Cyclic Abdominal Pain Research Articles

Endometriosis of the Abdominal Wall: A Case Report

Abdominal wall endometriosis is a rare condition characterized by the presence of endometrial tissue outside the uterus, typically within the abdominal wall muscles. This condition often presents with cyclic abdominal pain, swelling, and a palpable mass, mimicking other abdominal pathologies. Diagnosis is challenging and requires a high index of suspicion, especially in women of reproductive age with a history of pelvic endometriosis. Imaging studies such as ultrasound and MRI can aid in diagnosis, but definitive diagnosis is made through histopathological examination of excised tissue. Treatment options include surgical excision of the lesion with clear margins to alleviate symptoms and prevent recurrence. Multidisciplinary collaboration between gynecologists and general surgeons is essential for optimal management of abdominal wall endometriosis cases. We present the case of a 38-year-old female patient diagnosed with endometriosis involving the right abdominal muscle.

Cannabinoid hyperemesis syndrome: Clinical trajectories and patterns of use three months following a visit to the emergency department.

Cannabinoid hyperemesis syndrome (CHS) is a clinical condition of cyclic vomiting, nausea, and abdominal pain associated with chronic cannabis use. Despite increased recognition of CHS, there are limited details on cannabis use practices and symptoms over time. Understanding what happens in the period surrounding the emergency department (ED) visit, including any changes in symptoms and cannabis use practices following the visit, can help inform the development of patient-centered interventions around cannabis use disorder for patients with CHS. A prospective observational cohort (n = 39) of patients with suspected CHS recruited from the ED at the time of a symptomatic cyclic vomiting episode was followed for 3 months. Disease progression, cannabis use practices, and health care utilization were monitored. Participants reported high rates of persistent CHS symptoms (abdominal pain, nausea, or cyclic vomiting) in the 2-week period immediately following an ED visit with a median duration of 7 days. Cannabis use frequency and quantity were reduced immediately after the ED visit, but most participants returned to pre-ED visit cannabis use patterns within a few days. Recurrent ED visits for cyclic vomiting were reported by 25% of participants who completed follow-up during the 3-month follow-up period. Participants continued to have ongoing symptoms after the ED visit, but most managed symptoms on their own and did not return to the ED. Longitudinal studies beyond 3 months are needed to better understand the clinical course of patients with suspected CHS.

Cryptomenorrhea due to Agenesis of Upper Part of Vagina Treated by Vaginoplasty with Amnion Graft and Cervicovaginal Anastomosis: a Case Report

Cryptomenorrhea due to vaginal agenesis is a rare developmental anomaly of Mullerian duct. It may be complicated by retrograde menstruation, endometriosis and acute or chronic pelvic infection. We report a case of a 12-year-old girl who presented with a history of severe cyclical lower abdominal pain for 2 months. Her clinical examination revealed well developed secondary sexual characteristics, slightly bulged lower abdomen with a palpable tender mass and a short blind vagina. Ultrasound imaging showed hematometra, hematocervix and vaginal agenesis. She was treated by vaginoplasty with amnion graft and cervicovaginal anastomosis with serial vaginal dilatation using plastic vaginal mold. The patient was symptom free with regular menstruation on follow up visit at 1, 3 and 9 months. The Uterus was normal in size with empty cavity and well-defined endometrial lining on ultrasound. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):49-51

