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Novák P, Vacek V, Vondráková R. [Primary omental torsion in preschool girls case report]. ROZHLEDY V CHIRURGII : MESICNIK CESKOSLOVENSKE CHIRURGICKE SPOLECNOSTI 2016; 95:200-202. [PMID: 27336748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Primary omental torsion is a rare finding in cases of suspected acute abdomen. It is more common in children. Secondary omental torsion is typical for adults. CASE REPORT The authors describe two cases where pain in the right upper abdominal quadrant was caused by primary torsion of the omental corner due to increased intraabdominal pressure: after a strong cough in one girl and after a workout in the other. Primary omental torsion usually mimics acute appendicitis with clinical findings in the right lower abdominal quadrant, especially in obese children. However, our two cases describe normosthenic girls with pain in the right upper abdominal quadrant up to the mesogastrium. CONCLUSION Primary torsion of the omentum is a very rare cause of acute abdomen, which is also confirmed by its incidence in our group of patients where only two cases were seen during a 15-year period, which corresponds to 0.17% of all appendectomies performed in our department. This value is comparable to data reported in the literature. KEY WORDS acute abdomen omental torsion tenderness in right upper abdomen.
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Chen JM, Gao HY, Wang Q, Li Q. Expression and clinical significance of tumor markers in ovarian mature cystic teratoma. CLIN EXP OBSTET GYN 2016; 43:397-400. [PMID: 27328499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND CA19-9, CA125, AFP, CEA, and CA153 are common cancer biomarkers. This study aimed to detect the expression and assess clinical significance of these biomarkers in ovarian mature cystic teratomas (OMCT). MATERIALS AND METHODS The clinical data of 312 resected patients with ovarian mature cystic teratoma referred to the third Hospital of Suzhou University from January 2008 to February 2014 were analyzed retrospectively. Levels of serum CA19-9, CA125, CA153, AFP, and CEA were detected. RESULTS Levels of serum CA19-9, CA125, AFP, and CEA were detected in all patients, but the level of serum CA153 was detected in 36 patients. The positive expression of these biomarkers above is 45.83%, 6.09%, 0.00%, 0.64%, and 2.78%, respectively. Ovarian tumor diameter in CA19-9 and CA 125 elevation is larger than that in negative group. The levels of serum CA19-9 and CA125 in multilocular ovarian tumor patients is higher than that in unilocular ovarian tumor patients. The level of serum CA19-9 in bilateral ovarian tumor patients is higher than that in unilateral patients. The level of CA19-9 in patients three months after operation decreased significantly compared with that before operation. CONCLUSIONS The present study suggests that elevated CA 19-9 is probably the most reliable marker among many tumor markers in the OMCT. It is valuable for diagnosis and recurrence of OMCT.
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Otjen JP, Stanescu L, Goldin A, Parisi MT. A normal ovary in an abnormal location: A case of torsion. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:578-580. [PMID: 25110990 DOI: 10.1002/jcu.22223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/22/2014] [Indexed: 06/03/2023]
Abstract
The clinical and radiologic diagnosis of adnexal torsion is challenging. The patient's history, physical examination, and laboratory evaluation may overlap significantly with other causes of abdominal pain. Ultrasound is the most common radiologic tool to assess for torsion, and the imaging findings can be equally equivocal. We present a case of adnexal torsion in an 18-year-old emergency room patient with abdominal pain, diagnosed by ultrasound based solely on an abnormal medial position of the ovary-a finding that has been only rarely mentioned in the literature, and never in isolation.
