Cases reported "Ovarian Diseases"

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1/73. Ruptured tuboovarian abscess in late pregnancy. A case report.

    BACKGROUND: Tuboovarian abscess is an unusual obstetric complication that causes maternal and fetal morbidity and mortality. CASE: A woman, G1, P0, with a 32-week pregnancy presented with abdominal pain. physical examination on admission revealed fever and unremarkable abdominal signs. Eleven hours after admission, signs of peritonitis became prominent, necessitating emergency laparotomy. Surgical findings included an 8-cm, right, ruptured tuboovarian abscess with massive purulent contamination of the abdominal cavity. Cesarean hysterectomy with bilateral salpingo-oophorectomy was performed. Neither the newborn nor the mother had postoperative complications. CONCLUSION: Since there are discrepancies in the incidences of tuboovarian abscess in pregnant and nonpregnant groups, the pathogenesis of tuboovarian abscess may be different in the two populations. In pregnancy, diagnosis and management are also more difficult than in the nonpregnant state. Clinical data may not reveal the diagnosis until surgery is mandatory. Because most pregnant women with tuboovarian abscesses are young, conservative surgery should be attempted if the pathology is limited to only one side of the adnexa and further reproduction is desired.
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2/73. Torsion of a functional ovarian cyst in a premenopausal patient receiving tamoxifen.

    We report a case of torsion of an ovarian follicular cyst that developed during treatment with tamoxifen for breast cancer. A 40-year-old Japanese woman was admitted complaining of acute lower abdominal pain. Eight months earlier, she had undergone a partial mastectomy and local irradiation for ductal carcinoma of her left breast, estrogen receptor-positive stage I (T(1a) N(1b) M(0)). The administration of tamoxifen, 20 mg/day, and doxifluridine, 600 mg/day, were started immediately postoperatively. Pelvic examination after admission revealed the left ovarian cyst and enlarged uterus. Transvaginal ultrasonography and computed tomography revealed a multilocular cystic mass in the pelvic cavity. The pathological diagnosis of the tumor after total hysterectomy and bilateral salpingo-oophorectomy was a typical follicular cyst with torsion and uterine leiomyoma. This ovarian cyst was believed to have developed during tamoxifen administration.
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3/73. Unilateral chronic tuboovarian abscess secondary to ruptured colonic diverticulum presenting as a brain abscess. A case report.

    BACKGROUND: Tuboovarian abscesses (TOAs) are a somewhat unusual finding in postmenopausal patients without risk factors. We present a rare case of unilateral TOA initially presenting as a brain abscess in a postmenopausal woman. CASE: A 61-year-old woman presented with a complaint of forgetfulness, nausea and vomiting, with lower abdominal pain and diarrhea. She was found to have a brain abscess, which was treated by craniotomy, with drainage of the abscess, and intravenous antibiotics. The patient was subsequently found to have a pelvic mass, which, on laparotomy, was a unilateral TOA. pathology demonstrated that the abscess contained vegetable matter consistent with origin in a ruptured diverticulum. CONCLUSION: diagnosis of a brain abscess should prompt a thorough investigation for a primary infectious source, including the gastrointestinal and genitourinary tracts.
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4/73. Conservative management of bilateral asynchronous adnexal torsion with necrosis in a prepubescent girl.

    Conservative management of ovarian torsion consisting of detorsion and surgical stabilization of the involved ovary, and possibly including the uninvolved ovary, has been described in the adult population. A 6-year-old girl with a history of prior ovarian torsion resulting in oophorectomy presented with 72 hours of intermittent abdominal pain, anorexia, and 1 episode of vomiting. The patient had torsion of her remaining ovary diagnosed surgically and was managed with detorsion and oophoropexy, despite the severely necrotic appearance of the ovarian tissue. Postoperative serial ultrasound scans confirmed the viability and position of the ovary. In the prepubertal girl, ovaries may torse despite the absence of enlarging lesions such as tumors or cysts. To maximize the potential success of conservative therapy, torsion always must be included in the differential diagnosis of abdominal pain. Surgical management should attempt to salvage the torsed ovary, despite possible necrotic appearance, and also consider interventions to prevent recurrence, because bilateral torsion is a rare but potentially devastating complication.
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5/73. schistosomiasis of the ovary with endometriosis and corpus hemorrhagicum: a case report.