Thoracic Endometriosis Syndrome: a case series and review of literature

Background: The presence of endometrial tissue in the tracheobronchial tree, pleural, and lung is normally referred to as thoracic endometriosis. The association of catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis and pulmonary nodules is referred to as thoracic endometriosis syndrome (TES). TES is rare but not as rare as it has always been thought of.
 Case summaries:
 Case 1: We present EA, a 26-year-old chef/baker who presented to our unit on account of recurrent cyclical right sided chest pain and difficulty in breathing, recurrent haemoptysis and cyclical abdominal pain and swelling with multiple tender umbilical nodules. On general physical examination she was found to be in respiratory distress but not cyanosed with peripheral arterial oxygen saturation 97% on room air. Examination of the chest revealed a right sided chest fullness and reduced movement with breathing. Percussion note was stony dull and absent of breath sound on right hemithorax. Abdominal examination revealed a moderately distended abdomen with positive fluid thrill. Both Pleurocentesis (thoracocentesis) and paracentesis abdominis yielded a haemorrhagic fluid acellular and pleural and lung biopsy demonstrated endometrial stroma and glands. Imaging examination by way of chest X-ray showed a homogenous opacity of the right hemithorax, and pulmonary nodule following drainage. A diagnosis of Thoracic Endometriosis Syndrome was made. She had VAT with lung and pleural biopsy, pleural abrasion and a thoracostomy tube drainage.
 Case 2: We present IAE, a 29year-old Po+0 who presented to our unit on account of recurrent cyclical right sided chest pain and difficulty in breathing, unproductive cough. On general physical examination she was found to be in moderate respiratory distress but not cyanosed with peripheral arterial oxygen saturation of 98% on room air. Chest examination revealed an apical flattering of anterior chest wall with left trachea deviation. Percussion note was stony dull on the right lower third and hyper resonance middle and upper zones of right hemithorax. Pleurocentesis (thoracocentesis) yielded air and haemorrhagic fluid acellular and pleural and lung biopsies demonstrated endometrial stroma and glands. Imaging examination by way of chest X-ray and chest CT-scan showed air fluid level of the right hemithorax. A diagnosis of TES was made. She had Laparoscopy and VAT at the same sitting with pleural and lung biopsies. She was managed medically after closed thoracostomy tube drainage. She had partial collapse of right lower lobe and thoracotomy with right lower lobectomy was planned but patient declined. She also had Stage IV endometriosis by (rASRM)/ENZIAN systems
 Case 3: We present JA a 29-year-old lady, a filling station attendant who presented to our unit with a history of gradual onset of right sided chest pain, progressive difficulty in breathing and non-productive cough, and abdominal pain and swelling. On general physical examination she was found to be in respiratory distress but not cyanosed with SPO2 of 98% on room air. Examination of the chest revealed a right apical flattening, reduced ipsilateral chest movement with breathing. Percussion notes were stony dull and absent air entry on the ipsilateral hemithorax. Abdominal examination showed a mildly distended abdomen with a positive shifting dullness. Both Pleurocentesis (thoracocentesis) and paracentesis abdominis yielded a haemorrhagic fluid acellular at cytology and pleural and lung biopsy demonstrated endometrial stroma and gland. Imaging examination by way of chest X-ray showed a homogenous opacity of the right hemithorax. A diagnosis of Familial Thoracic Endometriosis Syndrome (FTES). Had USS guided lung and pleural biopsy and a thoracostomy tube drainage. She had chemical pleurodesis with tetracycline
 Conclusion: Thoracic endometriosis syndrome is the diagnosis in a lady of reproductive age who present with cyclic or a cyclical recurrent right sided chest pain, cyclical or a cyclical dyspnoea, haemoptysis, cyclical or a cyclical abdominal swelling and peritonitis.

The Use of the Malecot Catheter and Modified Stent Insertion in Transverse Vaginal Septum

A transverse vaginal septum is a Mullerian duct anomaly that occurs when there is a congenital failure of the lower vaginal central cells to generate. Severe cyclical abdominal pain can occur shortly after menarche. The retrograde menstrual flow can cause peritoneal inflammation, adhesion, and even infertility. This case series aims to describe the use of a modified corrugated stent and malecot catheter which has shown favourable results in maintaining vaginal patency. The post-operative care is always a challenge. Re-stenosis was extremely common and poorly reported despite the greatest surgical procedures in transverse vaginal septum, especially in high septum or thick septum. The malekot catheter insertion not only serves as a guide for future septum excision, but it can also self-prepare the young child to conduct the dilation with continued counseling while the menses are still present. Despite the usual return of menstruation based on the malekot catheter, the emphasis on regular dilation remains crucial. According to specific institutional experiences in China, the catheter can be implanted for up to three years without showing signs of infection.

Endo Belly: What Is It and Why Does It Happen?-A Narrative Review.