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Flores-Ríos E, Méndez-Díaz C, Rodríguez-García E, Pérez-Ramos T. Wandering spleen, gastric and pancreatic volvulus and right-sided descending and sigmoid colon. J Radiol Case Rep 2015; 9:18-25. [PMID: 26629290 DOI: 10.3941/jrcr.v9i10.2475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Wandering spleen is a rare condition, characterized by a mobile spleen that is attached only by an elongated vascular pedicle, allowing it to migrate to any part of the abdomen or pelvis. Mesenteroaxial gastric volvulus usually occurs in children and may be associated with wandering spleen. Both entities result from abnormal laxity or absence of the peritoneal attachments due to abnormal fusion of the peritoneal mesenteries. Pancreatic volvulus is a very rare anomaly, with only a few isolated case reports described in association with wandering spleen. Anomalous right sided descending and sigmoid colon is a very rare entity and its association with wandering spleen has not been previously reported. We report a case of wandering spleen associated with mesenteroaxial gastric volvulus, pancreatic volvulus and rightward shift of the splenic flexure of the colon and right sided descending and sigmoid colon in a young female.
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Alexiou K, Ioannidis A, Drikos I, Sikalias N, Economou N. Torsion of the greater omentum: two case reports. J Med Case Rep 2015; 9:160. [PMID: 26163136 PMCID: PMC4507315 DOI: 10.1186/s13256-015-0641-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/18/2015] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Torsion of the omentum is a benign self-limiting disorder, which is difficult to diagnose because the main symptoms are similar to those of other abdominal diseases. Most of the published cases had been diagnosed during operation via direct eye view. According to several studies, it is important that the correct preoperative diagnosis is made as omental torsion can be treated conservatively in most cases without any complications avoiding surgical intervention. However, patients should be under clinical and laboratory observation in order to detect symptoms that would lead to surgical intervention in which case a laparoscopy is the appropriate surgical treatment. CASE PRESENTATION Torsion of the great omentum is a rare cause of acute abdominal pain which is usually misdiagnosed. In this study we report two cases, a 52-year-old Greek woman and a 68-year-old Greek man, who presented at our emergency room with symptoms such as right lower quadrant pain and tenderness similar to acute appendicitis. In both cases a surgical exploratory laparotomy of the abdomen revealed a twisted heavily congested segment of the right part of the greater omentum accompanied by intra-abdominal serosanguinous fluid. CONCLUSIONS Greater omental torsion is difficult to diagnose preoperatively. It presents as acute abdominal pain located more often in the right iliac fossa. It is very important to make a correct preoperative diagnosis because omental torsion is a benign self-limiting disorder that can be treated conservatively, avoiding laparotomy. When a patient's clinical, laboratory and radiological findings worsen or diagnosis is doubtful then laparoscopy is the appropriate method for diagnosis and treatment.
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Teodorescu L. ANOMALOUS HEAD POSTURES IN STRABISMUS AND NYSTAGMUS DIAGNOSIS AND MANAGEMENT. Rom J Ophthalmol 2015; 59:137-140. [PMID: 26978880 PMCID: PMC5712957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 06/05/2023] Open
Abstract
UNLABELLED Abnormal head positions are adopted in order to improve visual acuity, to avoid diplopia or to obtain a more comfortable binocular vision. The head can be turned or tilted toward right or left, with the chin rotated up or downwards or combination of these positions. The ophthalmologic examination including the assessment of versions leads to the diagnosis. When versions are free, the cause may be congenital nystagmus or strabismus with large angle. When versions are limited we suspect paralytic or restrictive strabismus. The head tilted to one shoulder suggests cyclotropia (IV Nerve Palsy) or congenital nystagmus. We present few of the above cases. An adequate surgical treatment can improve or correct the ocular deviation, diplopia and the abnormal head posture. CONCLUSIONS The abnormal head posture must be assessed and treated early in order to correct the ocular position and head posture. All patient presenting abnormal head position HAD TO BE investigated by an ophthalmologist.