    We present a case of schistosomiasis of the ovary associated with endometriosis and corpus hemorrhagicum. This association has not been reported previously. A 31-year-old Filipino woman visited Li Shin Hospital because of several weeks' history of lower abdominal pain. An ultrasound study revealed a right ovarian mass, and a right oophorectomy was performed. The gross findings included a corpus hemorrhagicum and endometriosis. The histopathologic findings revealed schistosoma japonicum eggs in the fibrous wall of the ovary with evidence of a chronic inflammatory response containing eosinophils. After a second surgery and medical treatment with antiparasitic drugs, her symptoms were relieved. Adhesions resulting from the oophorectomy and endometriosis of the ovary had resulted in alteration of the blood channels and contributed to the aberrant spread of the Schistosoma eggs. The migration of overseas workers from endemic countries and the growing popularity of worldwide tourism may increase the incidence of parasitic infections.
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6/73. Rectus sheath hematoma in pregnancy.

    Although spontaneous hemorrhage into the sheath of the rectus abdominis muscle is uncommon in pregnancy, rectus sheath hematomas (RSHs) should be considered in patients who present with an acute onset of abdominal pain in the latter half of pregnancy or the immediate postpartum period. Both sonography and CT are useful in diagnosing RSHs. We report a case of pregnancy-associated RSH initially suspected of being a degenerating leiomyoma or torsed ovary. Sonography showed a large mass of mixed echogenicity with no internal vascularity. CT confirmed that the lesion was suprafacial.
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7/73. Laparoscopic unwinding and cystectomy of twisted dermoid cyst during second trimester of pregnancy.

    A woman in the sixteenth week of pregnancy experienced acute abdominal pain, and magnetic resonance imaging suggested a dermoid cyst. Laparoscopic unwinding and cystectomy of the twisted cyst was performed successfully.
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8/73. Postmenopausal tubo-ovarian abscess due to pseudomonas aeruginosa in a renal transplant patient: a case report and review of the literature.

    BACKGROUND: pseudomonas aeruginosa is an uncommon cause of infection in the female genital tract. We report a case of postmenopausal tubo-ovarian abscess (TOA) due to P. aeruginosa in a renal transplant recipient. The presentation included mild abdominal symptoms with rapid progression of peritonitis and surgical abscess drainage. This is the first such case in an organ transplant recipient described in the English literature. methods AND RESULTS: Published reports of 1040 cases of TOA were reviewed. The most common features were a history of sexually transmitted disease or pelvic inflammatory disease, and symptoms including abdominal pain and fever. escherichia coli, bacteroides spp., and klebsiella pneumoniae were the most frequently encountered pathogens. neisseria gonorrhoeae and chlamydia trachomatis, which are frequently isolated from cervical cultures, are uncommonly isolated from tubo-ovarian abscesses. Forty percent of patients were treated with antibiotics alone, 18.8% with abdominal surgery, and 32% with surgery and antimicrobial therapy. CONCLUSION: This report illustrates the muted presentation and atypical microbiology of gynecologic infection in an organ transplant recipient.
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9/73. Ovarian stone. A case report.

    BACKGROUND: To our knowledge, ovarian calcification and ossification involving the whole ovary with images that mimic stone formations have not been reported before. CASE REPORT: A 42-year-old woman presented with severe abdominal pain. Plain abdominal radiography showed a well-defined, calcified mass, 4 x 5 cm, located in the pelvis. physical examination showed a right adnexal mass accompanied by severe pain and tenderness while lifting. Transvaginal ultrasound showed an ill-defined mass with acoustic comet tail. Computed tomography demonstrated a well-defined mass on the right adnexa, 4 x 5 cm, with an extensively calcified shell. Surgical exploration revealed an enlarged, ovoid, pale brown ovary, which looked exactly like an ovary made of stone. The pathologic findings were compatible with a benign chocolate cyst with extensive calcification and ossification. The pelvic pain resolved completely after the surgery. CONCLUSION: Though the cause of this unique case remains unknown, torsion with subsequent infarction of an ovarian endometrioma was suggested. Complete excision was the treatment of choice.
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10/73. Massive ovarian edema causing early puberty.

    Massive ovarian edema is a rare tumor-like condition found predominantly in young women. patients usually present with abdominal pain and/or abdominal mass. Pre-operative diagnosis is often difficult. awareness of this rare and benign lesion in young women may allow conservative management and prevention of oophorectomy in some patients.
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