Endometriosis is a chronic inflammatory disease where endometrial-like lesions settle outside the uterus, resulting in extensive inflammatory reactions. It is a complex disease that presents with a range of symptoms, with pain and infertility being the most common. Along with severe dysmenorrhea, cyclic and acyclic lower abdominal pain, cyclic dysuria and dyschezia, dyspareunia, and infertility, there are also nonspecific complaints that can cause confusion and make endometriosis the chameleon among gynecological diseases. These symptoms include unspecific intestinal complaints, cyclic diarrhea, but also constipation, nausea, vomiting, and stomach complaints. It appears that in addition to general bowel symptoms, there are also specific symptoms related to endometriosis such as cyclic bloating of the abdomen, known as endo belly. During the second half of the menstrual cycle leading up to menstruation, the abdomen becomes increasingly bloated causing discomfort and pain due to elevated sensitivity of the intestinal wall. Patients with endometriosis exhibit a reduced stretch pain threshold of the intestinal wall. Here, we review the endo belly, for the first time, pathophysiology and the influence of other diseases (such as irritable bowel syndrome-IBS), microbiome, hormonal levels, inflammation, and diet on the presentation of this condition.

Laparoscopic-assisted neo-cervico-vaginal anastomosis and neo-vagina creation in congenital atresia: A retrospective study measuring the outcome and success

We aimed to study the surgical outcomes of vaginoplasty and laparoscopic-assisted cervical-vaginoplasty carried out using our set-up from June 2016 to December 2022. Additionally, we measured the success of our modified laparoscopy-assisted neo-cervical creation. A retrospective study. The study was conducted in a tertiary care center and included all patients who underwent vaginoplasty and neo-cervico-vaginal creation using the rail-road method. A total of 33 patients were followed-up meticulously and their outcomes were noted. The study was retrospective and largely depended on patient compliance during follow-up. Of the 33 patients, 22 underwent vaginoplasty (McIndoe technique) and 11 underwent neo-cervico-vaginoplasty (rail-road method using both open and laparoscopic methods). The most common presentation was primary amenorrhea (cyclic abdominal pain with primary amenorrhea) and urinary retention. Four patients underwent hysteroscopy-guided hematometra drainage and none underwent hysterectomy. The average vaginal length measured during the follow-up was 5.2±1.90cm. Significant symptom relief was observed. Longest follow-up duration was 4.7 years with a mean duration of 210 (180) days. Although the procedure is strenuous, postoperative results showed satisfactory outcomes in improving the quality of life of patients. With expertise in the technique, the associated comorbidity is reduced, which provides relief for the patients.

Perforated Transverse Vaginal Septum with Primary Infertility: A Case Report

IntroductionA transverse vaginal septum develops when the canalization of the vaginal plate fails at the intersection of the mullerian duct and the urogenital sinus and It is a rare genital abnormalities in women, with an estimated incidence of 1/70,000 females. Patient with transverse vaginal septum may present with primary amenorrhea, cyclical abdominal pain, haematocolpos, haematometra and infertility. Women with perforated septa may menstruate but have trouble during intercourse. The diagnosis is typically made by a clinical examination together with ultrasound and MRI used for confirmation. We report a case of 24 years female presented with infertility for 5 years diagnosed with perforated transverse vaginal septum managed with resection of septum by hysteroscopy and laparoscopy.

Diaphragmatic Endometriosis-A Single-Center Retrospective Analysis of the Patients' Demographics, Symptomatology, and Long-Term Treatment Outcomes.

Diaphragmatic endometriosis is rare and forms 0.67-4.7% of all endometriosis cases. Evidence regarding its optimal management is lacking. In this study, we retrospectively analyzed the patient characteristics and long-term treatment outcomes of diaphragmatic endometriosis patients. Over a 4-year period, 23 patients were diagnosed with diaphragmatic endometriosis. The majority of patients had coexisting deep pelvic endometriosis. Cyclic upper abdominal pain was reported by 60.9% of patients, while cyclic chest and shoulder pain were reported by 43.5% and 34.8% of patients, respectively. Most patients were treated with laparoscopic lesion ablation, while 21.1% were treated with minimally invasive excision. The mean follow-up time was 23.7 months. Long-lasting resolution of the chest, abdominal, and shoulder pain occurred in 50%, 35.7%, and 25% of patients, respectively. Nonetheless, 78.9% of patients reported major improvement in their symptoms postoperatively. Significantly higher rates of postoperative shoulder, abdominal, and chest pain were observed in patients who received postoperative hormonal therapy compared with those who did not. All patients treated expectantly remained stable. Therefore, we recommend treating diaphragmatic endometriosis only in symptomatic patients. The risk of incomplete surgery should be minimized by a multidisciplinary diagnostic and therapeutic approach with a careful assessment of the diaphragm and the thoracic cavity.

