparoscopy (DL) may improve ovarian salvage.
Topics: Female; Child; Humans; Adolescent; Retrospective Studies; Torsion Abnormality; Adnexal Diseases; Ovarian Cysts; Abdominal Pain
PubMed: 38515195
DOI: 10.1186/s13023-024-03101-4 -
Gynecology and Minimally Invasive... 2024This study aimed to evaluate the effectiveness of prophylactic laparoscopic surgery for avoiding adnexal torsion in pregnant women with benign adnexal masses.
OBJECTIVES
This study aimed to evaluate the effectiveness of prophylactic laparoscopic surgery for avoiding adnexal torsion in pregnant women with benign adnexal masses.
MATERIALS AND METHODS
This report contains two analyses, each for a different group of patients. Analysis 1: Surgical and pregnancy outcomes were examined among the 126 cases who underwent laparoscopic assisted cystectomy for adnexal masses during pregnancy in our hospital between January 2001 and December 2020. Analysis 2: The incidence of adnexal torsion during pregnancy was evaluated among the cases with adnexal masses ≥5 cm who opted for conservative follow-up in our hospital between January 2011 and December 2020.
RESULTS
In analysis 1, the most common pathological diagnosis was a mature cystic teratoma (76.2%). The mean gestational age at surgery was 13.1 ± 1.3 weeks. No cases were converted to laparotomy and oophorectomy. Regarding delivery outcomes, 97.4% of cases went on to have full-term deliveries. In Analysis 2, the incidence of adnexal mass ≥5 cm that did not resolve spontaneously during pregnancy was 89 cases (0.8%). The frequency of malignancy was 3 cases (0.03%). In 28 cases who opted for conservative treatment, 5 (17.9%) underwent emergency surgery for adnexal torsion.
CONCLUSION
Prophylactic surgery for benign adnexal masses during pregnancy can be performed laparoscopically and preserved ovarian functions. In pregnant women with adnexal masses that do not resolve spontaneously, planning laparoscopic surgery is considered beneficial for complications, such as adnexal torsion.
PubMed: 38487612
DOI: 10.4103/gmit.gmit_141_22 -
PloS One 2024Ovarian torsion (OT) is a gynecological emergency that can have diverse clinical presentations makings its diagnosis especially challenging. Few studies exist in the...
Ovarian torsion (OT) is a gynecological emergency that can have diverse clinical presentations makings its diagnosis especially challenging. Few studies exist in the literature describing the clinical presentation as well as the management of OT in the emergency department (ED). This study aims to describe the clinical presentation, physical examination, emergency management, radiographic and intraoperative findings, histopathology reports and the time-to-intervention metrics of OT cases presenting to the emergency room of our tertiary care center. Data was collected by a retrospective chart review of all OT cases that presented to our ED over a period of 1 year. A total of 20 cases were included in the final analysis. The incidence of OT in the ED was 157.4 per 100 000 visits of women in the reproductive age group. All patients were women of reproductive age, with a mean age of 27.3 years. A total of 15 patients (78.9%) presented within 24 hours of symptom onset. The most common presenting symptom was abdominal pain (95%, 19/20) with most localizing to the right lower quadrant (60%, 12/20), followed by nausea and vomiting (90%, 18/20). Almost all patients (95%, 19/20) required opioids for pain management. The majority (80%, 16/20) were diagnosed by ultrasound prior to surgery, whereas (20%, 4/20) went straight to surgery based on a high index of clinical suspicion. Among those who underwent ultrasound, ovarian cyst was present in (75%, 12/16) while (68.9%, 11/16) showed ovarian enlargement and (50%, 8/16) showed abnormal ovarian blood flow. All patients except one patient underwent operative management. Out of the 19 patients who underwent surgery, the majority of patients (94.7%, 18/19) had viable ovaries with the exception of 1 patient (5.3%) who required a salpingo-oophorectomy post ovarian detorsion. A total of 13 cases included histopathologic review of specimens out of which 6 (46.2%) had a mature cystic teratoma. The mean time from door to ultrasonography was 1.4 hours and from door to surgery was 11.4 hours. Our study provides valuable insights into the incidence, clinical presentation, physical examination, emergency management, ultrasonographic and intraoperative findings, histopathology reports as well as the time-to-intervention metrics of OT patients presenting to the ED.
