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Gynecologic Oncology Reports Jun 2023Psammocarcinoma is a rare form of serous carcinoma of the ovary or peritoneum characterized by extensive psammoma body formation seen on histology. A 49-year-old obese...
Psammocarcinoma is a rare form of serous carcinoma of the ovary or peritoneum characterized by extensive psammoma body formation seen on histology. A 49-year-old obese woman, gravida 1 para 1 with poorly controlled type 2 diabetes, presented with a history of menorrhagia. She was diagnosed with both leiomyomata and simple endometrial hyperplasia without atypia in the office. Consultation with gynecological oncology and primary gynecologist resulted in a planned hysterectomy with bilateral salpingo-oophorectomy. Laparoscopic hysterectomy and bilateral salpingo-oophorectomy were performed by primary gynecologist. Intraoperative survey of pelvis found concerning nodular lesions seen in posterior cul-de-sac. Lesions were excised and sent for frozen section. Pathology showed invasive peritoneal epithelial implant with psammomatous calcifications. Gynecological oncologist stand-by was called in and proceeded with surgical debulking and staging procedure. Post operatively, the patient has been diagnosed with primary peritoneal low grade serous psammomacarcinoma stage III A2. Her case has been presented to tumor board for multidisciplinary management and is now undergoing adjuvant hormonal therapy utilizing letrozole with chest, abdomen, and pelvic CT scans every 6 months. Standardized protocols are hindered by the rarity of this tumor. Benefits for this oncologic diagnosis are not clearly understood due to the rarity of this tumor. The significance of this case presentation is to highlight the multidisciplinary approach to the workup, diagnosis, treatment (both surgical and medical) and follow up of a rare gynecologic oncologic case. While the surgical team was expecting to find at most significant pathology, an endometrial carcinoma, a rarer primary peritoneal carcinoma was found. Due to the pre surgical planning, and intraoperative teamwork of the pathology, gynecology and oncology teams, this patient received the individualized and disease specific needed surgical and medical care warranted by her unique diagnosis.
PubMed: 37122436
DOI: 10.1016/j.gore.2023.101176 -
Annals of Medicine and Surgery (2012) Apr 2023Primary sclerosing encapsulating peritonitis (SEP), commonly known as abdominal cocoon syndrome (ACS), is considered to be one of the rare causes of intestinal...
UNLABELLED
Primary sclerosing encapsulating peritonitis (SEP), commonly known as abdominal cocoon syndrome (ACS), is considered to be one of the rare causes of intestinal obstruction. This syndrome is characterized by the formation of a fibrous-collagenous membrane that encapsulates the intestine and other abdominal organs. Several theories have been proposed to explain the disease's etiology. Patients often present with symptoms of partial intestinal obstruction, which is challenging to diagnose before laparotomy. Of all the available investigations, the contrast-enhanced computed tomography of the abdomen is the most sensitive, showing a sac-like fibrous membrane covering the bowel loops along with the fluid collection. Definitive treatment includes excision and adhesiolysis.
CASE PRESENTATION
We present a case report of ACS in a 30-year-old male patient.
CLINICAL FINDINGS AND INVESTIGATIONS
The patient presented with a chronic history of progressive colicky abdominal pain associated with nausea, vomiting, constipation, and weight loss.
INTERVENTIONS AND OUTCOME
Multiple investigations, including abdominal X-rays, ultrasound, and upper GI endoscopy, were unremarkable. However, the contrast-enhanced computed tomography abdomen suggested small bowel obstruction with a differential diagnosis of SEP. Later explorative laparotomy and histopathological examination confirmed the diagnosis of ACS. Adhesiolysis was performed intraoperatively, which resolved the patient's symptoms. The patient was asymptomatic at the 6th month follow-up visit.
RELEVANCE AND IMPACT
Being a fairly rare condition, primary SEP can lead to a plethora of misdiagnoses and discomfort to the patient if not diagnosed on time. This case report aims to create awareness of this disease outside of the expected demographics- perimenarchal Asian girls. It is highly important for this unusual case to serve as an educative tool for physicians all over the world.
PubMed: 37113854
DOI: 10.1097/MS9.0000000000000288 -
Journal of Surgical Case Reports Apr 2023Scrotal-inguino-retroperitoneal (SIR) lymphocele is a rare complication following kidney transplant. This entity is characterized by a tract originating in the...
Scrotal-inguino-retroperitoneal (SIR) lymphocele is a rare complication following kidney transplant. This entity is characterized by a tract originating in the retroperitoneal space, through the inguinal canal and scrotum following lymph hydrodissection. Systematic review investigating SIR lymphocele yielded cases with open fenestration of the sac into the peritoneum as treatment. We described a case report of a male in his 60s with a functioning kidney transplant and SIR lymphocele, which was successfully managed in the short term with percutaneous drainage of the collection. However, the collection recurred and computed tomography scan showed a multiloculated collection that prompted surgical management. Intraoperatively, the encapsulated fluid-filled tract was excised and a drain was placed, which was removed 48 h later. The patient wore a hernia belt for 6 weeks as support. He had no recurrence of his lymphocele following serial reviews for 9 months now.
