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Sugai Y, Kinoshita Y, Kobayashi T, Takahashi Y, Arai Y, Ohyama T, Yokota N, Takano S, Kobayashi A. A rare case of pyosalpinx in adolescent girl with Hirschsprung's disease who underwent transvaginal ultrasound-guided drainage. Surg Case Rep 2023; 9:74. [PMID: 37160491 PMCID: PMC10169977 DOI: 10.1186/s40792-023-01657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Hydrosalpinx and pyosalpinx are rare gynecologic problems during adolescence, especially in girls without a history of sexual activity. They are even rarer in women with Hirschsprung's disease (HD). We herein report a case of pyosalpinx in an adolescent girl with HD treated by transvaginal ultrasound-guided drainage. CASE PRESENTATION The present patient was a 12-year-old girl (weight 83 kg; height 159 cm; body mass index 32.8 kg/m2). She had undergone five laparotomies for long-segment HD by 2 years. Her menarche had occurred at 10 years. She was admitted with lower abdominal and anal pain. Computed tomography (CT), magnetic resonance imaging (MRI), and transvaginal ultrasound showed left pyosalpinx and abdominal abscess. Surgical drainage was necessary; however, she had a history of polysurgery and was severely obese, so laparotomy was considered to carry a high risk. Transvaginal ultrasound was deemed more likely to reach the abscess safely. Therefore, she was treated with transvaginal ultrasound-guided drainage by a gynecologist skilled in the procedure. She was discharged home after 52 days. One year and nine months after discharge, there was no reformation of either the abscess or pyosalpinx. CONCLUSIONS Adolescent girls with HD are at risk of developing hydrosalpinx. Depending on the defecation status, pyosalpinx may also develop. As a less-invasive surgical treatment, transvaginal ultrasound-guided drainage can avoid laparotomy. Collaboration with a gynecologist is essential for the diagnosis and treatment of this clinical condition. Pediatric surgeons should communicate with gynecologists for such cases beginning around puberty for continuous follow-up.
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Affiliation(s)
- Yu Sugai
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan.
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Takashi Kobayashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Yoshiaki Takahashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Yuhki Arai
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Toshiyuki Ohyama
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Naoki Yokota
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Shoichi Takano
- Department of Pediatric Surgery, Niigata University Graduate School of Medical & Dental Sciences, 1-757 Asahimati-Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Akiko Kobayashi
- Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, 1-754 Asahimati-Dori, Chuo-Ku, Niigata, 951-8520, Japan
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Abstract
Hirschsprung's disease (HD) is a complex colorectal disorder that can be challenging to understand and overwhelming to many parents. Counseling parents is critical for ensuring they understand their child's condition, how it must be treated, pitfalls that can occur during treatment, and how they will do in the long term. This article breaks down this process into a series of informally worded questions and reviews evidence-based discussion points around the most common concerns parents will have: survival, pathophysiology, surgical correction and complications, etiology and genetic basis, associated issues, outcomes, and familial nature. Where evidence is unclear, expert opinion is included. Discussion is geared towards the parents of a newly diagnosed and otherwise healthy neonate, with a brief section on complex situations including associated syndromes and late diagnosis. Embarking on the longitudinal care of a child with HD is a complex undertaking and requires significant parental education to establish a proper parent-surgeon relationship, an essential factor for optimizing outcome and family satisfaction.
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Affiliation(s)
- Nelson Rosen
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States.
| | - Monica Holder
- Colorectal Center at Cincinnati Children's, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States
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Riccio A, Lisi G, Miscia ME, Di Paolo G, Lauriti G, Lelli Chiesa P. Secondary hydrosalpinx in adolescents: a challenging decision-making process for surgical choice and future fertility preservation. LA PEDIATRIA MEDICA E CHIRURGICA 2021; 42. [PMID: 33601874 DOI: 10.4081/pmc.2020.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022] Open
Abstract
Hydrosalpinx in pre-pubertal children and non-sexually active adolescents is a rare finding with several etiology and negative impact on future female fertility. The therapeutic approach in these specific populations is debated and it must consider its etiology and adult guidelines focused on fertility issues, which suggest laparoscopic salpingectomy. We described two adolescent cases (15 years asymptomatic and 13 years with abdominal pain) presenting a monolateral hydrosalpinx secondary to surgery for Hirschsprung's disease and complicated appendicitis, respectively. Both patients underwent to uncomplicated robotic-assisted salpingectomy, with uneventful follow-up and preserved ovarian function. Robotic-assisted salpingectomy for hydrosalpinx secondary to previous surgical conditions is a safe and careful approach for adolescents in order to preserve ovarian vascularization, function and future fertility.
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Affiliation(s)
- Angela Riccio
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Gabriele Lisi
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Maria Enrica Miscia
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Gilda Di Paolo
- Service of Pediatric and Adolescent Gynecology, Department of Medicine and Aging Science, University "G. d'Annunzio" of Chieti-Pescara.
| | - Giuseppe Lauriti
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
| | - Pierluigi Lelli Chiesa
- Pediatric Surgery Unit, Hospital "Spirito Santo", Pescara - University "G. d'Annunzio", Chieti-Pescara.
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