Lower Quadrant Research Articles

Concomitant Bouveret’s syndrome and gallstone ileus: case report and literature review

Gallstone ileus and Bouveret's syndrome are rare gallstone complications; therefore, their combination is even rarer. The delay of diagnosis is associated with high rates of morbidity and mortality. We reported a 65-year-old woman presented with a three-day history of epigastric and lower right abdominal pain, nausea, and vomiting. A radiopaque shadow was noted on an abdominal X-ray in both the right upper and lower quadrants. In addition to the cholecysto-duodenal fistula, the CT abdomen revealed a combined ileal gallstone ileus with small bowel dilatation and stone in the second portion of the duodenum (Bouveret's syndrome). Initial attempts to extract duodenal stones endoscopically were unsuccessful. Therefore, the patient underwent an exploratory laparotomy and removal of both ileal and duodenal stones. The patient had an uneventful postoperative course. Serious complications include obstruction of the gastric outlet or the small intestine due to gallstone ileus, Bouveret's syndrome, or both. Despite the high failure rate, endoscopic extraction of the stone alone or in combination with lithotripsy is the standard treatment for Bouveret's syndrome. Furthermore, surgical intervention is the standard treatment for gallstone ileus. Gallstone ileus and Bouveret's syndrome remain diagnostic and therapeutic challenges, which necessitate an immediate multidisciplinary approach to prevent substantial morbidity and mortality. Further reports or larger-scale studies are encouraged.

Sigmoid Volvulus in a 13 Year Old Boy − Case Report

Objective − The aim of this report is to present the case of a child with a sigmoid volvulus. Sigmoid volvulus in pediatric patients is a rare but potentially life-threatening condition. This condition occurs when a redundant sigmoid loop, with a narrow mesenteric base of attachment to the posterior abdominal wall, rotates around its mesenteric axis.Case Report − A 13-year-old boy presented as an emergency with a 3-day history of back pain and abdominal distention. Plain abdomen X-ray showed dilated large bowel loops in the upper left quadrant. An abdominal computed tomographic scan revealed a bowel obstruction with swirling of the mesentery, which suggested a sigmoid volvulus. The redundant sigmoid colon was hugely dilated, and was resected after detortion and resection. End to end anastomosis was performed.Conclusion − This case report emphasizes the importance of clinicians keeping a sigmoid volvulus in mind as a rare, yet important differential when considering abdominal pain in young, healthy patients.

Imaging of Perisplenitis as an Unusual Presentation of the Fitz-hugh-curtis Syndrome

Objective − We present the imaging characteristics of an unusual case of Fitz-Hugh-Curtis syndrome (FHCS), a late complication of pelvic inflammatory disease in an adolescent girl with left upper abdominal pain due to perisplenitis seen on contrast-enhanced ultrasound and magnetic resonance imaging.Case Report − A 16-year-old girl presented with acute abdominal pain in the left upper quadrant, vomiting, diarrhoea, and vaginal odour with yellow discharge. She was recently diagnosed with infectious mononucleosis. Abdominal ultrasound showed perisplenic fluid collection that did not enhance post-contrast application, but it did show a mild enhancement of perisplenic tissue. MRI findings indicated perisplenitis. The results of the positive vaginal swab for Chlamydia trachomatis and Ureaplasma parvum and the imaging findings favoured a final diagnosis of FHCS with perisplenitis.Conclusion − Imaging findings, and clinical and laboratory data, including positive vaginal swabs, are crucial to confirm the unusual presentation of FHCS in an adolescent with left upper abdominal pain.

