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Sharma AM, Sharma RK, Sonkesariya V, Tiwari J. Incarcerated Procidentia Caused by Multiple Vesical Calculi: A Rare Case Report. J Obstet Gynaecol India 2022; 72:415-417. [PMID: 36457439 PMCID: PMC9701288 DOI: 10.1007/s13224-021-01600-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Aarti M Sharma
- Department of Obstetrics and Gynecology, Atal Bihari Vajpayee Government Medical College, Vidisha, M.P. 464001 India
| | - Rahil Kumar Sharma
- Department of Radiodiagnosis, Atal Bihari Vajpayee Government Medical College, Vidisha, M.P. India
| | - Vandana Sonkesariya
- Department of Obstetrics and Gynecology, Atal Bihari Vajpayee Government Medical College, Vidisha, M.P. 464001 India
| | - Jyotibala Tiwari
- Department of Obstetrics and Gynecology, Atal Bihari Vajpayee Government Medical College, Vidisha, M.P. 464001 India
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Warehime J, Metzinger D, Cope Z, Feroz R, Gupta A, Lenger SM. When prolapse cannot be reduced: incarcerated procidentia due to pelvic mass. Int Urogynecol J 2022. [PMID: 35376965 DOI: 10.1007/s00192-022-05175-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Our objective is to demonstrate a surgical approach to the treatment of incarcerated procidentia with obstructed ureters due to a pelvic mass. METHODS A 61-year-old woman presented with constipation, vaginal swelling, and difficulty voiding. On examination she had complete procidentia, which could not be reduced with gentle pressure. On imaging the prolapse appeared to contain a large pelvic mass measuring 11.5 cm in its greatest diameter, with features consistent with a mature teratoma. She was also noted to have bilateral ureteral obstruction and prominent hydronephrosis. After unsuccessful prolapse reduction under anesthesia, Bovie electrocautery was used to perform a posterior colpotomy. The obstructing mass was dissected away from the uterus and its connecting pedicle transected. The prolapse could then be reduced and a robotic hysterectomy performed. RESULTS Pathology showed multiple pelvic masses including an 8-cm necrotic cystic nodule most consistent with uterine fibroids and a 4.5-cm mature cystic teratoma with associated seromucinous cystadenoma of the left ovary. Bilateral nephrostomy tubes were placed postoperatively. CONCLUSION Incarcerated procidentia is an uncommon occurrence, which in rare cases may be due to a pelvic mass. Surgical management may be required with colpotomy for removal of the pelvic mass in order to reduce the prolapse and resolve the case.
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Payá Ten C, To J, Cui N. Management of procidentia in an achondroplastic patient. Int Urogynecol J 2022. [PMID: 35312807 DOI: 10.1007/s00192-022-05158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
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Smith MK, Paquette J, Lee PE. Surgical and Pre-Operative Considerations for Managing Pelvic Organ Prolapse in a Patient with a Müllerian Duct Anomaly. Int Urogynecol J 2021; 33:159-161. [PMID: 34825922 DOI: 10.1007/s00192-021-05016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Martha K Smith
- Division of Urogynecology, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, B732-2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
| | - Joalee Paquette
- Division of Urogynecology, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, B732-2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Patricia E Lee
- Division of Urogynecology, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, B732-2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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Yuan X, Ng KWR. First reported case of incidental complete passage of multiple vesical calculi after vaginal packing of edematous and ulcerated procidentia. Int Urogynecol J 2021; 33:1693-1695. [PMID: 34661683 DOI: 10.1007/s00192-021-04995-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Xi Yuan
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore
| | - Kwok Weng Roy Ng
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.
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Gill CM, Orfanelli T, Yoxtheimer L, Roy-McMahon C, Suhner J, Tomita S, Kalir T, Liu Y, Houldsworth J, Kolev V. Histology-specific FGFR2 alterations and FGFR2-TACC2 fusion in mixed adenoid cystic and neuroendocrine small cell carcinoma of the uterine cervix. Gynecol Oncol Rep 2020; 34:100668. [PMID: 33241100 PMCID: PMC7672274 DOI: 10.1016/j.gore.2020.100668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 01/28/2023] Open
Abstract
Neuroendocrine small cell carcinoma of the uterine cervix portends a dismal prognosis with limited treatment options. Rarely, tumors of mixed-lineage appear in gynecologic malignancies. Here, we report a 77-year-old woman who presented with complete uterine prolapse and 4-month history of vaginal bleeding. Histopathologic evaluation revealed a mixed adenoid cystic carcinoma and neuroendocrine small cell carcinoma of the uterine cervix. The tumor was PD-L1 and HPV 35 positive. The patient was treated with up-front surgery and adjuvant radiation. Independent, histology-specific alterations in FGFR2 and a FGFR2-TACC2 fusion were identified. Progression of disease occurred within 6 months for which she received chemotherapy and immunotherapy. However, the patient expired within a year. We comprehensively review how screening for and targeting of FGFR alterations in recurrent and metastatic cervical cancer might serve as a touchstone for future treatment regimens.