Holistic treatment of endometriosis

The pain phenomena caused by endometriosis are manifold. In addition to nociceptive pain there is also anociplastic reaction with central sensitization. Atypical symptoms, such as acyclic lower abdominal pain, radiating pain, nonspecific bladder and intestinal complaints or even depression increasingly occur in addition to the classical cyclic complaints, such as severe dysmenorrhea, cyclic lower abdominal pain, dyspareunia, dysuria and dyschezia. Due to the diffuse range of symptoms, affected patients often consult not just gynecologists but also specialists from other disciplines (internal medicine, gastroenterology, orthopedics, pain therapy, psychology etc.). The complexity of endometriosis is presented. The resulting approaches to multimodal interdisciplinary holistic treatment are described. Interdisciplinary concepts should be involved in the optimal treatment of endometriosis patients along with hormonal and surgical treatment, mostly under the supervision of agynecologist and pain management, dietary changes, psychological support and physiotherapeutic management should also be included. This article provides an overview of possible treatment strategies for chronic symptomatic endometriosis. Based on multimodal treatment strategies and regarding the complex pathophysiological alterations of this disease, the complex complaints that significantly impair the quality of life of endometriosis patients can be greatly improved.

Robot-assisted Laparoscopic Excision of Abdominal Wall Endometrioma Utilizing Intraoperative Ultrasound and Transabdominal Needle Placement

In patients with endometriosis, extra pelvic endometriosis is estimated to have an incidence of 11% and a rare subset of extra pelvic lesions include abdominal wall endometriosis with an incidence of 0.03-3.5%1,3. Evaluation for and surgical management of abdominal wall endometriosis is an essential skillset for the advanced gynecologic surgeon. In this video, we demonstrate a surgical technique for robot-assisted laparoscopic excision of abdominal wall endometriosis with intraoperative ultrasound-guided needle placement. Description and demonstration of surgical technique. Patient with previous history of 2 cesarean sections and right lower quadrant cyclic abdominal wall pain. Tertiary care, academic center INTERVENTIONS: Intraoperative ultrasound-guided needle placement to map location and boundaries of the lesion followed by minimally invasive resection of the lesion with the intermittent advancement and withdrawal of needles to confirm clear margins. Minimally invasive resection of abdominal wall endometriosis using intraoperative ultrasound guided needle placement is an effective technique to guide surgical dissection and allow for clear surgical margins and successful treatment of this rare condition.

A Classical Case of Cesarean Scar Endometriosis in a 35-Year-Old Woman Presenting with Cyclical Abdominal Pain: A Case Report.

BACKGROUND This report details the case of a 35-year-old woman who presented with cyclical abdominal pain diagnosed as cesarean scar endometriosis. Scar endometriosis is a phenomenon that occurs after abdominal/pelvic procedures like cesarean sections; after which, it is called cesarean scar endometriosis. It is frequently misdiagnosed as hernias, granulomas, abscesses, hematomas and neoplasms, and thus needs proper investigation to diagnose. The classic triad of symptoms are a positive surgical history, cyclical pain, and a mass at the surgical scar. Magnetic resonance imaging (MRI) is the imaging of choice owing to its high sensitivity and specificity when diagnosing scar endometriosis. CASE REPORT We report a 35-year-old woman who presented to the Obstetrics and Gynecology (OB/GYN) clinic with a triad of positive surgical history (cesarean section), cyclical abdominal pain, and an abdominal mass. Physical examination revealed a protruding, hyperpigmented mass at the left corner of the Pfannenstiel incision. An MRI was done, which showed a 3×3×3.5 cm left lower abdominal wall soft-tissue mass. A clinical diagnosis of scar endometriosis was made based on suggestive history, physical examination, and imaging. The mass was surgically removed and the patient made a full recovery. CONCLUSIONS Cesarean scar endometriosis is a complication of cesarean sections and should be a differential diagnosis when considering female patients with an abdominal mass and cyclical pain following an abdominal surgical procedure. A clinical diagnosis is made on the basis of thorough history-taking, physical examination, and imaging (particularly MRI). The criterion standard treatment is surgical excision.

