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Cureus Nov 2023Uterine leiomyomas are benign uterine tumors arising from the smooth muscle cells of the myometrium. Most of them are asymptomatic, and rarely do they present with...
Uterine leiomyomas are benign uterine tumors arising from the smooth muscle cells of the myometrium. Most of them are asymptomatic, and rarely do they present with symptoms like infertility, abdominal distension, and acute abdomen. According to experts, the most common cause of acute abdomen is torsion of a pedunculated subserosal leiomyoma, which is an extremely rare and life-threatening surgical emergency. Here, we discuss a case of torsion of a subserosal leiomyoma where the patient, a 40-year-old female with severe abdominal pain, was misdiagnosed with a twisted ovarian cyst. Ultrasonography and contrast-enhanced computed tomography (CECT) revealed a right-sided ovarian tumor and a twisted subserosal myoma, respectively. Thus, surgical intervention with myomectomy was done.
PubMed: 38073922
DOI: 10.7759/cureus.48414 -
Case Reports in Women's Health Dec 2023Isolated fallopian tube torsion (IFTT) is a rare cause of acute lower abdominal pain in women. Its nonspecific clinical presentation makes preoperative diagnosis more...
Isolated fallopian tube torsion (IFTT) is a rare cause of acute lower abdominal pain in women. Its nonspecific clinical presentation makes preoperative diagnosis more challenging. Laparoscopy is the gold standard in diagnosis and treatment. This is a case of a 25-year-old newly married patient presented to the emergency department with sever acute lower abdominal pain associated with nausea. Clinical physical examination revealed abdominal tenderness. Ultrasound showed a right ovarian cyst measuring 4.5 cm × 4.1 cm with mural nodule, no internal vascularity on color doppler. Laparoscopy was performed where the right fallopian tube was found edematous, darkened red in color. Therefore, isolated fallopian tube torsion was diagnosed and right salpingectomy was performed with preservation of the right ovary. Postoperative recovery was uneventful. Histopathological examination confirmed necrosis of the excised fallopian tube. Isolated fallopian tube torsion is a rare yet noteworthy event. Early diagnosis and timely management are crucial for tubal sparing surgery.
PubMed: 38073669
DOI: 10.1016/j.crwh.2023.e00565 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Dec 2023This study aimed to investigate whether Passiflora Incarnata (PI) has a protective effect against ischemia-reperfu-sion (IR)-induced oxidative and inflammatory ovarian...
BACKGROUND
This study aimed to investigate whether Passiflora Incarnata (PI) has a protective effect against ischemia-reperfu-sion (IR)-induced oxidative and inflammatory ovarian damage.
METHODS
The effects of PI on ovarian ischemia-reperfusion injury were investigated in female Wistar albino rats. The animals were randomly divided into three groups: Group 1 (sham), Group 2 (IR), and Group 3 (IR+PI).
RESULTS
The mean levels of Malondialdehyde (MDA), Myeloperoxidase (MPO), and Total Oxidant Status (TOS) were higher in the IR group (p=0.025, p<0.001, and p=0.016, respectively). The Total Antioxidant Status (TAS) levels were lower in the IR group (p=0.005). Immunostaining revealed significant differences across the groups for Tumor necrosis factor-alpha (TNF-α): 13.84%, 49.51%, and 22.51% for Groups 1, 2, and 3, respectively (p<0.01). Bax: 10.53%, 46.74%, and 26.46% for Groups 1, 2, and 3, respectively (p<0.01). Annexin V: 12.24%, 44.86%, and 23.28% for Groups 1, 2, and 3, respectively (p<0.01). The mean scores for hemorrhage, inflammation, follicular degeneration, and congestion showed significant variations among the groups, all registering p<0.001.
CONCLUSION
Passiflora Incarnata exhibited antioxidant, anti-inflammatory, and anti-apoptotic properties, promoting cell survival, histologically protecting ovarian tissue, and ameliorating IR injury by reducing oxidative stress.
Topics: Humans; Rats; Female; Animals; Antioxidants; Rats, Wistar; Ovarian Torsion; Passiflora; Oxidative Stress; Reperfusion Injury; Ischemia
PubMed: 38073455
DOI: 10.14744/tjtes.2023.52986 -
European Journal of Obstetrics &... Dec 2023Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging minimally invasive approach increasingly applied to perform many gynecological...