ANALISIS PERBANDINGAN KINERJA KEUANGAN BANK UMUM SYARIAH DENGAN METODE ISLAMICITY PERFORMANCE INDEX DAN MARKET VALUE ADDED

This study aims to analyze the comparison of the financial performance of Islamic Commercial Banks using the Islamicity Performance Index (IPI) and Market Value Added (MVA) methods. The study period covers the years 2018-2021. This research employs a quantitative method with a descriptive approach. The study population includes all Islamic Commercial Banks registered with the Financial Services Authority (OJK) during 2018-2021. The sampling technique used is purposive sampling, resulting in three Islamic Commercial Banks listed on the Indonesia Stock Exchange. The data analysis method involves descriptive analysis and using the Cartesian Diagram of IPI and MVA to determine the position of the Islamic Commercial Banks. The results of this study show that there are four quadrants in the Cartesian diagram, but only two quadrants are occupied by Islamic Commercial Banks. Firstly, Quadrant I, or the Upper Left Quadrant (ULQ), is occupied by Bank Tabungan Pensiunan Negara Syariah (BTPNS) and Bank Syariah Indonesia (BSI), indicating that these two banks have high Market Value Added (MVA) but low Islamicity Performance Index (IPI). Secondly, Quadrant IV, or the Lower Right Quadrant (LRQ), is occupied by Bank Panin Dubai Syariah, indicating that this bank has a high Islamicity Performance Index (IPI) but a low Market Value Added (MVA). Meanwhile, no banks occupy Quadrant II or the Lower Left Quadrant (LLQ) and Quadrant III or the Upper Right Quadrant (URQ), indicating that no banks have both low IPI and MVA or both high IPI and MVA.

Pancreaticopleural Fistula: Navigating the Enigma of an Elusive Diagnosis

BACKGROUND: Pancreaticopleural Fistula is a Rare Complication of Acute and Chronic Pancreatitis. This Usually Presents With Chest Symptoms Due to Pleural Effusion, Pleural Pseudocyst, or Mediastinal Pseudocyst. Diagnosis Requires a High Index of Clinical Suspicion in Patients Who Develop Alcohol-induced Pancreatitis and Present With Pleural Effusion Which is Recurrent or Persistent. Analysis of Pleural Fluid for Raised Amylase Will Confirm the Diagnosis and Investigations Like Ct. The Rarity of Pancreaticopleural Fistulas, Especially Without the Context of Chronic Pancreatitis, Makes This Case Noteworthy. The Presence of Pleural Effusion in the Absence of Lung Disease Prompted Thorough Investigation, Leading to the Identification of an Unusual Etiology. THE CASE: A 35-year-old Alcoholic Male Presented to Emergency Room With 4-day History of Breathlessness Which Was Sudden Onset, Gradually Progressing to Grade-3 Dyspnea on NYHA Scale, Associated With Dry Cough. Hospitalization and Chest Radiograph1 Revealed Gross Right Side Pleural Effusion. Emergency thoracentesis and Intercostal Drainage Tube Placement were done and Patient Was Referred to Pulmonology Department. On further Evaluation, Patient Also Complained of Mild Persistent Left Upper Quadrant Abdominal Pain for More Than 6 Months Which Was Relieved on Medication Hence, Ignoring the Complaint. Thoracentesis Procedure Yielded 1.5l Amylase-rich Fluid in the Pleural Space. The Patient Was Then Referred to Surgical Department for Further Evaluation. Usg Abdomen Was Inconclusive. Lab Reports Revealed Mildly Elevated Pancreatic Enzymes. contrast- Enhanced Computed Tomography (Ct) Scan of the Abdomen and Chest Revealed a Dilated Main Pancreatic Duct and Multiple Direct Communication Between the Pancreatic Duct(see Figures 1) and the Right Pleural Space, Leading to the Formation of Massive Pleural Effusion and Complete Collapse of Right Lung. Rest of the Pancreas Appeared Normal With No Evidence of Calcification. After a Thorough Clinical Evaluation, Laboratory Investigations, and Imaging Studies, the Patient Was Diagnosed With a Pancreaticopleural Fistula. The Patient Was Managed Through a Multidisciplinary Approach Involving Gastroenterology, radiology, and General Surgery Teams. Initial Management Included Aggressive Medical Treatment With Bowel Rest, Total Parenteral Nutrition, Antibiotics and Administration of Proton Pump Inhibitors. The Patient Showed Gradual Improvement Post-drainage, With a Significant Decrease in Pleural Effusion Volume and Resolution of Dyspnea. Follow-up With CT scan Was Advised. The patient Was Subsequently Monitored Continuously With Dietary Recommendations. CONCLUSION: the Chosen Case is Significant Due to Its Diagnostic Intricacies and the Necessity for Collaboration Among Various Medical Specialties. The Management of Pancreaticopleural Fistulas Requires a Tailored Approach. This Case Underscores the Importance of Early Diagnosis, Meticulous Evaluation, and Timely Intervention in Achieving Successful Outcomes for Patients. In conclusion,by Sharing This Case, I Aim to Contribute to the Understanding of This Rare Condition and Emphasize the Significance of Timely Diagnosis and Appropriate Management Strategies.