Erythema Ab Igne Associated With Cannabinoid Hyperemesis Syndrome

A woman in her early 50s presented with a chronic rash and abdominal pain. The patient’s pain was relieved by prolonged hot showers. When the patient’s hot water ran out, she found that using a heating pad provided more sustained relief. She subsequently cut off the cover of heating pads to augment the temperature and used this continuously on her abdomen throughout the day. The patient smoked cannabis for 38 years but noticed stomach pain with the introduction of medicinal marijuana within the past 2 years. Physical examination demonstrated reticulated, hyperpigmented, and erythematous patches with desquamative scaling (Figure). A punch biopsy revealed a subepidermal blister with epidermal atrophy and dermal melanophages. Results of direct immunofluorescence were negative, confirming the diagnosis of bullous erythema ab igne. Erythema ab igne is a cutaneous disorder caused by chronic exposure to heat. Typical sources include space heaters, fireplaces, heating pads, and heating blankets. Rarely, squamous cell carcinoma can result. The treatment of choice is discontinuation of the heat source. Cannabinoid hyperemesis syndrome (CHS) is an increasingly reported disorder manifested by cyclical nausea, vomiting, or abdominal pain that is relieved by prolonged and extreme heat.1Chang Y.H. Windish D.M. Cannabinoid hyperemesis relieved by compulsive bathing.Mayo Clin Proc. 2009; 84: 76-78https://doi.org/10.1016/S0025-6196(11)60811-2Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar Abstinence from the use of cannabis is the only known therapy to definitively treat the syndrome.2Simonetto D.A. Oxentenko A.S. Herman M.L. Szostek J.H. Cannabinoid hyperemesis: a case series of 98 patients.Mayo Clin Proc. 2012; 87: 114-119https://doi.org/10.1016/j.mayocp.2011.10.005Abstract Full Text Full Text PDF PubMed Scopus (247) Google Scholar In addition to heat, capsaicin topical cream has been used to alleviate abdominal pain. Haloperidol and droperidol may be used for nausea and vomiting symptoms.3Razban M. Exadaktylos A.K. Santa V.D. Heymann E.P. Cannabinoid hyperemesis syndrome and cannabis withdrawal syndrome: a review of the management of cannabis-related syndrome in the emergency department.Int J Emery Med. 2022; 15: 45https://doi.org/10.1186/s12245-022-00446-0Crossref Scopus (0) Google Scholar Use of cannabis (also referred to as marijuana, weed, or pot) among all age groups is rapidly rising. Duration and quantity of cannabis used are risk factors for CHS. The introduction of high-potency cannabis, with increased levels of tetrahydrocannabinol, might also be responsible for increased addiction and the emergence of CHS. The World Health Organization4World Health Organizationwww.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/cannabisDate accessed: December 10, 2022Google Scholar and the Centers for Disease Control and Prevention5Centers for Disease Control and Preventionwww.cdc.gov/marijuana/health-effects/ index.htmlDate accessed: December 10, 2022Google Scholar do not specifically list CHS as an acute or chronic health effect of cannabis use. Many physicians are also unsuspecting of this syndrome. Physicians should be aware that abdominal erythema ab igne could be a dermatologic clue to CHS. Our patient was referred to an addiction specialist and directed to use capsaicin 0.1% cream to the abdomen 3 to 4 times daily. The authors report no competing interests.

Amenorea Primer et Hematokolpos et Hematometra ec. Septum Vagina Transversal

Background: Amenorrhea is defined as the absence of menarche in females of reproductive age. Primary amenorrhea is the failure to reach menarche by age 13 with no secondary sexual characteristics if menarche has not occurred five years after initial breast development or if the patient is 15 years or older. A transverse vaginal septum is a rare congenital abnormality in Mullerian duct development that can cause primary amenorrhea. Transverse vaginal septum incidence ranges from 1:2.100 to 1:72.000. The surgical treatment should be carried out as early as possible to prevent vaginal stenosis. Objective: To describe a rare müllerian duct abnormality and its management. Methods: This study is a case report. Primary data was obtained through auto anamnesis, anamnesis, physical examination, and ultrasound workup. Result: A 15 years old girl complained of cyclical abdominal pain a year ago without a history of menstruation. Ultrasound examination showed signs of hematometra and hematocolpos. The septum location was approximately 3cm from the vaginal introitus. We performed simple excision of the septum, then the distal end of the vagina wall of the septum was sutured to the proximal end of the vaginal wall with a simple interrupted suture. The patient was then discharged in good condition. Conclusion: The transverse vaginal septum remains a rare anomaly of the female genital tract; the reasons for its discovery are highly variable according to its shape and location. Haematocolpos remains the main consequence of these septums. The management is based on surgery while considering the risks of postoperative stenosis and the repercussions on the upper genital tract.