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Lloyd A, Steinberg SM. Gallbladder torsion in a 91-year-old female: an unusual cause of right upper quadrant pain. Am Surg 2015; 81:E201-E203. [PMID: 25975309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Gibson GN, Dunn DP. RADIOLOGY REPORT: 2 cases to test your skills. THE JOURNAL OF FAMILY PRACTICE 2015; 64:293-294. [PMID: 26009739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Sojo-Rodríguez V, Cañete-Gómez J, Olivares C, Reguera-Rosal J, Segura-Sampedro JJ, Camacho-Marente V, López-Bernal F, Padillo-Ruiz J. Acute abdomen due to torsion of the wandering spleen. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2015; 107:229-230. [PMID: 25824922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Sun ZJ, Yuan Y, Liu RB. [Correlation analysis on the disorders of patella-femoral joint and torsional deformity of tibia]. ZHONGGUO GU SHANG = CHINA JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY 2015; 28:222-225. [PMID: 25936190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To reveal the possible mechanism involved in patella-femoral degenerative arthritis (PFDA) in- duced by torsion-deformity of tibia via analyzing the relationship between torsion-deformity of the tibia in patients with PFDA and the disorder of patella-femoral joint under the static and dynamic conditions. METHODS From October 2009 to October 2010, 50 patients (86 knees, 24 knees of male patients and 62 knees of female patients) with PFDA were classified as disease group and 16 people (23 knees, 7 knees of males and 16 knees of females) in the control group. The follow indexes were measured: the torsion-angle of tibia on CT scanning imagings, the patella-femoral congruence angle and lateral patella-femoral angle under static and dynamic conditions when the knee bent at 30 degrees of flexion. Based on the measurement results, the relationship between the torsion-deformity of tibias and the disorders of patella-femoral joints in patients with PFDA were analyzed. Finally,the patients were divided into three groups including large torsion-angle group, small torsion-angle group and normal group according to the size of torsion-angle, in order to analyze the relationship between torsion-deformity and disorders of patella-femoral joint, especially under the dynamic conditions. RESULTS Compared with patients without PFDA, the ones with PFDA had bigger torsion-angle (30.30 ± 7.11)° of tibia, larger patella-femoral congruence angle (13.20 ± 3.94)° and smaller lateral patella-femoral angle (12.30 ± 3.04)°. The congruence angle and lateral patella-femoral angle under static and dynamic conditions had statistical differences respectively in both too-big torsion-angle group and too-small torsion-angle group. The congruence angle and lateral patella-femoral angle under static and dynamic conditions had no statistical differences in normal torsion-angle group. CONCLUSION Torsion-deformity of tibia is the main reason for disorder of patella-femoral joint in the patients with PFDA. Torsion-deformity of tibia is always accompanied by instability of patella-femoral joint,especially under the dynamic condition, thus causing PFDA. It can not only provide arrangement information and degenerative condition of patella-femoral joint,but also provide guidance through the analysis on the relationship for better clinical prevention and early treatment of degenerative bone and joint disease.
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Di Carlo C, Savoia F, Fabozzi A, Gargano V, Nappi C. A case of ovarian torsion in a patient carrier of a FSH receptor gene mutation previously affected by spontaneous ovarian hyperstimulation syndrome. Gynecol Endocrinol 2015; 31:105-8. [PMID: 25495063 DOI: 10.3109/09513590.2014.987229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We here report a case of ovarian torsion in a patient with an history of two previous episodes of spontaneous ovarian hyperstimulation syndrome during her two pregnancies. A mutation of follicle-stimulating hormone receptor (FSHr) gene was identified in this patient and in other members of the family. Two years after her successful second pregnancy, the patient showed signs of severe thyroiditis during administration of oral contraceptive, with suppressed TSH and increased thyreoglobulin, in the absence of any abnormalities of the auto-antibodies. In few days, she developed severe pelvic pain and ultrasonographic evidence of increased ovarian volume. She underwent laparoscopy with unilateral adnexectomy for ovarian ischemic necrosis due to adnexal torsion. Our experience suggests that patients' carrier of a mutation of FSHr gene are at risk of ovarian pathologies also when non-pregnant and in the presence of low TSH levels. Further investigations are needed for an appropriate knowledge of typical and atypical manifestations of spontaneous ovarian hyperstimulation syndrome.