Abdominal viscera in the thoracic cavity: a case of large Bochdalek hernia in an adult

Introduction: Bochdaleck hernias (BH) are a congenital defect in the diaphragm's postero lateral part that may cause the abdominal viscera's protrusion into the chest cavity. This type of hernia is rare in adults. Most cases are referred to the emergency department with gastrointestinal obstruction and visceral strangulation symptoms. Case presentation: A 50-year-old man was referred to the emergency department complaining of abdominal pain in the left upper quadrant, intermittent vomiting, and pain in the left hemithorax from one day ago. We found a large diaphragmatic hernia on the left side during evaluation, which causes intra-abdominal organ shift to the left hemithorax. The patient underwent surgery for diaphragmatic herniorrhaphy. Conclusion: Congenital diaphragmatic Bochdaleck hernias are rare and are associated with nonspecific symptoms in adults. They may be symptom-free during the patient's life as in our case. It is necessary to investigate more cases and long-term follow-ups of patients, to improve the diagnosis and treatment of these patients.

Laparoscopic Surgery of an Isolated Splenic Hydatid Cyst in a 43- Year- Old Man: A Case Report

Introduction: Hydatid disease is a type of parasitic disease mainly affect the lungs and the liver and splenic hydatid cyst is a rare disease. We hereby present a rare case of splenic hydatid disease. Case report: A 43-years-old man with a history of left upper quadrant pain (LUQ) pain, anorexia, weakness, and weight loss was admitted to the surgery department in Iran. The imaging studies showed a cystic mass in the gastro-splenic ligament extending up to below the left diaphragm with adhesion to the spleen capsule and the fundus of the stomach caused focal elevation of this part of the diaphragm. A laparoscopic surgery was performed and splenic hydatid cyst with adhesion to the stomach and the left lobe of the liver and with penetration into the left hemi thorax was observed. Splenectomy, hepatectomy of the left segment of the liver, repair of diaphragmatic defect and stomach release was done. Conclusion: Splenic hydatid cyst surgery can be difficult and requires appropriate diagnostic evaluations and examination for adhesions and invasion to other organs.

Mesenteric Lymphadenopathy: a Rare Case of Rosai-Dorfman Disease

Introduction: 
 Rosai-Dorfman Disease (RDD) is rare with approximately 100 new cases annually in the United States and a mean age of 20.6 years [1]. RDD is characterized by massive lymphadenopathy and sinus histiocytosis [1]. Bilateral cervical lymphadenopathy is the typical presentation, however extra nodal sites have been noted [1]. This case discusses manifestations of a rare disease state. 
 Case Presentation: 
 A 19 year old male with a history of eczema and juvenile rheumatoid arthritis presented to the emergency room with four days of diffuse abdominal pain localized to the left upper quadrant, radiation to the right lateral ribs with nausea and diarrhea. He reported an unintentional weight loss of 30 pounds in the last three months. Physical exam revealed generalized abdominal tenderness and rebound. Computed tomography of the abdomen and pelvis (CTAP) along with routine labs were ordered. CTAP showed retroperitoneal lymphadenopathy up to two centimeters in the short axis (figure 1) and mesenteric adenopathy with a 15 millimeter lymph node in the right lower quadrant. Histopathology reported necrotizing granulomatous lymphadenitis with benign sinus histiocytes. Referral to rheumatology was made and treatment was initiated with prednisone 20 milligrams daily with plans for repeat abdominal imaging to evaluate for reduction of adenopathy. 
 Discussion: 
 RDD coexists with immunologic disease in 10% of cases.3 It has been associated with systemic lupus erythematous, idiopathic juvenile arthritis, autoimmune hemolytic anemia,24 and one case of RAS-associated autoimmune leukoproliferative disease [1]. The prognosis for RDD is indolent, 50% of patients experiencing resolution, one third with residual asymptomatic adenopathy and 17% with persistent symptomatology [2]. Our case highlights our patient’s associated history of juvenile rheumatoid arthritis now presenting with histological findings of RDD. A methodical approach to assessing patients with diffuse abdominal pain and ensured collaboration amongst different medical specialists will ensure favorable treatment outcomes.