Mayer-Rokitansky-Kuster-Hauser syndrome type II with crossed fused renal ectopia: A rare case report

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital disorder characterized by agenesis or aplasia of the uterus. Patients usually present with primary amenorrhea. MRKH can be isolated (type I) or accompanied by other malformations (type II) involving the kidney, skeletal, and vascular systems. Magnetic resonance imaging (MRI) is the mainstay of imaging modality in evaluating this syndrome. A 20-year-old woman presented with cyclic abdominal pain and primary amenorrhea. Secondary sexual characteristics and hormone evaluation were normal. Ultrasound and MRI were conducted and revealed no normal uterus structure with ectopic ovarium and crossed fused ectopic renal.

Safety and efficacy of microwave ablation for abdominal wall endometriosis: A retrospective study.

This retrospective study aimed to evaluate the safety and feasibility of ultrasound-guided microwave ablation in the treatment of abdominal wall endometriosis (AWE). AWE is a rare form of endometriosis that often results in cyclic abdominal pain. The current treatment algorithm for AWE is not well established. Microwave ablation technology is a promising new thermal ablation technique for treating AWE. This was a retrospective study of nine women with pathologically proven endometriosis of the abdominal wall. All patients were treated with ultrasound-guided microwave ablation. Grey-scale and color Doppler flow ultrasonography, contrast-enhanced ultrasonography, and MRI were used to observe the lesions before and after treatment. The complications, pain relief, AWE lesion volume, and volume reduction rate were recorded 12 months after treatment to evaluate the treatment efficacy. Complications were classified according to the Common Terminology Criteria for Adverse Events and the Society of Interventional Radiology classification system. Contrast-enhanced ultrasound showed that all lesions underwent successful treatment with microwave ablation. The average initial nodule volume was 7.11 ± 5.75 cm3, which decreased significantly to 1.85 ± 1.02 cm3 at the 12-month follow-up with a mean volume reduction rate of 68.77 ± 12.50%. Periodic abdominal incision pain disappeared at 1 month after treatment in all nine patients. The adverse events and complications were Common Terminology Criteria for Adverse Events grade 1 or Society of Interventional Radiology classification grade A. Ultrasound-guided microwave ablation is a safe and effective technique for the treatment of AWE, and further study is warranted.

V04-03 COMBINED ROBOTIC TRANSPERITONEAL AND TRANSVAGINAL PULL-THROUGH FOR REPAIR OF DISTAL VAGINAL ATRESIA: A VIDEO CASE REPORT

You have accessJournal of UrologyCME1 Apr 2023V04-03 COMBINED ROBOTIC TRANSPERITONEAL AND TRANSVAGINAL PULL-THROUGH FOR REPAIR OF DISTAL VAGINAL ATRESIA: A VIDEO CASE REPORT Jeremiah Dallmer, Peris Castaneda, Andrew Freedman, and Paul Kokorowski Jeremiah DallmerJeremiah Dallmer More articles by this author , Peris CastanedaPeris Castaneda More articles by this author , Andrew FreedmanAndrew Freedman More articles by this author , and Paul KokorowskiPaul Kokorowski More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Distal vaginal atresia is a unique Mullerian pathology where the urogenital sinus, responsible for the lower 1/3 of the vagina, fails to cannulate during development. Unlike Meyer-Rokitansky-Kuster-Hauser syndrome, which is characterized by agenesis of the upper vagina and uterus, patients with distal vaginal atresia have normal Mullerian development including the uterus and proximal vagina. METHODS: We present the case of a 12 yo female with a three month history of cyclical abdominal pain. Upon outside workup, she was found to have a short, blind ending vagina. MRI showed a 9 cm x 8 cm dilated uterus, open cervix and proximal vagina filled with blood products. She was taken to the operating room for combined perineal and robotic transperitoneal pull-through. RESULTS: An 8.5 mm camera port was placed in the umbilicus and three 8.5 mm working ports were placed using a hidden incision approach below the belt line. We incised the peritoneum and dissected as distally as feasible along the rectovaginal space. At the blind-ending introitus, a U-shaped incision was made to create an anterior flap. This space was dissected proximally, monitoring the correct plane via a finger in the rectum and with direct visualization with the robotic camera. The two planes were connected. A 0-silk was robotically placed to manipulate the vagina. As the vagina was severely dilated from menstrual products, mobility was insufficient to reach the introitus. A small posterior incision on the proximal vagina was made and blood products were partially evacuated. The vesicovaginal space was then dissected robotically, maintaining the lateral attachments as blood supply and avoiding ureteral injury. The vaginal apex was then pulled to the introitus and anastomosed to the anteriorly based flap from the introitus. The patient remained hospitalized for two days with vaginal packing in place. She was trained in the use of vaginal dilators and has been progressively increasing the size without difficulty. CONCLUSIONS: Robotic dissection of the proximal vagina in the setting of distal vaginal atresia using a hidden incision approach allows for orthotopic reconstruction, and superior aesthetics as compared to traditional port placement. This approach obviated the need for the use of tissue grafting or more extensive open dissection. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e338 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeremiah Dallmer More articles by this author Peris Castaneda More articles by this author Andrew Freedman More articles by this author Paul Kokorowski More articles by this author Expand All Advertisement PDF downloadLoading ...