OBJECTIVE
Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging minimally invasive approach increasingly applied to perform many gynecological procedures. Despite a still limited level of evidence, compared to conventional laparoscopy, vNOTES seems to be associated with reduced blood loss, shorter operative time, less postoperative pain, shorter hospitalization time, better cosmetic results and decreased postoperative morbidity. Although growing evidence supports the effectiveness of vNOTES for elective adnexal surgeries, there is still limited knowledge regarding its feasibility and safety in emergency settings. In the present study, we report our experience performing vNOTES in gynecological emergency cases.
STUDY DESIGN
We prospectively collected and analyzed data from patients who underwent vNOTES for gynecological emergencies between November 2021 and June 2023. Demographic and perioperative characteristics were collected and analyzed.
RESULTS
Seventeen patients were included. Interventions were realized for suspicion of ectopic pregnancy in 7 cases (41.2%), for suspicion of adnexal torsion in 7 cases (41.2%), for post-hysterectomy hemoperitoneum in 2 cases (11.8%), and for uncontrollable uterine bleeding in 1 case (5.9%). Emergency procedures included unilateral salpingectomy (35.3%), ovarian cystectomy (23.5%), ovarian cystotomy (17.6%), adnexal detorsion (11.8%), hemoperitoneum drainage (11.8%), hysterectomy (5.9%), and appendectomy (5.9%). The overall median operative time was 38 [18-72] minutes. The median estimated intraoperative blood loss was 30 [5-150] mL, and no intraoperative complications occurred. Conversion to conventional laparoscopy or laparotomy was never needed. Patients stayed hospitalized for a median time of 30 [4-144] hours after the intervention. The median visual analog scale value for postoperative pain evaluation was 2 [0-5] at 12, 24, and 48 postoperative hours. No complications associated with the procedure occurred.
CONCLUSIONS
This study demonstrated the feasibility of performing vNOTES procedures for managing gynecological emergencies such as tubal ectopic pregnancy, adnexal torsion, painful ovarian lesions, post-hysterectomy hemoperitoneum, and uncontrollable uterine bleeding. Associated with data reported in the available literature, our results suggest potential benefits in treating gynecological emergencies by vNOTES over conventional laparoscopy. However, stronger evidence from larger studies is needed to confirm it.
PubMed: 38035122
DOI: 10.1016/j.eurox.2023.100261 -
Gynecology and Minimally Invasive... 2023Synchronous bilateral ovarian torsion is rare that too in nonpathological ovaries. To the best of our knowledge, this is the second case of synchronous bilateral ovarian...
Synchronous bilateral ovarian torsion is rare that too in nonpathological ovaries. To the best of our knowledge, this is the second case of synchronous bilateral ovarian torsion of nonpathological ovaries in adolescents. A 14-year-old girl presented with pain lower abdomen, vomiting, and constipation for the last 10 days. Ultrasonography (USG) suggested bilateral ovarian torsion without any ovarian pathology. Emergency laparoscopy confirmed bilateral ovarian torsion with necrosed-looking ovaries, and detorsion was done. During follow-up period, she had intermittent mild pain abdomen, and on USG, her left ovary returned to normal size, but her right ovary had been bulky throughout without any cyst. At around 10 months, the patient presented with severe abdomen pain. This time only right ovarian torsion was there. Laparoscopic bilateral ovarian detorsion with bilateral ovarian ligament plication was done. Ovarian torsion can be bilateral, even in nonpathological ovaries. Ovarian fixation should be done in these cases to prevent recurrent torsion.
PubMed: 38034117
DOI: 10.4103/gmit.gmit_32_23 -
Cureus Oct 2023Ovarian masses are rare in the postmenopausal age group, and ovarian torsion is a gynecological emergency. We present a case report of a 63-year-old postmenopausal woman...
Ovarian masses are rare in the postmenopausal age group, and ovarian torsion is a gynecological emergency. We present a case report of a 63-year-old postmenopausal woman who presented a massive abdominal mass with pain that gradually increased during the previous 12 months. A contrast-enhanced computed tomography scan of the abdomen and pelvis suggested a 16.6 cm × 14 cm × 13 cm originating from the right ovary. Total abdominal hysterectomy, bilateral salphingo-oophorectomy, and partial omentectomy were performed in an emergency as the patient's symptoms worsened. A massive cyst was visualized from the right ovary, which had undergone a torsion of three turns. Histopathological analysis revealed a serous cystadenoma. The twisted ovarian cyst typically manifests as an acute abdomen, although there are cases where this presentation can cause a significant delay in diagnosis. Therefore, high clinical suspicion is often necessary to prevent morbidity and mortality.