Abscess formation of abdominal wall mimicking lymphoma due to Morganella morganii infection in a prepubescent children

Introduction: Morganella morganii infection mainly occurred in elderly people and immunocompromised patients.However, the abdominal wall abscess due to Morganella morganii infection in prepubertal children hasn't been documented.Our presented case is a 4-year-old male patient with a 1 month history of left lower quadrant abdominal mass. Preoperative ultrasonography showed a hypoechoic, heterogeneous mass and the mass wasn't just confined to the abdominal wall, mimicking lymphoma. On CDFI, an image of highly vascularized mass was demonstrated. The patient underwent lump resection of abdominal wall.Postoperative process was uneventful except intermittent haematuria, and bladder sludge and urethral calculus on ultrasonography.By symptomatic treatment, haematuria disappeared and urethral calculus and bladder sludge decreased. Then the patient discharged home. Postoperative histopathology and immunohistochemistry were suggestive of abscess formation and Morganella morganii was isolated finally from the aspirated pus. Conclusion: Therefore, although the abdominal wall abscess due to Morganella morganii infection is rare, it should not be absent in the differential diagnosis of abdominal wall masses in children. Imaging features of abdominal wall masses should closely integrate the pertinent clinical history.

Progressive Muscle Relaxation Therapy to Reduce Pain Level in Gastritis Patients: A case Study

Introduction: Gastritis is a common gastrointestinal condition often associated with pain and discomfort. Exploring effective pain management strategies is crucial for enhancing the well-being of individuals affected by gastritis. This study investigates the potential effectiveness of progressive muscle relaxation therapy in alleviating pain among gastritis patients. Objective: This study aimed to assess the effectiveness of progressive muscle relaxation therapy in alleviating pain among patients diagnosed with gastritis. Methods: The research was conducted at BLUD RSU Banjar City from May 27 to May 31, 2022. The participant for this study was Mrs. I, a 62-year-old individual presenting complaints of pain in the left upper quadrant of the abdomen. Results: Findings from the case study indicated observable changes post-progressive muscle relaxation therapy. The patient exhibited signs of relaxation, and the pain scale, initially high, decreased to 4 within 2 days after the intervention. Further reduction to a pain scale of 2 was noted using the Numeric Rating Scale method. Conclusion: The study concludes that progressive muscle relaxation therapy exhibits promise in effectively reducing pain. Consequently, this therapeutic approach holds potential applicability in addressing acute pain issues among gastritis patients.

Contribution of Hypersensitivity to Postureteroscopy Ureteral Stent Pain: Findings From Study to Enhance Understanding of Stent-associated Symptoms

To examine the relationships between preoperative hypersensitivity to pain and central sensitization, and postoperative ureteral stent pain after ureteroscopy (URS) for urinary stones. Adults enrolled in the STudy to Enhance uNderstanding of sTent-associated Symptoms (STENTS) underwent quantitative sensory testing (QST) prior to URS and stent placement. Hypersensitivity to mechanical pain was assessed using a pressure algometer. Participants rated their pain intensity to pressure applied to the ipsilateral flank area and lower abdominal quadrant on the side of planned stent placement, and the contralateral forearm (control). Pressure pain thresholds were also assessed. Central sensitization was assessed by applying a pointed stimulator (pinprick) and calculating the temporal summation. Postoperative stent pain intensity and interference were assessed using PROMIS questionnaires. Data were analyzed using repeated-measures mixed-effects linear models. Among the 412 participants, the median age was 54.0years, and 46% were female. Higher preoperative pain ratings to 2 kg and 4 kg mechanical pressure to the ipsilateral flank and abdominal areas were associated with higher postoperative stent pain intensity with the stent in situ. Greater degree of central sensitization preoperatively, manifesting as higher temporal summation, was associated with higher postoperative pain intensity. Factors associated with preoperative hypersensitivity on QST included female sex, presence of chronic pain conditions, widespread pain, and depression. Hypersensitivity to pain and central sensitization preoperatively was associated with postoperative ureteral stent pain, suggesting a physiologic basis for stent symptom variation. QST may identify patients more likely to develop stent pain after URS and could inform selection for preventive and interventional strategies.