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Lee DH, Park YK. Isolated fallopian tube torsion during pregnancy: a case report. CLIN EXP OBSTET GYN 2015; 42:681-682. [PMID: 26524824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Isolated fallopian tube torsion is a rare pregnancy-related complication. It is frequently misdiagnosed as acute appendicitis or ovarian torsion owing to the lack of specific symptoms or signs. Here, the authors report a case of a 35-year-old primigravida at 30 weeks and six days of gestation who had presented with right isolated fallopian tube torsion and a history of right oophorectomy. The authors propose that isolated fallopian tube torsion should be included in the list of differential diagnosis when encountered with patients complaining of lower abdominal pain.
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Ghribi A, Slama A, Sghairoun N, Sahli S, Gasmi M, Hamzaoui M. Small cell carcinoma of the ovary of the hypercalcemia type in children. LA TUNISIE MEDICALE 2014; 92:698-699. [PMID: 25867158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Johnson AR, Meeuwsen A, Khodaee M, Deutchman M. 4 pregnant women with an unusual finding at delivery. THE JOURNAL OF FAMILY PRACTICE 2014; 63:670-672. [PMID: 25362497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Ratnayake K, Kim TY. Evidence-based management of neonatal vomiting in the emergency department. PEDIATRIC EMERGENCY MEDICINE PRACTICE 2014; 11:1-20. [PMID: 25928976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Vomiting accounts for up to 36% of neonatal visits to the emergency department. The causes of vomiting can range from benign to life-threatening. Evidence to guide the diagnosis and management of neonatal vomiting in the emergency department is limited. History and physical examination are extremely important in these cases, especially in identifying red flags such as bilious or projectile emesis. A thorough review is presented, discussing various imaging modalities, including plain abdominal radiography, upper gastrointestinal studies, ultrasonography, and contrast enema. A systematic approach in the emergency department, as outlined in this review, is required to identify the serious causes of vomiting in the neonate.
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Pu TW, Fu CY, Lu HE, Cheng WT. Complete body-neck torsion of the gallbladder: A case report. World J Gastroenterol 2014; 20:14068-14072. [PMID: 25320548 PMCID: PMC4194594 DOI: 10.3748/wjg.v20.i38.14068] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/07/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Gallbladder torsion is a rare, acute abdominal disease. It was first reported by Wendell in 1898. Since then, only 500 cases have been reported. Gallbladder torsion occurs in all age groups, although it usually appears in the latter stages of life. The occurrence ratio between women and men is 3:1. Most cases are diagnosed during surgery. The main treatment is surgical detorsion and cholecystectomy. Despite progress in radiologic imaging diagnosis, it is not easy to obtain a precise preoperative diagnosis of gallbladder torsion. In previous reports, only 9.8% of all gallbladder torsion cases were diagnosed preoperatively. We present a case of acute body-neck gallbladder torsion in an elderly man, and we review the radiologic findings of magnetic resonance imaging, computed tomography, and ultrasonography. The radiologic findings in the present case were helpful in obtaining a preoperative diagnosis of gallbladder torsion. The diagnosis was confirmed by T2-weighted magnetic resonance images, which showed an intra-gallbladder segment located between the body and neck of the gallbladder, with a notable crease within this segment.