Topics: Humans; Female; Adult; Ovarian Torsion; Retrospective Studies; Tertiary Care Centers; Research; Emergency Service, Hospital
PubMed: 38446824
DOI: 10.1371/journal.pone.0297690 -
Sultan Qaboos University Medical Journal Feb 2024Dermoid cysts are common benign ovarian tumours arising from totipotent germ cells. We report a rare case of chemical peritonitis and prolonged fever following...
Dermoid cysts are common benign ovarian tumours arising from totipotent germ cells. We report a rare case of chemical peritonitis and prolonged fever following laparoscopic salpingo-oophorectomy for torsion of a large ovarian dermoid and discuss the management of this patient with prolonged hospital stay, antibiotics and anti-inflammatory use, repeated drainage of the collection as well as re-laparotomy. The occurrence of this rare condition can be extremely distressing for the patient and treating surgeon alike, as the recommendations for management are limited. The management of chemical peritonitis may require one or more surgical procedures along with prolonged anti-inflammatory therapy.
Topics: Humans; Female; Dermoid Cyst; Laparoscopy; Anti-Bacterial Agents; Drainage; Anti-Inflammatory Agents
PubMed: 38434467
DOI: 10.18295/squmj.3.2023.019 -
International Journal of Surgery Case... Mar 2024Ovarian strumal carcinoid is a rare type of germ cell tumor. It usually affects perimenopausal and postmenopausal women. Very few cases of stromal carcinoid have been...
INTRODUCTION
Ovarian strumal carcinoid is a rare type of germ cell tumor. It usually affects perimenopausal and postmenopausal women. Very few cases of stromal carcinoid have been reported in the literature in women of childbearing age, particularly during pregnancy. The clinical presentation of the tumor, and in particular its non-specific clinical and radiological appearance and rarity, explain the difficulties in diagnosis and management.
PRESENTATION OF CASE
Herein, we describe a rare case of a 36-year-old patient who was followed-up in our outpatient clinic for organic cyst of the ovary. The ultrasound revealed a multilocular regular cystic mass with a modestly thickened wall and fine septations. The MRI indicated a right ovarian cyst with solid tissue. The levels of tumor markers were normal. The patient was lost to follow-up and did not return until six months later. She was admitted in our Department with acute ovarian torsion and underwent emergency surgery at 17 weeks' gestation. A laparoscopic cystectomy of the right ovary was provisionally performed. Pathology revealed an ovarian strumal carcinoid tumor.
DISCUSSION
Patients with ovarian stromal carcinoid have an excellent prognosis. Ovarian strumal carcinoid 's primary therapy method is operation. The majority of original ovarian carcinoid tumors progress slowly, and practically all thyroid carcinoid tumors are clinical stage I with a positive prognosis.
CONCLUSION
In the absence of standardized treatment, the association of carcinoid strumal tumor with pregnancy, underlines the need for early diagnosis and appropriate multidisciplinary management, taking into account both the maternal and fetal prognosis.
PubMed: 38430900
DOI: 10.1016/j.ijscr.2024.109468 -
International Journal of Surgery Case... Mar 2024Uterine torsion are extremely rare in pregnancy as few cases have been reported. Torsion of the pregnant uterus is defined as the rotation more than 45 degrees around...
INTRODUCTION AND IMPORTANCE
Uterine torsion are extremely rare in pregnancy as few cases have been reported. Torsion of the pregnant uterus is defined as the rotation more than 45 degrees around the long axis of the uterus. It has been referred as, once-in-a-lifetime diagnosis by obstetricians and gynecologists. This paper reports a case of uterine torsion and velamentous cord insertion from our obstetrical practice, along with a review of reported cases.