Successful management of portal hypertension with splenomegaly and cavernous transformation of the portal vein: a rare case report

Abstract Portal hypertension, often stemming from liver cirrhosis or vascular anomalies, can result in cavernous transformation of the portal vein, a rare condition associated with biliary obstruction, variceal hemorrhage, and splenomegaly. This case report details a unique occurrence of portal hypertension, splenomegaly, and cavernous transformation of the portal vein successfully managed through splenectomy and spleno-renal shunt. A 30-year-old female with a history of portal hypertension, portal gastropathy, and splenomegaly presented with left upper quadrant abdominal pain. She had previously undergone esophageal variceal ligation and required intermittent blood transfusions. Additional complications included easy bruising, heavy menstrual bleeding, and a prior episode of hematemesis. Clinical assessment confirmed splenomegaly, while a CT scan confirmed the diagnosis. A tailored surgical approach was chosen, leading to splenectomy and spleno-renal shunt.

Sculpting life: Studying the intricacies of human fetal spleen morphology during development

Introduction: The spleen, a crucial lymphoid organ, plays a significant role in blood cell production and regulation. Emerging from mesodermal cells in the dorsal mesogastrium during the fourth embryonic week, the spleen is located in the left upper quadrant alongside the tenth rib. This study investigates morphological variations in human fetal spleens, serving as blood filters and storage sites for iron, erythrocytes, and platelets. This study aimed to assess morphological measurements of human fetal spleen development. Materials and Methods: Sixty formalin-preserved fetuses (33 male, 27 female) of varying gestational ages were examined over a three-year period (2020-2023) at the Anatomy Department, Govt. Medical College Srinagar Garhwal, ensuring adherence to ethical guidelines. Gross characteristics such as position, shape, relations, notches & fissures, and ligaments were assessed and statistically analyzed. Results: All fetal spleens were located in the left hypochondrium, with 50% exhibiting a wedge shape. The stomach consistently associated with the spleen, while no relationship was observed between the kidney, left colic flexure, and spleen in early fetal stages. The liver exhibited connections with the fetal spleen. Notches were most prevalent along the superior border, followed by the inferior border and lateral pole, with 27 spleens showing fissures. Conclusions: Studying prenatal spleen development aids in understanding organ pathologies, thereby enhancing diagnostic and preventive techniques. Keywords: Fetal Spleen, Wedge Shape, Notches, Fissures

Situs inversus with levocardia in a 15-year-old male adolescent: a case report

BackgroundSitus inversus with levocardia is a rare anomaly in which the heart is present in the left chest but the abdominal viscera are transposed. It is caused by a single incomplete penetration of an autosomal recessive gene. It is unclear what exactly causes situs inversus with levocardia. Even if situs inversus can be identified following a comprehensive physical examination, it is now possible to validate the results and search for further information and pathologies since medical imaging is so widely accessible.CaseA 15-year-old Oromo male child from a remote area of Bale Zone presented to the Goba Referral Hospital’s medical emergency outpatient department complaining of periumbilical pain that had persisted for 4 months. He frequently came to our hospital and was admitted three times with the same problem. Objectively, there was tenderness over the left lower quadrant and periumbilical area. The sonographic evaluation discovered the transposition of the liver and spleen with cardiac apex on the left side. He received conservative treatment with ceftriaxone 1 g intravenous twice a day and metronidazole 500 mg intravenous for 5 days, and he went home improved.ConclusionIsolated levocardia is a rare form of situs inversus in which the heart is in the traditional levo position while the abdominal organs are in the dextro position. What causes situs inversus with levocardia is unknown. Despite the fact that situs inversus can be diagnosed after a thorough physical examination, medical imaging has allowed us to confirm the findings as well as understand more about diseases. Due to the severity of an underlying heart defect, situs inversus with levocardia has a dismal prognosis.

