Pain In Right Lower Abdomen Research Articles

Clear Cell Carcinoma of Ovary - Rare Subtype with Poor Prognosis: A Case Report

Ovarian clear cell carcinoma is a rare subtype of epithelial carcinoma of ovary having poor prognosis. This tumor has been found to be associated with endometriosis and has similarities with the pathogenesis of endometrioid carcinoma. We report a case of 37 years female presenting with the pain in right lower abdomen. Computerized Tomography revealed right ovarian cystic mass. Histopathology showed tubulocystic pattern of arrangement of tumor cells with few foci showing hobnail cells which confirmed the diagnosis. Keywords: Clear cell carcinoma, Ovary, Poor prognosis

8499 Laparoscopic Myomectomy for Symptomatic Pedunculated Fibroid with Degeneration and Subserous Fibroids in Second Trimester of Pregnancy

Study Objective To demonstrate the feasibility of emergency laparoscopic myomectomy for a large pedunculated fibroid (FIGO type 7) with degeneration and multiple subserous fibroids (FIGO type 6) in a patient with pregnancy of 12.4 weeks. Design Stepwise demonstration of laparoscopic myomectomy in a patient with gravid uterus with narrated video footage with sonographic images. Setting Tertiary care hospital. Patients or Participants A 27 years primigravida with 12.4 weeks of gestation presented with severe pain in right lower abdomen and vomiting for three days. Abdominal ultrasound showed gravid uterus with multiple subserous fibroids of size 30 × 30mm, 23 × 26mm, 24 × 21mm and a large avascular lesion showing central degeneration of size 117 × 93 mm in right hypochondriac region separately from uterine fundus suggestive of pedunculated fibroid. Patient counselling was done about the risks and benefits of surgery during pregnancy. Interventions Laparoscopic myomectomy of a large pedunculated myoma and other multiple subserous fibroids was done. The base of pedunculated fibroid ligated with two sutures and rest of fibroids enucleated out. Myometrial walls sutured. Use of vasopressin was avoided during myomectomy. The fibroids were removed by in bag morcellation with morcellator. Measurements and Main Results The myomas were removed with very minimal blood loss of 50 ml. The pedunculated large myoma measured 10 × 12 cm and six subserosal fibroids measured 2 × 2 cm to 2 × 3 cm each. Histopathological reports revealed degeneration in large pedunculated fibroid. The patient had complete resolution of right lower abdominal pain and recovered well post operatively and underwent vaginal delivery at term with healthy baby. Conclusion Laparoscopic myomectomy can be done selectively for patients with only symptomatic pedunculated and subserous fibroids. Minimal handling of the gravid uterus is necessary to minimize the chances of abortion and preterm delivery. Proper selection of patients for this type of surgery during pregnancy is very important and requires surgical expertise. To demonstrate the feasibility of emergency laparoscopic myomectomy for a large pedunculated fibroid (FIGO type 7) with degeneration and multiple subserous fibroids (FIGO type 6) in a patient with pregnancy of 12.4 weeks. Stepwise demonstration of laparoscopic myomectomy in a patient with gravid uterus with narrated video footage with sonographic images. Tertiary care hospital. A 27 years primigravida with 12.4 weeks of gestation presented with severe pain in right lower abdomen and vomiting for three days. Abdominal ultrasound showed gravid uterus with multiple subserous fibroids of size 30 × 30mm, 23 × 26mm, 24 × 21mm and a large avascular lesion showing central degeneration of size 117 × 93 mm in right hypochondriac region separately from uterine fundus suggestive of pedunculated fibroid. Patient counselling was done about the risks and benefits of surgery during pregnancy. Laparoscopic myomectomy of a large pedunculated myoma and other multiple subserous fibroids was done. The base of pedunculated fibroid ligated with two sutures and rest of fibroids enucleated out. Myometrial walls sutured. Use of vasopressin was avoided during myomectomy. The fibroids were removed by in bag morcellation with morcellator. The myomas were removed with very minimal blood loss of 50 ml. The pedunculated large myoma measured 10 × 12 cm and six subserosal fibroids measured 2 × 2 cm to 2 × 3 cm each. Histopathological reports revealed degeneration in large pedunculated fibroid. The patient had complete resolution of right lower abdominal pain and recovered well post operatively and underwent vaginal delivery at term with healthy baby. Laparoscopic myomectomy can be done selectively for patients with only symptomatic pedunculated and subserous fibroids. Minimal handling of the gravid uterus is necessary to minimize the chances of abortion and preterm delivery. Proper selection of patients for this type of surgery during pregnancy is very important and requires surgical expertise.

