Intrapelvic Space Research Articles

Arthroscopic Debridement of Intrapelvic Abscess With Coexistent Septic Hip in an Adult Female: A Technical Note

The aim of this study was to describe the technique for debridement of an intrapelvic abscess through an arthroscopic approach. We present a 24-year-old female with an obturator internus muscle abscess that extended across the obturator membrane and into the hip joint. Decompression of the intrapelvic abscess through hip arthroscopy was planned after close examination of preoperative images. Intrapelvic space was safely accessed by hip arthroscopy. The patient was asymptomatic and had normalized biomarkers at 6 months; however, the abscess recurred at 1 year postoperation. Details of the technique for intrapelvic access and anatomic structures at risk are described in this study.

Abdominal Myomectomy for Huge Uterine Myomas with Intra-arterial Balloon Occlusion: Approach to Reduce Blood Loss.

Abdominal myomectomy for a huge myomas, especially uterine cervical myoma, is difficult because of risks, such as intraoperative bleeding or injury to adjacent organs. Therefore, understanding of the positional relationships among a huge myoma, especially cervical or intraligamental myoma, and the vascular plexuses in the right and left cardinal ligaments is important for prevention of massive bleeding during myomectomy. While sufficiently performing preoperative assessment with pelvic examination, ultrasonography, magnetic resonance imaging (MRI), etc., surgeons should always keep in mind how they can reduce the blood loss volume, while safely and surely performing resections. For a cervical myoma of the uterus and giant uterine leiomyoma that leave no intrapelvic space and prevent palpation and identification of the uterine arteries and the internal iliac arteries, surgery can be performed safely by preoperatively placing balloon catheters in the internal iliac arteries. Hemostaic strategies for myomectomy and tips of subsequent pregnancy following myomectomy are also described.

A Case of Rectal Obstruction Caused by Bilateral Internal Iliac Artery Aneurysms

In this article, we report a rare case of rectal obstruction caused by bilateral internal iliac artery aneurysms that required open surgical repair. A 73-year-old man was admitted to our hospital complaining of abdominal pain and persistent constipation for >1 month. Computed tomography demonstrated bilateral internal iliac artery aneurysms, 5.0 and 7.0 cm each in diameter, which occupied the intrapelvic space. An urgent surgery was performed to reduce the volume of the aneurysms and release the obstructed rectum. The postoperative course was uneventful, in which he had good evacuation. Aneurysms in the iliac region can be a good indication for the use of newly developed endovascular devices; however, open surgery should be considered without delay to avoid ileus or subileus symptoms when the aneurysms cause space-occupying complications.

A case of a cellular schwannoma variant arisen in an intrapelvic space

Cellular schwannoma is rare neoplasma and often situates in deep structures, so that its diagnosis is quite difficult. We herein report a case of a cellular schwannoma variant arisen in an intrapelvic space. A 62 year-old female had a magnetic resource imaging (MRI) examination of the lumber, which indicated a mass in the intrapelvic space behind the rectum. In T1-weighted image, the mass was slight low in intensity with cystic lesions being low. In T2-weighted image, the majority of the mass was low in intensity, whereas diffuse cystic lesions within it high. In computed tomography (CT), the tumor was well-demarcated round mass with heterogeneous low and intermediate attenuation area and punctual calcification. Because the mass was highly suspected as a pelvic mesenchymal neoplasm such as gastrointestinal stromal tumor or sarcoma, operation was performed. At laparotomy, the tumor had a thin capsule without invasion to the rectum or the mesorectum, and was arisen from the left hypogastric nerve. We cut off the left hypogastric nerve to extirpate the tumor. Macroscopically, it was a solid tumor and the color of the cutting surface was yellow-white with cysts. Pathologically, the tumor consisted of compact spindle cells arranged in short bundles or interlacing fascicles with high density. Nuclear palisading and Verocay body formation that is seen in the typical schwannomas were not spotted. Hyalinization, hemorrhage, xanthic change and lipofuscin precipitation were detected. Mitosis and necrosis were not present. Immunohistochemically, S-100β and glial fibrillary acidic protein (GFAP) was positive in tumor cells. Smooth muscle actin (SMA), CD34, CD117 and neurofilament were negative. MIB-1 index was less than 5%. Final diagnosis was obtained as a cellular schwannoma variant.