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Sahlu Z, Negash S, Yusuf L. ADNEXAL TORSION A FIVE-YEARS RETROSPECTIVE REVIEW IN TWO HOSPITALS. ETHIOPIAN MEDICAL JOURNAL 2014; 52:155-164. [PMID: 26410988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Adnexal torsion remains a challenging diagnosis, often leading to delayed operative intervention and resultant ovarian loss. Objective: To describe the clinical profile and therapeutic approaches of adnexal torsion in the Ethiopian setting. METHODS A retrospective cross sectional descriptive chart review ofwomen with surgically proven adnexal torsion was conducted in two teaching hospitals from Jan 1 2007 - Dec 31, 2011. RESULTS A total of 53 women with AT were analyzed. About 33(62%) of torsion occurred in the age group of 20 - 29 years. The most common symptoms were lower abdominal pain 52 (98.1 %) followed by nausea and vomiting 46 (86.8%), whereas, the common physical findings were lower abdominal tenderness 49(92.5%) and palpable pelvic mass 40 (76.9%). Adnexal torsion was considered in the diferential diagnosis upon initial evaluation only in 27 (51%) of the cases. Of the study subjects, only 7(13.2%) had surgery within 24 hours of arrival to the facility and the mean time from initial evaluation to surgery was 53.8±44.5 hours. Moderately positive correlation was observed between ultrasound and intra-operative adnexal size measurement (r = 0.716, p = 0.000). Using non-parametric independent sample test, none of the clinical profile categories studied show significant difference in mean time from initial evaluation to surgery. Despite the overwhelmingly benign pathology, most 46 (86.8%) ofpatients underwent adnexectomy_with only 3(5.7%) adnexal salvage rate. CONCLUSION Delayed surgical intervention and low ovarian salvage rate inspite of predominantly benign pathology was observed. Therefore, high degree of suspicion, especially in patients with high risk factors, and timely intervention must be exercised in an effort to salvage the adnexae.
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Narayanan S, Bandarkar A, Bulas DI. Fallopian tube torsion in the pediatric age group: radiologic evaluation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1697-1704. [PMID: 25154955 DOI: 10.7863/ultra.33.9.1697] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Fallopian tube torsion is a rare but important cause of acute pelvic pain in young adolescent girls. It is a surgical emergency treated with either detorsion or salpingectomy. The imaging findings can be nonspecific and challenging. However, an accurate early diagnosis is essential for prompt surgical treatment. Our objective was to review whether imaging findings can be specific enough to suggest the diagnosis of tubal torsion prospectively in the appropriate clinical setting. An Institutional Review Board-approved retrospective review of our imaging database from 2005 to 2012 revealed 10 surgically proven cases of fallopian tube torsion. All cases had sonography performed; 5 cases had additional multidetector computed tomography. All 10 patients (9-17 years) presented with acute pelvic pain. Sonographic findings included dilated tubular structures in 6 of 10 cases: adjacent to a normal ipsilateral ovary in 5 of 6 and adjacent to a benign ovarian teratoma in 1. In 4 cases, no dilated tube was identified; 3 of 4 had a cystic mass separate from the ovaries, and 1 had the imaging appearance of a multicystic ovary. Computed tomographic findings in the 5 cases that underwent multidetector computed tomography included a dilated tubular structure in 3 of 5; 2 of 5 had a cystic adnexal mass identified. Although rare, tubal torsion should be considered in female adolescents with acute pelvic pain. Sonography should be the first imaging choice. When a tubular structure or a midline cystic mass associated with a normal ipsilateral ovary is noted, tubal torsion should be considered in the differential diagnosis.
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Steinthorsdottir KJ, Folmer L, Bisgaard T. [Acute lower abdominal pain caused by adnexal torsion in a ten-year-old girl]. Ugeskr Laeger 2014; 176:V03140193. [PMID: 25292479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A ten-year-old girl presented with four days of lower abdominal pain. A diagnostic laparoscopy on the suspicion of acute appendicitis revealed left-sided adnexal torsion. The cyanotic ovary was detorsed and recovered. At three-month follow-up there were no clinical or ultrasonic signs of pathology. The clinical presentation of adnexal torsion is unspecific and mimics several differential diagnosis. Adnexal torsion is a rare condition, especially in pre-pubertal girls. However, it must still be kept in mind when evaluating girls regardless of age with lower abdominal pain.