RETROPERITONEAL PERFORATION OF INTESTINAL AMOEBIASIS: A RARE CASE PRESENTATION

Amoebiasis is caused by Entamoeba Histolytica and is still a major healthcare concern, especially in the Indian subcontinent where almost half the population is infected. The lack of sanitary control and hygiene measures make parasites infections still a burden for patients and physicians. Despite infections due to this parasites are usually mild, severe infections and fatal outcomes although rare still occur. Bowel Perforation is a rare complication of amoebiasis, and unfortunately, it continues to be almost fatal. We present a unique case of a 48 yr old man who presented to the emergency room with an acute abdomen. A 48-year-old man presented to Emergency room with complaints of pain in right lower abdomen and with abdominal distension, vomiting, fever and diarrhea. Ultrasonography suggestive of no free uid in abdomen and pelvis. Computed tomography suggestive of mottled air pockets with uid in retroperitoneal space. Patient underwent Extraperitoneal drainage of retroperitoneal collection with bilateral ank drain in extraperitoneal space. Bowel perforation due to Entamoeba histolytica was the nal diagnosis.

A rare scenario of perforated gastrointestinal stromal tumours of ileum

Gastro-intestinal stromal tumours (GIST) are among the common mesenchymal tumours of the gastro-intestinal (GI) tract. It varies in location and presentation. GIST are reported in the stomach frequently (60-70%), followed by small intestine (20-25%). Mainly GIST manifest typically with bleeding or vague abdominal pain and discomfort. The spontaneous perforation of GIST is very rare. We report case of a middle-age male patient who presented in emergency with pain in right lower abdomen associated with features of peritonism. After clinical evaluation and preliminary radiological investigations, a working diagnosis of perforated appendix was made. Patient was undertaken for emergency surgery. A diagnostic laparoscopy followed by midline laparotomy was done. Intra-operatively, a perforated and necrotic outpouching at antimesenteric border of terminal ileum was found. Histopathological examination of the resected part of ileum revealed compatibility with GIST. It was strongly positive for cluster of differentiation 117 (CD117) and smooth muscle actin. Patient received adjuvant therapy with Imatinib. A complete surgical resection without extensive lymph node sampling is the primary treatment option. As GIST are rare, a high index of suspicion is warranted for diagnosis and appropriate treatment.

Management of Acute Appendicitis in Covid Pandemic- A Prospective Study of 25 Cases

Acute Appendicitis is a surgical emergency. Patients present with pain in right lower abdomen, with other symptoms like nausea/vomiting, fever, diarrhoea, urinary symptoms. Diagnosis is based on a multimodality approach that includes, clinical, radiological and pathological findings. Alvarado Score helps determine the severity of infection, confirm diagnosis and guide further management. Management is either conservative with antibiotics or surgical depending on severity. However approach to surgical management has changed with the ongoing Covid-19 pandemic. It has necessitated categorisation of surgical procedures into essential and non essential to limit risk to both patient and surgical team and also for prioritization of resources to the rising, continued spread of Covid-19. We present a prospective study of 25 cases of appendicitis presenting during the Covid Pandemic between 15th March and 30th May to our hospital, with an intent to try conservative management for all patients except in the presentations with complications like perforation, abscess or the presence of fecolith or poor response to conservative management.Patients not amenable to conservative management were treated by Open appendicectomy.

Torsed intraabdominal testis mimicking acute appendicitis in a 60 year old male

We present a case of 60-year-old male who came to our emergency room with complaints of severe pain in right lower abdomen. Based on history, clinical examination and investigation, we made a provisional diagnosis of acute appendicitis. We explored the patient and found a torsed intraabdominal testis just below the deep ring. Histopathology of the resected specimen showed gangrenous testis.

Successful Outcome of Spontaneously Conceived Heterotopic Pregnancy masquerading Ovarian Torsion

ABSTRACT Aim To sensitize clinicians regarding possibility of heterotopic pregnancy even in spontaneous conceptions. Background Though heterotopic pregnancy is a rare condition, its incidence is rising, which varies from one in 8,000 to 30,000, more in assisted reproductive technique conceptions. It is being commonly misdiagnosed. Here, we present a case of heterotopic pregnancy after spontaneous conception, diagnosis of which was confused with ovarian torsion. Case Report A 31-year-old second gravid para one with one living issue at 12 week 6 day period of gestation presented to emergency with acute-onset pain in right lower abdomen for 3 days. On examination, an ovarian tumor with ascitis with probable torsion was suspected along with intrauterine pregnancy. These findings were further supported by similar ultrasound picture. Patient was taken up for laparotomy. Intraoperative finding was suggestive of heterotopic pregnancy with ruptured left tubal ectopic pregnancy. Left salpingectomy was done with minimal uterine manipulation. Histopathology showed blood clots, hyalinized villi, and acute inflammatory cell infiltrate suggestive of ectopic pregnancy. Ultrasonography (USG) done in the postoperative period showed viable intrauterine pregnancy. The patient is currently following with us and is in her second trimester of pregnancy. Conclusion Heterotopic pregnancy is a diagnostic and therapeutic challenge; a high index of suspicion is required. It is important for clinicians to see adnexal in detail even if intrauterine pregnancy has been seen clearly during USG, especially in high-risk cases. Clinical significance Heterotopic pregnancies can occur even in the absence of high-risk factors. In patients with intrauterine pregnancy, who present with adnexal mass with free fluid in abdomen, clinicians should keep their mind open for possible diagnosis of heterotopic pregnancy. Early diagnosis and surgical management will decrease maternal morbidity and increase chances of survival of intrauterine pregnancy. How to cite this article Vatsa R, Meena J, Kumar S, Zangmo R, Bharti J, Roy KK. Successful Outcome of Spontaneously Conceived Heterotopic Pregnancy masquerading Ovarian Torsion. J South Asian Feder Obst Gynae 2017;9(1):60-62.