RESULTS OF THE ANTIBIOTICS TREATMENT COMBINED WITH LIVER ABSCESS DRAINAGE AT NGUYEN TRI PHUONG HOSPITAL

Background: Percutaneous drainage of liver abscess is the initial treatment of choice for abscesses larger than 5 cm in size and has long been applied in many hospitals in Vietnam. However, there are not many summary reports on both antibiotic treatment and abscess drainage under ultrasound guidance. Subjects and methods: Retrospective study of patients with liver abscess who were treated with antibiotics and drained the abscess under ultrasound guidance at Nguyen Tri Phuong Hospital from January 2017 to March. 12/2022. Results: There were 61 patients included in the study. The first-line antibiotic treatment is Cephalosporin III generation combined with intravenous metronidazole, most are sensitive to third generation Cephalosporins (49.2%), 8.2% are multi-resistant ESBL-secreting bacteria using Carbapenems. The treatment success rate is high (96.7%). The time for the patient to have no fever and no pain in the right lower quadrant is from 1 to 4 days. Most of the interventions were 1 time (90.2%). The average tube retention time was 12 days. Conclusion: Treatment of liver abscess with antibiotics combined with ultrasound-guided drainage is an effective and safe measure. Most of the cases are only intervention 1 time with high success rate.

Successful management of a giant retroperitoneal ancient schwannoma mimicking malignant tumors: A case report and literature review

Introduction and Importance: Schwannomas, originating from Schwann cells surrounding nerve sheaths, tend to be slow-growing. Among these, giant ancient schwannomas are remarkable for their rare occurrence and their capacity for substantial growth and regressive changes. Furthermore, the expansiveness and flexibility of the retroperitoneal space often conceal the symptoms of retroperitoneal schwannomas, leading to delayed diagnosis and allowing these tumors to grow significantly and become large and long-standing before detection. Case Presentation: A 24-year-old man presented with left flank pain and a growing abdominal bulge in the left upper quadrant. Computed tomography scan revealed a 15×15×10 cm lytic expansile lesion. Consequently, the encapsulated mass was surgically excised and diagnosed as an ancient retroperitoneal schwannoma through histological and immunohistochemical studies. Clinical Discussion: Comprehensive preoperative planning and a multidisciplinary strategy are imperative for the complete excision of schwannomas. These tumors can present diagnostic complexities, particularly due to nuclear atypia and pleomorphism, which might lead to misinterpretation regarding malignancy. Despite the risks associated with percutaneous biopsies, the low mitotic count is a critical diagnostic factor. Our study underscores the consensus that the definitive diagnosis should rely on postoperative histopathological findings, highlighting the importance of accurate assessment. Conclusion: Rare giant retroperitoneal ancient schwannomas pose diagnostic challenges due to their rarity, lack of distinct symptoms, and atypical locations. This study presents a successful case and management.

Non-Mass-Forming Myeloid Sarcoma of the Colon Presenting With Diarrhea

ABSTRACT A female patient in her mid-70s, with a history of diverticulosis, presented with a 2-month history of severe diarrhea, left lower quadrant abdominal pain, decreased appetite, and fever. She was treated for diverticulitis, but did not improve. Subsequent workup revealed leukocytosis and circulating myeloblasts on a peripheral blood smear. Bone marrow evaluation and flow cytometry confirmed the diagnosis of acute myeloid leukemia. Abdominal computed tomography and sigmoidoscopy were performed for her persistent diarrhea. While both failed to show an obvious mass or anatomical abnormality, pathology from the colorectum showed infiltration by leukemic cells consistent with myeloid sarcoma. The diarrhea improved with acute myeloid leukemia chemotherapy.

Ruptured Splenic Abscess with Pneumoperitoneum: A Rare Presentation

Splenic abscess is a rare entity encountered during clinical practice, with a high mortality rate. Formation of gas in splenic abscess is usually localized to the left upper quadrant of the abdomen. Here we report a case where the splenic abscess ruptured and presented with generalized peritonitis. The erect chest radiograph showed free air under the right dome of the diaphragm, thus masquerading a hollow viscera perforation (most common cause of pneumoperitoneum).