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Maksoud SFA, Swamy N, Khater NH. Tale of a wandering spleen: 1800 degree torsion with infarcted spleen and secondary involvement of liver. J Radiol Case Rep 2014; 8:18-26. [PMID: 25426231 DOI: 10.3941/jrcr.v8i6.1534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Wandering spleen is a rare clinical entity characterized by splenic hypermobility resulting from laxity or maldevelopment of the suspensory splenic ligaments. The spleen can "wander" or migrate into various positions within the abdomen or pelvis due to this ligamentous laxity. It is usually detected between 20 and 40 years of age, and is more common in women. The clinical presentation of a wandering spleen is variable, it could present as an asymptomatic, incidentally detected, abdominal or pelvic mass, or as an acute abdomen secondary to splenic torsion. Diagnosis in an emergent setting can be challenging as it is a rare cause of acute abdomen and does not produce any symptoms until splenic torsion has occurred. We present and discuss a case of ectopic, torsed spleen resulting in complete infarction of the spleen and severe hepatic vascular compromise, diagnosed by ultrasound, confirmed by computed tomography and effectively managed by splenectomy.
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Vitezica I, Czernik C, Rothe K, Hinkson L, Ladendorf B, Henrich W. Prenatal diagnosis and management of a massive fetal ovarian hemorrhagic cyst torsion with secondary fetal anemia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:219-222. [PMID: 24027173 DOI: 10.1002/jcu.22082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 02/12/2013] [Accepted: 06/28/2013] [Indexed: 06/02/2023]
Abstract
We report the case of one of the largest prenatally detected fetal hemorrhagic cyst with ovarian torsion and fetal anemia leading to subsequent cesarean section delivery and further unilateral oophorectomy of the neonate. Usually, fetal ovarian cysts tend to resolve spontaneously within the first months after birth. There is no need of surgical treatment for such simple cysts. Routine sonographic examinations are obligatory, because in some cases complications such as massive hemorrhage, cyst rupture, or ovarian torsion with following infarction can occur. With the occurrence of these complex cyst signs by sonographic investigation, subsequent intervention should be considered by an interdisciplinary team.
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Ozkisacik S, Yazici M, Gursoy H, Culhaci N. Does gradual detorsion protect the ovary against ischemia-reperfusion injury in rats? Pediatr Surg Int 2014; 30:437-40. [PMID: 24519483 DOI: 10.1007/s00383-014-3480-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2010] [Indexed: 11/26/2022]
Abstract
AIM Adnexal torsion is an infrequent and serious gynecologic surgical emergency. Adnexal torsion may result from pre-existing tubal or ovarian pathology or hyperstimulation of the ovary during ovulation. Early diagnosis and emergency surgical treatment (detorsion) are important to preserve fertility and to prevent peritonitis or loss of the adnexa. However, during reperfusion, tissue damage is more severe than during ischemia because of oxygen-derived radicals. The present study aimed to investigate the protective effect of gradual detorsion on adnexal torsion. MATERIALS AND METHODS Twenty-one adult female rats were divided into three groups as sham-operated (Sh group, n = 7); torsion + detorsion (TD group, n = 7); and torsion + gradual detorsion (TGD group, n = 7). A midline laparotomy was performed under anesthesia. In the TD and TGD groups, the left adnexa along with tubal and ovarian vessels were twisted three times in a clockwise direction and fixed to the abdominal wall. After 30 h, detorsion was performed on the mesenteries of both TD and TGD groups. In the TGD group, however, detorsion was performed gradually: the ovarian mesentery was detorsioned 360°, followed by a 5-min pause, then a repeat of the cycle until full detorsion was achieved. Rats were killed 1 week later. Left ovaries were removed and evaluated histopathologically. RESULTS The histopathological mean grade was significantly higher in the TD than in the TGD group (p < 0.05). CONCLUSION Gradual detorsion can reduce reperfusion injury in a rat model of ovarian torsion. This method is easily applicable and may be a useful method for human patients with ovarian torsion.