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Affiliation(s)
- Corey M Gill
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Theofano Orfanelli
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lorene Yoxtheimer
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Christine Roy-McMahon
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jessa Suhner
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Shannon Tomita
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Tamara Kalir
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jane Houldsworth
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Valentin Kolev
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Meshram GG, Kaur N, Hura KS. Complete Rectal Prolapse in Children: Case Report, Review of Literature, and Latest Trends in Management. Open Access Maced J Med Sci 2018; 6:1694-1696. [PMID: 30337991 PMCID: PMC6182530 DOI: 10.3889/oamjms.2018.376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND: Complete rectal prolapse is the circumferential descent of all the layers of the rectum through the anus. It often leads to bleeding, obstructed defecation, incarceration or fecal incontinence. CASE REPORT: We present a rare case of a 4-year-old child with complete rectal prolapse of 12 cm in length. The prolapsed rectum was manually repositioned after reducing the oedema. The precipitating factor was identified as excessive straining while passing stools. A change in position while passing stools was advised along with a high fibre diet and a stool softener. Recurrence was not observed in the 3 month of follow-up. CONCLUSION: Most cases of pediatric rectal prolapse are managed conservatively by addressing the associated and precipitating etiological factors. Surgical intervention may be required for recurrent or persistent cases.
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Affiliation(s)
- Girish Gulab Meshram
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Neeraj Kaur
- Department of Radiology, University of Texas Health Science Centre, San Antonio, Texas, USA
| | - Kanwaljeet Singh Hura
- Department of Paediatrics, Richmond University Medical Centre, Staten Island, New York, USA
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Dawkins JC, Lewis GK, Toy EP. Cervical cancer complicating pelvic organ prolapse, and use of a pessary to restore anatomy for optimal radiation: A case report. Gynecol Oncol Rep 2018; 26:14-16. [PMID: 30148199 PMCID: PMC6106706 DOI: 10.1016/j.gore.2018.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/06/2018] [Accepted: 08/13/2018] [Indexed: 12/20/2022] Open
Abstract
Cervical cancer is the most common gynecologic malignancy worldwide and the third most common gynecologic cancer in the USA. Improved screening methods such as liquid-based cytology accompanied by Human Papilloma Virus (HPV) co-testing have contributed to a declining incidence of cervical cancer. There are approximately 13,000 new cases per year in the United States, accounting for 4200 deaths (Siegel et al., 2011). Pelvic organ prolapse increases with age, obesity and parity. In the absence of bothersome urinary, gastrointestinal or pressure symptoms, patients may choose conservative management options. The index patient was a 72 year old woman with a known history of pelvic organ prolapse who had been managed by her primary physician for 7 years until she developed new-onset vaginal bleeding. One month following worsening prolapse and increased vaginal bleeding she presented to the emergency department and was evaluated. On physical examination the cervix appeared as an 8 cm exophytic fungating mass extruding from the vagina and bled easily from areas of apparent necrosis. Multiple biopsies confirmed an invasive squamous cell carcinoma. The patient underwent the insertion of a Gelhorn pessary and perineorrhaphy to reduce her procidentia, cystocele and enterocele. Chemotherapy with Cisplatin and radiation therapy in the form of brachytherapy and external beam radiation therapy were then administered with curative intent. Cervical cancer complicating a uterine procidentia in an elderly patient is a rare occurrence in the United States and requires a multidisciplinary approach involving a urogynecologist, a gynecologic oncologist and a radiation oncologist. Nonetheless, in carefully selected patients, the outcome can be successful.
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Affiliation(s)
- Josette C Dawkins
- Department of Obstetrics and Gynecology, Rochester Regional Health, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - Gregory K Lewis
- Department of Obstetrics and Gynecology, Rochester Regional Health, 1425 Portland Avenue, Rochester, NY 14621, USA
| | - Eugene P Toy
- Department of Obstetrics and Gynecology, Rochester Regional Health, 1425 Portland Avenue, Rochester, NY 14621, USA
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Maiti S. Posterior Sagittal Mesh Rectopexy (PSMR) and Anal Encirclement with Polypropylene Mesh for Correction of Complete Rectal Prolapse-a New Application. Indian J Surg 2015; 77:244-6. [PMID: 26246712 DOI: 10.1007/s12262-013-0986-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 09/27/2013] [Indexed: 11/25/2022] Open
Abstract
The posterior sagittal route is utilized as an alternative to the abdominal and perineal routes for the operation of a complete rectal prolapse (syn. procidentia). A mesh is interposed between the rectum and sacrum. The mesh also acts as a sling suspended from the sacrum. The levator muscle is repaired from behind. Anal encirclement is made to correct a patulous anus.
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Affiliation(s)
- Sukumar Maiti
- Department of Surgery, Medical College, Kolkata, 88, College Street, Kolkata, 700 073 India ; Vill Bahargram, Post Panskura RS, Dist Purba Medinipur, PIN 721152, West Bengal, India
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Abstract
Rectal prolapse is defined as a protrusion of the rectum beyond the anus. Although rectal prolapse was recognized as early as 1500 BC, the optimal surgical procedure is still debated. The varied operative procedures available for treating rectal prolapsed can be confusing. The aim of treatment is to control the prolapse, restore continence, and prevent constipation or impaired evacuation. In elderly and high-risk patients, perineal approaches, such as Delorme's operation and Altemeier's operation, have been preferred, although the incidence of recurrence and the rate of persistent incontinence seem to be high when compared with transabdominal procedures. Abdominal operations involve dissection and fixation of the rectum and may include a rectosigmoid resection. From the late twentieth century, the laparoscopic procedure has been applied to the treatment of rectal prolapse. Current laparoscopic surgical techniques include suture rectopexy, stapled rectopexy, posterior mesh rectopexy with artificial material, and resection of the sigmoid colon with colorectal anastomosis with or without rectopexy. The choice of surgery depends on the status of the patient and the surgeon's preference.
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Affiliation(s)
- Eung Jin Shin
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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