INTRAOPERATIVE FROZEN SECTION ANALYSIS OF ENDOMETRIOID OVARIAN BORDERLINE TUMOR: A DIFFICULT DIAGNOSIS

Abstract Introduction/Objective Borderline ovarian tumors (BOT) comprise approximately 15% of all primary ovarian neoplasms; of these endometroid borderline ovarian tumors (EBOT) are much rarer (2-3%). BOT is often potentially misdiagnosed as a malignant tumor based on its challenging histomorphological features and thus, treated aggressively. Herein, we present an unusual case of EBOT with adenofibromatous pattern in a 50-year-old gravida 3, para 2 female diagnosed on intraoperative frozen sections (IOFS). Methods/Case Report Patient with history of endometriosis presented with left lower quadrant abdominal pain. MRI revealed complex bilateral ovarian masses with solid and cystic components measuring 5 cm and 6.7 cm in right and left ovary, respectively. An ovarian malignancy was suspected. Patient underwent exploratory laparotomy, total abdominal hysterectomy with bilateral salpingo-opherectomy, and omentectomy. Grossly, bilateral ovaries (BO) showed intact capsule with solid and cystic components. On IOFS, the solid areas demonstrated endometrioid glands arranged in a lobular fashion with squamous morules. The cystic component demonstrated papillary projections with squamous differentiation. Cytology is mildly atypical at best. Based on these findings, a diagnosis of EBOT was made, necessitating staging. Differential diagnoses include atypical endometriosis, endometrioid adenofibroma (EAF) and endometrioid adenocarcinoma (EA). Lack of endometrial stroma surrounding the glands ruled out endometriosis. Presence of CC with papillary architecture ruled out EAF and lack of destructive stromal invasion with desmoplasia, confluence of glands and significant cytologic atypia ruled out EA. Final histopathological diagnosis of formalin-fixed paraffin-embedded specimen revealed EBOT, pT1bN0M0. Uterus and cervix revealed endometrial hyperplasia with atypia, adenomyosis, leiomyomas, and endocervical polyp. Results (if a Case Study enter NA) NA Conclusion The accurate diagnosis of BOT during IOFS is critical as it directs surgeons towards staging studies and in choosing conservative surgical treatment over aggressive treatment especially in cases of young women who desire future childbearing. As this is a rare entity, it serves the pathologist well to keep all relevant differential diagnoses in mind.

The Prevalence and Characteristics of Symptomatic Uncomplicated Diverticular Disease Among Asian Patients With Unexplained Abdominal Symptoms.

The precise incidence of symptomatic uncomplicated diverticular disease (SUDD) and its effects on the quality of life (QOL) remain unclear, particularly in Asian patients with right-sided SUDD. We assess the prevalence of SUDD and its impact on QOL in a real-world population. Five institutional cohorts of patients who received outpatient treatment for unexplained abdominal symptoms from January 15, 2020 to March 31, 2022, were included. All patients underwent colonoscopy. SUDD was defined as the presence of recurrent abdominal symptoms, particularly pain in the lower right or left quadrant lasting > 24 hours in patients with diverticulosis at the site of pain. The 36-item short-form health survey was used to assess QOL. Diverticula were identified in 108 of 361 patients. Among these 108 patients, 31% had SUDD, which was right-sided in 39% of cases. Of the 50 patients with right-sided diverticula, 36% had SUDD, as did 15 of 35 patients with left-sided diverticula (43%). Among the 33 patients with SUDD, diverticula were right-sided, left-sided, and bilateral in 39%, 45%, and 15% of patients, respectively. Diarrhea was more frequent in the SUDD group than in the non-SUDD group. Patients with SUDD had significantly lower physical, mental, and role/social component scores than those without SUDD. It is important to recognize that patients with SUDD account for as high as 31% of outpatients with unexplained abdominal symptoms; these patients have diarrhea and a low QOL. The presence of right-sided SUDD was characteristic of Asian patients.