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Kaabar N, Ben Abdallah R, Yengui H, Hellal Y, Ben Malek R, Bouthour H, Sayed S. Torsion of a wandering spleen: a case report. LA TUNISIE MEDICALE 2014; 92:275-277. [PMID: 25224425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Wandering spleen is a rare entity in child. It is generated by laxity or failure of development of spleen ligaments causing the migration of the spleen from its normal anatomical site to another abdominal or pelvic location. It can be congenital or acquired. The most dangerous complication is the occurrence of torsion of the spleen around its pedicle. aim: Report of a new observation and present the diagnostic, treatment and outcome aspects of torsion of ectopic spleen. CASE We report the case of a 17 years old girl who was admitted for an acute abdomen pain and fever. Clinical examination revealed generalized abdominal defence and an under umbilical mass which was very painful on palpation. Ultrasound and CT scans have visualized the pelvic mass, which measured four inches long axis. The spleen wasn't on its normal seat. The patient was operated urgently. Surgical exploration showed that the mass corresponded to a wandering spleen in pelvic position, necrotic and twisted around its pedicle. A splenectomy was performed with simple sequences. CONCLUSION torsion of the wandering spleen can progress to total necrosis of the spleen mass. This complication is feared in any ectopic and painful spleen.
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Portinari M, Liboni A, Feo CV. Strangulated adenoma of the liver: a unique cause of acute abdomen. Ann Ital Chir 2014; 85:S2239253X14022439. [PMID: 25475531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hepatic adenomas are uncommon benign tumours of the liver which may eventually present with acute onset following rupture of the lesion and haemorrhage. We present here a unique case of strangulated adenoma of the liver presenting as acute abdomen. A 27-year-old woman taking oral contraceptives, presented to the emergency department with abdominal pain, palpable abdominal mass, fever, and neutrophilia. An abdominal ultrasound showed a 3-cm hepatic nodule and an 11-cm mesogastric mass. Computed tomography of the abdomen revealed a 2.3-cm liver adenoma and a 13-cm pedunculated mass of the liver showing no contrast enhancement suggestive of pedicle torsion with ischemia of the mass. The patient underwent an emergent open resection of the strangulated liver mass, she recovered without complications, and was discharged home after three days. Final pathology confirmed an hepatocellular adenoma with areas of necrosis and hemorrhage. The clinical significance of the disease is discussed.
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Olasehinde O, Aderibigbe AS, Akinkuolie AA, Adisa AO, Ajenifuja KO, Aladesuru OA, Oyekunle O. Torsion of wandering spleen, an unusual cause of acute abdomen; a report of two cases. AFRICAN JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2014; 43:75-78. [PMID: 25335381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Wandering spleen is an uncommon entity that is rarely considered in the evaluation of patients with acute abdominal conditions. OBJECTIVE To report two cases of wandering spleen presenting with acute abdominal pain. METHODS The clinical records of the patients including preoperative evaluation, intra-operative findings and postoperative care were reviewed RESULT A 6 year old boy presented with right lumbar pain which worsened over a 36 hour period with findings of a tender right lumbar mass. Abdominal ultrasound showed a mass with echogenicity consistent with that of the spleen with no blood flow and an empty splenic bed. The pre-operative diagnosis was torsion of a wandering spleen. The second case was that of a 42 year old woman who presented with severe colicky lower abdominal pain which worsened over three days with a background history of progressively increasing lower abdominal mass which was tender and about 26 week gestational size at presentation. The initial diagnosis was torsion of an ovarian cyst. Abdomino-pelvic Ultrasound scan showed a heterogeneously hypo-echoic mass overlying the uterus and the left ovary with no blood flow. The presence of wandering spleen with torsion of the vascular pedicle was confirmed at laparotomy in both instances. Splenectomy was performed in both cases with good recovery. CONCLUSION Torsion of a wandering spleen poses a diagnostic challenge. A high level of suspicion is required to make a diagnosis and institute appropriate treatment.
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