“I still partly think this is bullshit”: A qualitative analysis of cannabinoid hyperemesis syndrome perceptions among people with chronic cannabis use and cyclic vomiting

BackgroundCannabis is the most widely used psychoactive substance in the United States (US), with reported use patterns increasing among adults in recent years. Cannabinoid hyperemesis syndrome (CHS) has been one concern related to increased cannabis use patterns. US emergency departments have reported an increase of CHS cases over the last decade, yet little is known about CHS. This study explores the experiences of people with chronic cannabis use and cyclic vomiting and their perceptions of CHS. MethodsSemi-structured interviews were conducted with 24 people recruited from a prospective cohort of patients presenting to Rhode Island emergency departments with symptomatic cyclic vomiting and chronic cannabis use. Data were analyzed thematically using NVivo. FindingsParticipants characterized their cyclic vomiting as related to food and alcohol consumption patterns, stress, and existing gastrointestinal issues. Despite recurrent episodes of cyclic vomiting, nausea, and abdominal pain, many participants remained uncertain whether their symptoms were driven by cannabis. Many participants relied on at-home research to assess their symptoms and seek out management approaches. Clinical treatment recommendations focused on cannabis cessation. However, most participants felt clinical recommendations failed to consider the complexity and challenge of stopping cannabis use given the chronicity of use and therapeutic benefits some perceived cannabis to have. ConclusionsAlthough cannabis cessation is the only reported CHS cure to date, additional clinical and non-clinical treatment approaches are needed to better support people with chronic cannabis use and cyclic vomiting to meet their ongoing needs.

Isolated Retroperitoneal Deep Infiltrating Endosalpingiosis in Absence of Endometriosis

A 36 year-old female presented with a 4-year history of cyclic left lower abdominal pain and severe dyspareunia. Physical exam revealed a 2cm tender, mobile nodule at the left apex of the vagina with normal overlying vaginal mucosa. Magnetic resonance imaging demonstrated a 1.6 × 1.6 × 1.7cm round, solid smooth intramural mass in the bladder base, without mucosal invasion (Figure 1). The patient elected surgical management, with cystoscopy demonstrating a large bulge adjacent to the left ureteral orifice without mucosal involvement (Figure 2).

Antenatal ultrasound diagnosis of huge fetal hydrometrocolpos secondary to imperforate hymen and successful postnatal treatment: a case report

Abstract Objectives Hydrometrocolpos is a pelvic cystic mass representing the distension of the vagina and uterus due to obstructive congenital anomalies of the female causing accumulation of fluid secretions in the vagina and endometrial cavity. Prenatal diagnosis is uncommon and usually noticed during the adolescent period for failure to see menses with cyclic abdominal pain, abdominal mass, and local compressive symptoms. Late diagnosis after delivery of newborns with this condition results in poor outcomes from local compressive symptoms. Case presentation Here, we present a case diagnosed with congenital hydrometrocolpos at 39 weeks of gestation during routine third-trimester ultrasound scanning. The newborn was delivered vaginally and huge hydrometrocolpos secondary to imperforate hymen was diagnosed postnatally, and a hymenectomy was done and the newborn was discharged and improved from the hospital. Conclusions Although congenital hydrometrocolpos occurs rarely, it is also better to suspect prenatally in a female fetus with a cystic pelvic mass. Antenatal ultrasound diagnosis of this condition will help to make decisions early and to prevent further complications which might occur both intrauterine and after birth.