CASE PRESENTATION
The 30-year-old patient (G2P1) at 38 weeks' gestation with a singleton pregnancy, was admitted to the Obstetrical Unit with uterine cramping and decreased fetal movement. Her prior obstetrical history included one uncomplicated term Cesarean section (2016), the current pregnancy had been velamentous cord insertion at 20 weeks' gestation and intra-uterine growth restriction at the 33rd -week gestation until the presentation date. Emergency Cesarean section was performed the 90 degrees uterine torsion and was diagnosed intra-operatively. This patient and her baby recovered and were discharged home on the fifth post-operative day.
CLINICAL DISCUSSION
Uterine torsion, a rare pregnancy complication, should be considered when evaluating acute abdominal pain or performing a Cesarean delivery, especially in cases of abnormal fetal presentation, pelvic adhesions, uterine fibroids, malformations, or ovarian tumors. Early diagnosis and proper treatment are crucial due to the negative prognosis for both mother and baby.
CONCLUSION
Uterine torsion along with velamentous cord insertion is difficult to diagnosis due to its rarity. It is essential to focus on uterine malformations during ultrasound examinations in the first, second, and third trimesters.
PubMed: 38430898
DOI: 10.1016/j.ijscr.2024.109441 -
Case Reports in Obstetrics and... 2024A case report of a premenarcheal patient with ovarian torsion and mullerian agenesis is presented. A 12-year-old prepubertal girl is presented with severe right lower...
A case report of a premenarcheal patient with ovarian torsion and mullerian agenesis is presented. A 12-year-old prepubertal girl is presented with severe right lower quadrant abdominal pain and mild rebound. Laparoscopy showed mullerian agenesis and twisted right adnexa. Detorsion and cystectomy of the right ovary were done, and the ovary was fixed to the pelvic sidewall. The postoperative course was uneventful. An association between the lax attachment of the adnexa and torsion may be a contributing factor in this condition.
PubMed: 38425676
DOI: 10.1155/2024/1305476 -
International Journal of Surgery Case... Mar 2024Ovarian cavernous hemangioma is a rare benign vascular tumor primarily found as either an isolated ovarian mass or as diffuse abdominopelvic hemangiomatosis. Its...
INTRODUCTION AND IMPORTANCE
Ovarian cavernous hemangioma is a rare benign vascular tumor primarily found as either an isolated ovarian mass or as diffuse abdominopelvic hemangiomatosis. Its discovery is often incidental, but symptomatic presentations can occur, including ovarian torsion, can occur without any specification.
CASE PRESENTATION
We present the case of a 55-year-old menopausal woman with chronic pelvic pain. Initial diagnostic imaging and tumor markers suggested ovarian malignancy. Subsequent investigations, including ultrasound and MRI, revealed a vascularized adnexal mass with characteristics mimicking malignancy. Surgical exploration through laparoscopy unveiled an 8 cm multicystic solid-cystic lesion with histopathological analysis confirming a 9 cm cavernous hemangioma.
CLINICAL DISCUSSION
Histologically, the lesion displayed features consistent with a benign vascular malformation. Literature review indicates variability in presentations and diagnostic challenges in distinguishing these lesions from malignant ovarian tumors. Treatment involved successful cystectomy via laparoscopic surgery, ensuring ovarian preservation so as not to increase the cardiovascular risk due to bilateral annexectomy.
CONCLUSION
Ovarian cavernous hemangiomas pose diagnostic challenges due to their rarity and potential mimicry of malignancy. Timely recognition through imaging modalities, especially MRI, and confirmation via histopathological examination remain pivotal. Ovarian-sparing surgical interventions are recommended, particularly for younger patients without suspicious tumor features. Despite their rarity, awareness of these lesions is crucial for accurate diagnosis and appropriate management.