Parametropathy: novel principal cause of female unexplained chronic pelvic pain, and its diagnostic method and effective therapy

Female chronic pelvic pain (CPP) is a common and serious problem for both women and gynecologists. When laparoscopy fails to reveal the cause of CPP, it is diagnosed as unexplained CPP (UCPP). Although several etiologies, including psychogenic disorders, have been hypothesized, the cause of UCPP is unknown, and, unfortunately, most patients with UCPP ultimately undergo hysterectomy. Since laparoscopy cannot detect the cause of UCPP, the cause of UCPP may lie in the extraperitoneal and intrapelvic space.

Sacrococcygeal teratoma [SCT] in adults: Report Of A Case And Literature Review

Background: Sacrococcygeal teratomas [SCT] are derived from embryonic germ-cell layers and are mostly encountered in infants. In adults, this entity is extremely rare and always worrisome for malignancy. Methods: The authors present a case of a 42-year-old woman with the pathologic diagnosis of SCT. The clinical presentation, the histologic findings and the patients' clinical outcome are described. A review of the literature on SCT in adults is also presented. Results: In this patient, who had no evidence of recurrence after adequate resection, examination of the specimen showed mature SCT. Conclusion: Although rare in adults, SCT should be considered in the differential diagnosis of patients with a pelvic mass presenting with obstructive symptoms. Modern imaging techniques may be helpful to delineate the extent of the mass, and surgical removal is generally indicated at the time of detection. Sacrococcygeal mature teratoma is surgically curable if the lesion is completely resected. The presence of malignant transformation is associated with a less favorable outcome. SUMMARY The sacrococcygeal area is the most frequent site of teratoma in infancy. This tumor rarely presents in adulthood, and is confined mostly to the intrapelvic space. Most common are benign, also called mature teratomas. We report a case of adult saccroccocygeal teratoma treated in our hospital, and a literature overview.Introduction The sacrococcygeal area is the most frequent site of teratoma in infancy [ 1]. A female, rather than male, predominance exists [ 2, 3]. This tumor rarely presents in adulthood. Unlike teratomas in infants, which are externally visible in 90% of cases, sacrococcygeal teratomas in adults are confined mostly to the intrapelvic space [ 4]. Most common are benign,

Radical Perineal Prostatectomy: A Novel Approach For Lymphadenectomy from Perineal Incision

A major disadvantage of radical perineal prostatectomy is that lymphadenectomy cannot be performed through the same incision. We developed a novel approach to access the obturator and internal iliac lymph nodes, partially the external iliac lymph nodes, via the perineal incision. We describe the method of lymphadenectomy. After moving the rectum off of the prostate we separate the levator ani muscle and endopelvic fascia from the lateral prostate with finger dissection. A trocar mounted balloon distention device is inserted toward this space and distended with 200 cc air to create an intrapelvic space. Using several retractors or laparoscopy for viewing we first identify the obturator nerve and then the external iliac vessels next in order of depth. By retracting the obturator nerve with vessel tape we perform lymph node dissection between the obturator nerve and external iliac vessels under direct vision or laparoscopic guidance. We have performed this technique in 20 consecutive patients because of prostate specific antigen greater than 10 ng/ml, Gleason score greater than 7 or bilateral disease. Bilateral lymph node dissection required 15 to 20 minutes. No major bleeding or complications occurred. The number of nodes was similar to that in our retropubic prostatectomy series because of the limited lymphadenectomy that we usually performed. Fecal incontinence and potency results were almost the same as in patients without lymphadenectomy. Although urinary continence was not good at catheter removal on day 7, patients became dry in 1 to 6 months. This method resolves the major disadvantage of perineal prostatectomy. Radical perineal prostatectomy with lymphadenectomy via the same incision is feasible and reproducible.