PubMed: 37082647
DOI: 10.1093/jscr/rjad192 -
International Journal of Surgery Case... May 2023A femoral hernia is a protrusion of the peritoneum through a defect in the femoral ring into the femoral canal. A rare form of a femoral hernia is a femorocele, which...
INTRODUCTION AND IMPORTANCE
A femoral hernia is a protrusion of the peritoneum through a defect in the femoral ring into the femoral canal. A rare form of a femoral hernia is a femorocele, which requires a highly skilled physician for accurate diagnosis and management. Clinical examination is the gold standard for diagnosis, with a CT used to confirm clinical suspicion. Once diagnosed, the only curative option is surgery. This case report provides evidence for the use of robotics to treat a femorocele.
CASE PRESENTATION
A 23-year-old female with a two-year history of a non-reducible fluid-filled swelling in the right groin presented to the surgical clinic. Upon clinical suspicion and CT imaging, a femorocele was diagnosed. The surgeon opted for a femoral hernia repair using the da Vinci surgical system. Peritoneal connection with the hernia sac was noted, confirming the diagnosis. The content of the cystic mass was reduced; further to that, the omental content was also reduced and the hernia was repaired. The patient tolerated the procedure with no complications.
CLINICAL DISCUSSION
This case highlights the use of robotics to treat a rare clinical entity. Robotics was used for this case as it provided exceptional ergonomics, three-dimensional visualization, and wristed movements.
CONCLUSION
A femorocele is a rare form of a femoral hernia that requires accurate diagnosis and proper management. In this case, we demonstrated the possibility of using robotics as a viable option for treatment of a femorocele.
PubMed: 37043899
DOI: 10.1016/j.ijscr.2023.108123 -
Asian Journal of Surgery Oct 2023To explore a method of visually establishing preperitoneal space. In this paper, the procedure is described in detail and its safety and efficacy evaluated.
OBJECTIVE
To explore a method of visually establishing preperitoneal space. In this paper, the procedure is described in detail and its safety and efficacy evaluated.
METHODS
A retrospective style was adopted. The clinical data of 33 patients who accepted the total visceral sac separation (TVS) procedure from December 2019 to November 2021 were collected. Observation indices included location and area of abdominal defect; surgical method and duration of operation to establish preperitoneal space and any postoperative complications; developments during follow-up. Follow-up was performed up to December 2021 using outpatient examination and telephone interview to detect any complications of incision or recurrence of ventral hernia.
RESULTS
For operative indices, all patients underwent the TVS procedure successfully except for one who had to be converted to laparoscopic intraperitoneal onlay mesh (IPOM) due to failure to establish preperitoneal space. The time required to establish preperitoneal space was 185.75 ± 44.37 s and the duration of hospital stay was 8.27 ± 1.42 days. No complications, such as abdominal bleeding or digestive tract injury, occurred during hospitalization. No complications of incision were observed during follow up, which lasted 2-24 months with an average of 7 months.
CONCLUSIONS
Preliminary results of the novel attempt to establish the preperitoneal space visually confirmed this to be a safe and feasible method. However, the sample size used here was small, with a short follow up. The details and notes need to be further discussed.
Topics: Humans; Retrospective Studies; Surgical Mesh; Hernia, Ventral; Laparoscopy; Peritoneum; Herniorrhaphy; Recurrence
PubMed: 37003886
DOI: 10.1016/j.asjsur.2023.03.055 -
Cureus Jan 2023The incidence of ectopic pregnancy in India is increasing over time along with a considerable mortality rate. The common site for ectopic pregnancy is the fallopian...
The incidence of ectopic pregnancy in India is increasing over time along with a considerable mortality rate. The common site for ectopic pregnancy is the fallopian tubes and is also associated with a higher incidence of mortality following the tubal rupture. Even though lactational amenorrhea prevents pregnancy to some extent, the probability of pregnancy increases when the frequency of lactation decreases. Rupture of ectopic pregnancy can occur abruptly without any serious symptoms as well. One should not ignore even mild symptoms in females of reproductive age group especially those who are sexually active. A 25-year-old female with an alleged history of sudden onset of severe abdominal pain was taken to AIIMS Bhopal, where she was declared brought dead and her body was sent for autopsy. She got married at the age of 23 years and was still breastfeeding her 11-month-old child. The autopsy revealed 2.2 liters of fluid and clotted blood in the peritoneal cavity. The right fallopian tube enlarged along with a tear of size 1cm x 1cm evident on the anterior aspect. Meticulous dissection revealed a membranous sac of size 4cm x 2cm x 2cm containing a placenta of size 1cm x 1cm and an embryo of size 2cm x 1cm. All other organs were pale and normal. The uterine cavity was found empty. The cause of death was attributed to ruptured ectopic pregnancy.
