1/6. Neuropathic uterine pain after hysterectomy. A case report.BACKGROUND: Neuropathic pain arises when there is damage to or dysfunction of the nervous system. Diabetic neuropathy, postherpetic neuralgia and phantom limb pain are common types of neuropathic pain. It is not commonly recognized in gynecologic practice. CASE: A patient underwent a hysterectomy for a tuboovarian abscess and underlying endometriosis. Despite maximal dosing with conventional pain medications, she continued to have significant pain that had not been present following prior surgeries. Use of low-dose amitriptyline successfully treated the pain, with no sequelae. CONCLUSION: Persistent pain following gynecologic surgery that does not respond to conventional therapy may have a neuropathic origin. attention to appropriate history and physical examination may lead to an increase in the diagnosis of neuropathic pain in gynecology patients. This may have implications for persistent pain in other gynecologic diseases.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/6. diagnosis of adnexal torsion in the third trimester of pregnancy: a case report.The diagnosis of adnexal torsion is difficult to establish on the basis of symptoms, physical findings, or radiologic techniques. If possible, in pregnancy the diagnostic workup should avoid any risk of drug administration, and the indication for a surgical intervention needs to be severe. Between 10% and 20% of ovarian torsions are associated with pregnancy, but adnexal torsion in the third trimester is rare. We present the case of a 22-year-old female presenting with a sudden onset of severe right lower quadrant abdominal pain associated with nausea and vomiting. The presumptive diagnosis was appendicitis. Transvaginal sonography showed some free fluid in the pouch of Douglas, but could not define the accurate diagnosis. In transabdominal ultrasound, a predominantly hyperechogenic mass containing small cysts was found in the right lower abdomen. No blood flow within the mass was detected with color and power Doppler sonography. With ultrasound, the anatomic relation of the mass could not be precisely identified. magnetic resonance imaging clearly delineated the mass, which was due to enlargement of the right ovary, with predominately hyperintense signal containing small areas with hypointense lesions in T2-weighted images, a potential sign of hemorrhagic infarction. The mesovarium was hyperintense in T2-weighted images and also enlarged. The left ovary seemed to be normal. Due to the displacement of the ovaries in the second and third trimesters, the diagnostic workup is very largely restricted when using transvaginal ultrasound. Especially in pregnancy, it is mandatory to obtain a reliable diagnosis to reduce any risk to the fetus. Our case report indicates that the combination of magnetic resonance imaging and Doppler sonography fulfills these requirements and allows for accurate and fast diagnosis of adnexal torsion.- - - - - - - - - - ranking = 0.10849081842407keywords = physical (Clic here for more details about this article) |
3/6. The irreducible ovary: a true emergency.The management of a child with an irreducible ovary remains inconsistent in pediatric surgical centers. An informal survey of senior pediatric surgeons and an extensive review of the literature showed a prevailing view that the trapped ovary is not at significant risk of vascular compromise. Two recent cases prompted a review of our experience from 1984 to 1989, during which 1,699 children with inguinal hernias underwent operation, 386 (23%) of whom were girls. Fifteen girls (4%) had irreducible ovaries present at the time of operation and in 4 of the 15 (27%) the ovary was twisted and infarcted. Two of the 4 girls were known to have an irreducible ovary prior to the day of operation--1 was noted 2 months earlier and 1 was noted 1 month earlier. At the time of the initial diagnosis, neither patient had physical findings of vascular compromise of the ovary. In the other two girls, evidence of an infarcted ovary was present when the hernia was first diagnosed and an emergency operation was performed. A 27% incidence of torsion and strangulation of irreducible ovaries appears to be high, but reports of strangulated ovaries have been reported in 2% to 33% of other series. The normal anatomy is altered when an ovary is trapped in a hernia sac, and these changes make torsion more likely. Although an irreducible ovary is not at great risk of compression of its blood supply, this report identifies a significant risk of torsion. This risk warrants treating the asymptomatic irreducible ovary as any other incarcerated hernia--as a true emergency.- - - - - - - - - - ranking = 0.10849081842407keywords = physical (Clic here for more details about this article) |
4/6. Uterine adnexal torsion: a case report.Uterine adnexal torsion is a surgical condition that requires prompt diagnosis and intervention. An ultrasound examination demonstrating a unilaterally enlarged, hypoechoic ovary with several small spherical, peripherally located sonolucent structures in the involved ovary, in addition to a history and physical consistent with torsion, confirms the need for surgical intervention. In this article, we present a case of uterine adnexal torsion and discuss the etiologic, diagnostic and therapeutic aspects of this entity.- - - - - - - - - - ranking = 0.10849081842407keywords = physical (Clic here for more details about this article) |
5/6. A case of a postmenopausal ruptured pyosalpinx. A rare finding at laparotomy for an acute abdomen.A case is described of an 84-yr-old woman with a ruptured tubo-ovarian abscess. This condition, which is rare in postmenopausal women, is usually diagnosed during laparotomy. Neither the medical history, nor the physical examination, nor the laboratory examination gives specific clues concerning the right diagnosis. The treatment is primarily a surgical one and consists principally of an abdominal hysterectomy and bilateral salpingo-oopherectomy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/6. Diagnosing ovarian torsion with computed tomography. A case report.BACKGROUND: The diagnosis of adnexal torsion is difficult to make on the basis of symptoms, physical findings or radiologic techniques. Unfortunately, delayed intervention can lead to irreversible damage and loss of the adnexa. This report describes a finding seen on computed tomography (CT) that may increase suspicion of the diagnosis of ovarian torsion. CASE: A 21-year-old woman was admitted with constant abdominal pain and a tender retrouterine mass. Ultrasound failed to provide a definitive diagnosis. CT showed a central, hypodense area consistent with fat and surrounded by a shell of intermediate density. At laparotomy the patient was found to have a necrotic left adnexa due to torsion. Bisection of the adnexal mass confirmed a dermoid cyst with overlying edematous ovarian cortex. CONCLUSION: The observation of a round, hypodense central lesion (dermoid cyst) surrounded by thickened, edematous ovarian cortex on CT is a finding that may aid in the diagnosis of adnexal torsion. The finding is a thickened shell of ovarian cortex surrounding a central mass that has caused the torsion; in this case it was a dermoid cyst.- - - - - - - - - - ranking = 0.10849081842407keywords = physical (Clic here for more details about this article) |