PubMed: 38022205
DOI: 10.7759/cureus.47693 -
Clinical and Experimental Reproductive... Dec 2023Ovarian torsion is a gynecological disorder that causes ischemia-reperfusion injuries in the ovary. Our study investigated berberine's short- and long-term effects on...
OBJECTIVE
Ovarian torsion is a gynecological disorder that causes ischemia-reperfusion injuries in the ovary. Our study investigated berberine's short- and long-term effects on ovarian ischemia-reperfusion injuries.
METHODS
This study included 28 Wistar albino female rats weighing 180 to 220 g, which were divided into four groups: sham (S), torsion/detorsion (T/D), torsion/ detorsion+single dose berberine (T/D+Bb), and torsion/detorsion+15 days berberine (T/D+15Bb). The torsion and detorsion model was applied in all non-sham groups. In the T/D+Bb group, a single dose of berberine was administered, while in the T/D+15Bb group, berberine was administered over a period of 15 days. After the rats were euthanized, their ovaries were excised. The left ovaries were used for histopathologic evaluation, which included ovarian injury scoring and follicle count, while the right ovaries were used for biochemical analyses (tissue transforming growth factor-β [TGF-β] and alpha-smooth muscle actin [α-SMA] levels).
RESULTS
The histopathologic evaluation scores for the ovaries were significantly lower in the T/D+B group (p<0.05) and the T/D+15B group (p<0.005) than in the T/D group. The follicle counts in the T/D group were lower than those in both the sham and treated groups (p<0.005). The TGF-β levels were significantly lower in the T/D+15B group (p<0.005), whereas the α-SMA levels did not show a significant difference.
CONCLUSION
Both short- and long-term berberine use could potentially have therapeutic effects on ovarian torsion. Long-term berberine use exhibited anti-inflammatory effects by reducing TGF-β levels, thereby preventing ischemia-reperfusion injuries. Therefore, we suggest that long-term berberine use could be beneficial for ovarian torsion.
PubMed: 37995758
DOI: 10.5653/cerm.2023.06366 -
Journal of Pediatric Surgery Mar 2024Laparoscopic ovarian-sparing surgery (OSS) is safe and effective management approach for benign ovarian lesions in pediatric patients. This study evaluates the outcomes...
INTRODUCTION
Laparoscopic ovarian-sparing surgery (OSS) is safe and effective management approach for benign ovarian lesions in pediatric patients. This study evaluates the outcomes of females younger than 18 years who underwent the OSS procedure between December 2013 and November 2022 at a single institution.
MATERIAL AND METHODS
We conducted a retrospective analysis of records from 82 females who underwent OSS for ovarian lesions. OSS was performed based on diagnostic imaging that suggested the benign nature of the lesion.
RESULTS
Of the 82 patients studied, 78 had unilateral lesions and 4 had bilateral synchronous lesions. The mean age was 14 years. The majority (62 cases) of the surgeries were laparoscopic, with 20 requiring conversion to open surgery due to factors such as indistinguishable edges and large size of the lesion. We identified 8 cases of ovarian torsion. The surgical specimens revealed that 46 were ovarian teratomas, 2 were granulosa cell tumors, 15 were cystadenomas, and 23 were functional cysts. There were no intraoperative complications. Two recurrences were observed in patients who were initially treated for bilateral ovarian teratomas. One patient developed a pelvic abscess. Additionally, three patients had metachronous ovarian tumors during the follow-up period. In patients followed with ultrasound imaging, the viable ovary was visualized in 83.6% of the cases (61 out of 73).
CONCLUSION
Our findings demonstrate the effectiveness of laparoscopic OSS in preserving ovarian function and providing clinical benefits in patients with benign ovarian lesions. We recommend regular follow-up with ultrasound to exclude metachronous lesions or recurrence.
LEVEL OF EVIDENCE
III.