PubMed: 38394939
DOI: 10.1016/j.ijscr.2024.109431 -
Cureus Jan 2024A hydatidiform mole (HM), often known as molar pregnancy, is a type of prenatal trophoblastic illness that develops in the placenta and has the potential to spread. HMs...
A hydatidiform mole (HM), often known as molar pregnancy, is a type of prenatal trophoblastic illness that develops in the placenta and has the potential to spread. HMs are caused by genetic issues with either the egg or the sperm. They are typically discovered in the first trimester of pregnancy. Abnormal bleeding is one of the initial symptoms, which can seldom be accompanied by the passage of hydropic villi. Theca lutein cysts, absent fetal heart tones, enlarged uterus more than anticipated for gestational age, pregnancy-induced hypertension in the first trimester, hyperemesis, and increased levels of human chorionic gonadotropin (HCG) for gestational dates are other characteristic symptoms and signs. A rare type of follicular cyst known as a theca lutein cyst is a benign ovarian disease caused by natural overstimulation of follicles, also known as hyperreactio lutealis (HL). This is linked to choriocarcinomas, multiple gestations, and prenatal trophoblastic illness (molar pregnancy). Unless exacerbated by torsion, rupture, or bleeding, the majority of theca lutein cysts are treated conservatively. Theca lutein cysts do not impact the course of pregnancy and spontaneously recede following delivery. However, HL may mistakenly be diagnosed by doctors as a cancer during pregnancy if it has the potential to look like one. Frequently, inappropriate surgical intervention is caused by the fear of failing to diagnose malignancy. These treatments may therefore result in decreased fertility in the future. Here we present a case of a young unmarried female with an HM and cysts.
PubMed: 38357086
DOI: 10.7759/cureus.52240 -
Heliyon Feb 2024Primary dysmenorrhea is a common gynecological disease with typical clinical symptoms and diverse treatment methods. Acupoint patch therapy is one of the traditional...
Primary dysmenorrhea is a common gynecological disease with typical clinical symptoms and diverse treatment methods. Acupoint patch therapy is one of the traditional external treatments of traditional Chinese medicine, with a long history, and has been widely used in the treatment of many diseases in China. Graphene nuangong acupoint plaster (GNGAP) developed based on traditional acupoints and new materials have been used in the clinical treatment of primary dysmenorrhea, and satisfactory therapeutic effects have been achieved. However, the underlying mechanisms of GNGAP still need further investigation. In this study, we used estradiol benzoate combined with oxytocin intraperitoneally to establish dysmenorrhea model rats, and observed the torsion response, uterine organ coefficients, prostaglandin levels and metabolite changes of rats with dysmenorrhea model after the intervention of GNGAP, to elucidate the mechanism of the effect of GNGAP. Compared with normal rats, the dysmenorrhea model rats exhibited increased writhing response and latency time, increased uterine organ coefficient, and significant changes in 79 metabolites. Twenty-three significantly enriched pathways were discovered, including amino acid metabolism, arachidonic acid metabolism, pyrimidine metabolism, and ovarian steroidogenesis, which may be involved in the pathogenesis of primary dysmenorrhea. Compared with the model group, the torsion response, latency time and uterine organ coefficient of rats in the acupoint patch group were significantly improved, and nine uterine metabolites were significantly altered, among which metabolites such as 4-pyridoxic acid, d-glucarate and Phenol were identified as potential biomarkers for the therapeutic effects of GNGAP. Vitamin B6 metabolism, Ascorbate and aldarate metabolism and Tyrosine metabolism were enriched in nine metabolic pathways. These findings contribute to the screening study of potential pathological metabolic pathways in primary dysmenorrhea. Additionally, they reveal the biological effects of GNGAP in the treatment of primary dysmenorrhea at the metabolite level.
PubMed: 38327403
DOI: 10.1016/j.heliyon.2024.e25268