Torsion of Ovarian Cyst During Pregnancy (Laparoscopic Cystectomy): A Case Report

In this case we report a 27 year old primigravida having 14 weeks of pregnancy with torsion of ovarian cyst. She presented to a private clinic with acute pain in right lower abdomen. She was diagnosed to have torsion of ovarian cyst during pregnancy and laparoscopic cystectomy was done. Histopathology report showed benign serous cystadenoma. Her pregnancy was followed up. She delivered a healthy baby at term. Though the safety of antepartum surgical intervention has been accepted, laparoscopic surgery needs more advanced surgical skill and knowledge.J. Paediatr. Surg. Bangladesh 4(2): 67-71, 2013 (July)

Role of Laparoscopy in uncertain diagnosis of right lower abdominal pain

Aim: Aim of the study was to evaluate role of laparoscopy for diagnosis & management of patients with pain in right lower abdomen with uncertain diagnosis.Material and Methods: A prospective study was carried out on 36 patients with right lower abdominal pain who had uncertain clinical diagnosis, whose diagnosis was not established by clinical examination and laboratory investigations at Lata Mangeshkar Hospital, Digdoh Hills, Hingna Road, Nagpur for a period of one year.Results: Total 36 patients were subjected for diagnostic laparoscopy out of which 25 were females and 11 were males. Mean age of presentation was 31.52 years. Out of 36 patients, 27 patients have appendicitis, 2 patients have appendicitis and right ovarian cyst, 1 patient have only right ovarian cyst, 2 patients have pelvic inflammatory disease and in 4 patients no abnormality detected. Appendicitis was found on laparoscopy in 29 patients with 93.1% diagnostic accuracy. In our study, sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of laparoscopy in acute appendicitis comes out to be 100%, 66.6%, 96.2%, 100% and 93.1% respectively. Out of36 patients, the sensitivity of Alvarado score comes out to be 46.1 %, specificity 90 %, positive predictive value 92.3 %, negative predictive value39.1 % and diagnostic accuracy 58.3%. Negative appendicectomy was avoided in one male patient out of 11 patients (9.09%) and six female patients out of 25 female patients (24%). The use of laparoscopy as diagnostic tool can cut down unnecessary appendectomies especially in females. In our study, total seven (19.44%) negative appendectomies were avoided. Laparoscopy can detect pelvic inflammatory disease, ovarian cyst in patients of uncertain diagnosis of right lower abdominal pain.Conclusion: Laparoscopy has definite role in evaluation of pain in right lower abdomen with uncertain diagnosis. Diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value are more than Alvarado score in detecting acute appendicitis. It is useful especially in female patients to diagnose pelvic disease and rule out other pathology. With the help of laparoscopy therapeutic intervention can also be done at the same time with its advantages over open appendicectomy. We can reduce the no of negative appendectomies. Diagnostic laparoscopy can also be therapeutic with its advantages.

Malignant Peripheral Nerve Sheath Tumour of Small Intestine Presenting as Ileo-Ileal Intussusception - A Rare Tumour with Unusual Complication

Malignant Peripheral Nerve Sheath Tumours (MPNST) arises from a peripheral nerve or exhibit nerve sheath differentiation on histology. Proximal portions of the upper and lower extremities and the trunk are the most common sites of occurrence. Around 50% are associated with Neurofibromatosis Type 1 (NF1) with incidence of two to five per cent in patients with NF1. The estimated incidence in general population without NF1 is 0.0001% of which gastrointestinal MPNST are extremely rare. A 45-year-old lady without pathological antecedent for NF1 was admitted with pain in right lower abdomen and multiple episodes of vomiting for 3 months. Preoperatively intussusception was diagnosed in the small bowel with USG and CECT abdomen showing characteristic target sign. On laparotomy Ileo-ileal intussusception (proximal ileum telescoping into distal ileum) was found 2 feet proximal to ileo-caecal junction with surrounding inflammed mesentery and presence of intraluminal tumour as lead point. Resection of involved segment of ileum along with its mesentery was done followed by ileo-ileal anastomosis. Histopathology was suggestive of high grade MPNST. Postoperative course and follow up for last 10 month is uneventful. This case is unique in terms of a rare tumour presenting with unusual complication and only one case had been reported so far in western literature.