Topics: Female; Child; Humans; Adolescent; Ovarian Neoplasms; Retrospective Studies; Ovarian Cysts; Laparoscopy; Teratoma; Neoplasms, Second Primary
PubMed: 37980197
DOI: 10.1016/j.jpedsurg.2023.10.057 -
Transient ovarian torsion in a pregnant woman after vitrified-warmed embryo transfer: a case report.JBRA Assisted Reproduction Feb 2024Assisted reproduction is a risk factor for adnexal torsion due to ovarian hyperstimulation and increased incidence of twin pregnancy. Both risk factors can be eliminated...
Assisted reproduction is a risk factor for adnexal torsion due to ovarian hyperstimulation and increased incidence of twin pregnancy. Both risk factors can be eliminated in frozen embryo transfers, but in our case ovarian torsion occurred after the use of an aromatase inhibitor (Femara) in endometrium preparation due to the presence of corpus luteum. Case presentation: G2P1+0 presented at 7 weeks gestation after vitrified-warmed embryo transfer with right loin pain and mild right iliac pain and tenderness. Ultrasound examination revealed transient or incomplete ovarian torsion. The presentation of the case was somewhat misleading and the transient nature of the torsion provided an opportunity for the conservative management of the case. In conclusion, ovarian torsion is still an undesired event, even after single embryo transfers and in vitrified-warmed cycles. Clinical and ultrasound follow-up precluded the need for surgery in our case.
Topics: Pregnancy; Female; Humans; Pregnant Women; Ovarian Torsion; Cryopreservation; Retrospective Studies; Embryo Transfer; Pain
PubMed: 37962972
DOI: 10.5935/1518-0557.20230056 -
Cureus Oct 2023Background and objectives Pelvic pathologies affect females in all age groups. They vary in size and location and can be wide in classification, such as masses, ectopic...
Assessment of Female Pelvic Pathologies: A Cross-Sectional Study Among Patients Undergoing Magnetic Resonance Imaging for Pelvic Assessment at the Maternity and Children Hospital, Qassim Region, Saudi Arabia.
Background and objectives Pelvic pathologies affect females in all age groups. They vary in size and location and can be wide in classification, such as masses, ectopic pregnancy, ovarian torsion, and ruptured ovarian follicles. Patients commonly present with gynecological complaints such as menstrual irregularities, abnormal pelvic bleeding, and infertility. Extra-gynecological symptoms such as dysuria and painful defecation can also manifest. To diagnose these pathologies, magnetic resonance imaging (MRI) and other imaging modalities can be useful alongside history and physical examination for early clinical diagnosis. Due to the importance of prevalence rate in predicting pathologies in a certain age and due to the lack of research studies on pelvic MRI studies in Qassim region, Saudi Arabia, this study aimed to demonstrate the wide spectrum of female pelvic pathologies that can be diagnosed using MRI in Qassim region, Saudi Arabia. Methods and results A cross-sectional study was conducted among patients referred to the MRI Department for evaluation of female pelvic pathologies at the Department of Radiology at Maternity and Children Hospital in Buraydah, Qassim region, Saudi Arabia. A total of 325 patients were included in the study, with the majority being in the age group of 31-40 years. Fibroids were the most common pathology, being present in more than one-fifth of the study sample, followed by neoplastic growths and placental pathologies. Inflammatory pathologies were the least common pathologies, being present in approximately 5% of the participants. Statistically significant associations were found between the age groups, and the presence of anomalies (p = 0.009), existence of neoplastic changes (p < 0.001), presence of placental pathologies (p < 0.001), inflammatory changes (p = 0.025), and adenomyosis (p = 0.028). Conclusion MRI data offer important new information about the prevalence of various disorders among different age groups in the Qassim region of Saudi Arabia. Younger age groups had much higher rates of anomalies, whereas older age groups had much lower rates. Adenomyosis and neoplastic alterations were more prevalent in the later age groups, but endometrioma was more prevalent in younger age groups. Placental pathologies were more prevalent in women in their middle years, while scar pregnancy was more prevalent in women between 31 and 40 years of age. Younger people, especially those between 16 and 20 years of age, were more likely to experience inflammatory alterations. In the younger age group, there was no discernible association between age and the prevalence of normal outcomes. These findings help us understand how different illnesses manifest differently as we get older and emphasize the value of taking aging into account when diagnosing and treating disorders.
PubMed: 37937024
DOI: 10.7759/cureus.46621