PubMed: 36788817
DOI: 10.7759/cureus.33598 -
Surgical Case Reports Feb 2023The finding of a vermiform appendix within the peritoneal sac of an inguinal hernia is called Amyand's hernia. The reported incidence of Amyand's hernia and femoral...
BACKGROUND
The finding of a vermiform appendix within the peritoneal sac of an inguinal hernia is called Amyand's hernia. The reported incidence of Amyand's hernia and femoral hernia is 1% and 3.8%, respectively. To our knowledge, no cases have been reported in the literature that associate these two entities. We present the first case of incarcerated left-sided Amyand's hernia and synchronous ipsilateral femoral hernia found during emergency surgery.
CASE PRESENTATION
A 72-year-old woman was admitted to the Emergency Department for a complicated left inguinal hernia. An inguinotomy was performed that detected a large direct hernial sac and a synchronous femoral hernia. The opening of the inguinal hernia showed the presence of the cecum and the appendix, both without signs of inflammation. The femoral space was evaluated transinguinally, identifying the larger omentum that had slipped into the femoral canal. The primary closure of the posterior wall defect was performed with the McVay technique due to its large size, and then the hernioplasty was completed with a polypropylene mesh. No postoperative complications were reported.
CONCLUSIONS
In the context of an incarcerated Amyand's hernia, the decision to perform an appendectomy in addition to hernia repair with or without mesh will depend on intraoperative findings.
PubMed: 36723671
DOI: 10.1186/s40792-023-01597-9 -
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 -
Cureus Nov 2022Paraduonenal hernia constitutes more than 50% of internal hernia cases. It can result in perilous sequelae like gut ischemia and perforation. We report a case of a...
Paraduonenal hernia constitutes more than 50% of internal hernia cases. It can result in perilous sequelae like gut ischemia and perforation. We report a case of a patient who presented with acute intestinal obstruction and peritonitis and was diagnosed as a case of complicated paraduodenal as an incidental finding on laparotomy. A 26-year-old male patient presented with three days history of continuous severe incapacitating diffuse abdominal pain. The pain was associated with multiple episodes of bilious vomiting and absolute constipation. Patient had signs and symptoms of shock. Abdomen examination showed generalized peritonitis. Patient had deranged laboratory investigations. Abdominal X-ray showed acute intestinal obstruction. Patient was resuscitated and taken up for emergency laparotomy. Intraoperatively there was a long segment of gangrenous small bowel entrapped in the paraduodenal sac. Gangrenous gut was released from the sac and excised with proximal and distal ends fashioned as stoma through separate sites. Patient was managed with intravenous fluids with total parental nutrition. Patient gradually started on oral diet and jejunostomy output was refed through the distal stoma. Patient was discharged on postoperative day 14. Patient had uneventful early stoma closure at postoperative day 45 and now is on regular follow-up in the outdoor department. Paraduodenal hernias are one of the rare causes of intestinal obstruction that is difficult to diagnose. Radiologic investigation like abdominal computed tomography (CT) scan can aid in diagnosis of paraduodenal hernia. Surgeons should have clear knowledge about abnormal anatomy of internal hernias and complications they can face during surgery.
PubMed: 36589185
DOI: 10.7759/cureus.32008 -
Annals of Medicine and Surgery (2012) Dec 2022Ectopic pregnancy is defined as a pregnancy in which the fertilized ovum implants itself in a location other than the uterine endometrium. Abdominal ectopic pregnancies...
INTRODUCTION AND IMPORTANCE
Ectopic pregnancy is defined as a pregnancy in which the fertilized ovum implants itself in a location other than the uterine endometrium. Abdominal ectopic pregnancies involve the implantation and development of the embryo within the peritoneal cavity. Primary omental pregnancies are the rarest form of abdominal pregnancy and possibly the rarest extrauterine gestation.
CASE PRESENTATION
We report the first case of a primary omental pregnancy in a subseptate uterus in literature. Our patient, a 33-year-old female, G8P4+3, presented with nausea, severe abdominal pain, and vaginal spotting at 6 weeks' gestational age. She had mild tenderness below the umbilicus, with positive cervical and right adnexal tenderness. 2D-ultrasound revealed a subseptate uterus, normal ovaries and fallopian tubes, absence of a gestational sac, and a 4x3x2.5 cm mass in the right adnexa. A mini-laparotomy was performed due to suspicion of ruptured tubal pregnancy, revealing a primary omental pregnancy which was managed via partial omentectomy.
CLINICAL DISCUSSION
Ectopic pregnancies have ambiguous presentations, however correct diagnosis and management is crucial to prevent complications. A high index of suspicion must be exercised to make an accurate diagnosis of primary omental pregnancy. A subseptate uterus is a subtype of the most common uterine anomaly and should be investigated via 3D-ultrasound and magnetic resonance imaging as it causes increased risk of primary omental implantation.
CONCLUSION
Correct identification of subseptate or septate uteri is vital. Greater research is needed to elucidate the association between septate or subseptate uteri and ectopic pregnancy, particularly primary omental pregnancy.
PubMed: 36582853
DOI: 10.1016/j.amsu.2022.104924