Pelvic Cavity Research Articles

The anatomy of the internal iliac artery: a meta-analysis.

The internal iliac artery (IIA) originates from the common iliac artery at the level of the sacroiliac joint and bifurcates between the L5 and S1 vertebrae. The aim of the present meta-analysis was to demonstrate the most up-to-date and evidence-based data regarding the general anatomy of the IIA, including their variations, length, and diameter. Major online medical databases such as PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar were searched in order to find all studies considering the anatomy of the IIA. Eligibility assessment and data extraction stages were performed. In the general population the pooled prevalence of Type I (The superior gluteal artery arises independently with the inferior gluteal and internal pudendal arteries arising from a common trunk which dividing inside (Type IA) or outside (Type IB) pelvic cavity) was found to be 56.57% (95% CI: 53.00-60.10%). The pooled mean length of the IIA was set to be 39.95 mm (SE = 1.79) in the overall population. The pooled mean diameter of the IIA was found to be 6.86 mm (SE = 0.27). The IIA is responsible for supplying the majority of the structures located in the pelvis. Hence, it is crucial to be aware of the possible variants of the said vessel. The results presented in our study may be highly significant in various surgical procedures performed in that region.

High-fat diets promote peritoneal inflammation and augment endometriosis-associated abdominal hyperalgesia.

Immune dysfunction is one of the central components in the development and progression of endometriosis by establishing a chronic inflammatory environment. Western-style high-fat diets (HFD) have been linked to greater systemic inflammation to cause metabolic and chronic inflammatory diseases, and are also considered an environmental risk factor for gynecologic diseases. Here, we aimed to examine how HFD cause an inflammatory environment in endometriosis and discern their contribution to endometriotic-associated hyperalgesia. Our results showed that HFD-induced obesity enhanced abdominal hyperalgesia that was induced by endometriotic lesions. Peritoneal inflammatory macrophages and cytokine levels increased by lesion induction were elevated by chronic exposure to HFD. Increased expression of pain-related mediators in the dorsal root ganglia was observed after lesion induction under the HFD condition. Although HFD did not affect inflammatory macrophages in the peritoneal cavity without lesion induction, the diversity and composition of the gut microbiota were clearly altered by HFD as a sign of low-grade systemic inflammation. Thus, HFD alone might not establish a local inflammatory environment in the pelvic cavity, but it can contribute to further enhancing chronic inflammation, leading to the exacerbation of endometriosis-associated abdominal hyperalgesia following the establishment and progression of the disease.

Dystocia Due to Secondary Partial Uterine Inertia in a New Zealand White Rabbit

A one-year-old Doe weighing 1.2 kg was brought to Teaching Veterinary Clinical Complex, FVAS, BHU-Mirzapur, with a history of giving birth to three dead bunnies 3 days before and after that not show any signs of kindling. Vulvul lips were swollen, congested and edematous. The Perineal area was smeared with uterine discharge. Doe had Inappetence dehydration for 3 days. Doe was previously treated with inj. oxytocin @ 1 to 3 IU I/M and inj. Epidosin @ 8mg/ kg I/M along with calcium gluconate @ 0.25 ml/kg slow I/V before 24 hrs. Abdominal palpation revealed the presence of fetal mass. Lateral abdominal radiograph showed the presence of one fetus’s skeleton located in the pelvic cavity. Based on the history and obstetrical examination it was diagnosed as a case of dystocia due to secondary partial uterine inertia. A male dead bunny was relived through exploratory laparotomy under general anaesthesia (premeditated with inj. xylazine 5 mg/kg body weight and induction with isoflurane 3-5%). Doe had an uneventful recovery following exploratory laparotomy with proper postoperative care. Dystocia due to secondary partial uterine inertia is a rare case in rabbits and it can be managed through exploratory laparotomy with proper post-operative care.

Disseminated multiloculated peritoneal inclusion cysts: Bubble trouble in belly.

Multiloculated peritoneal inclusion cysts, usually arise from peritoneal mesothelium lining the serous cavity of the abdomen, pelvis and retroperitoneum. These lesions can be incidentally found on imaging or during surgery, and confirmation of the diagnosis is done by radiological imaging, histomorphology and immunohistochemical findings. Although fewer than 200 cases of solitary peritoneal inclusion cysts have been reported, their occurrence in a disseminated fashion has hardly ever been described in literature. Herein, we report a case of multiloculated peritoneal inclusion cysts that involved the whole abdominal and pelvic cavity and were successfully treated with surgery.

Giant peritoneal loose body and its protein composition: a case report

Peritoneal loose body (PLB) is a kind of lesions located in the abdominal cavity or pelvic cavity, which is rare and difficult to diagnose. The diameter of PLB is mostly 0.5–2.5 cm. Most PLBS are asymptomatic. Here we reported a case of giant PLB in the pelvis and analyzed its structure and protein composition. Surgical exploration revealed a white oval mass (4.5*4*3 cm) in the pelvic cavity. After the mass was removed, the symptoms of hematuria disappeared and the patient was discharged on the second postoperative day. Histochemical staining showed that PLB was mainly composed of collagen and scattered calcification. The protein components of PLB were detected by proteome analysis, and a variety of proteins related to collagen deposition and calcification were identified in PLB.

Prefoldin-5 Expression Is Elevated in Eutopic and Ectopic Endometriotic Epithelium and Modulates Endometriotic Epithelial Cell Proliferation and Migration In Vitro.

Endometriosis is a common disease among women of reproductive age in which endometrial tissue grows in ectopic localizations, primarily within the pelvic cavity. These ectopic "lesions" grow as well as migrate and invade underlying tissues. Despite the prevalence of the disease, an understanding of factors that contribute to these cellular attributes remains poorly understood. Prefoldin-5 (PFDN5) has been associated with both aberrant cell proliferation and migration, but a potential role in endometriosis is unknown. As such, the purpose of this study was to examine PFDN5 expression in endometriotic tissue. PFDN5 mRNA and protein were examined in ectopic (lesion) and eutopic endometrial tissue from women with endometriosis and in eutopic endometrium from those without endometriosis using qRT-PCR and immunohistochemistry, respectively, while function of PFDN5 in vitro was evaluated using cell count and migration assays. PFDN5 mRNA and protein were expressed in eutopic and ectopic endometrial tissue, predominantly in the glandular epithelium, but not in endometrium from control subjects. Expression of both mRNA and protein was variable among endometriotic eutopic and ectopic endometrial tissue but showed an overall net increase. Knockdown of PFDN5 by siRNA transfection of endometriotic epithelial 12Z cells was associated with reduced cell proliferation/survival and migration. PFDN5 is expressed in eutopic and ectopic glandular epithelium and may play a role in proliferation and migration of these cells contributing to disease pathophysiology.

Deep learning-accelerated T2-weighted imaging versus conventional T2-weighted imaging in the female pelvic cavity: image quality and diagnostic performance.

The deep learning (DL)-based reconstruction algorithm reduces noise in magnetic resonance imaging (MRI), thereby enabling faster MRI acquisition. To compare the image quality and diagnostic performance of conventional turbo spin-echo (TSE) T2-weighted (T2W) imaging with DL-accelerated sagittal T2W imaging in the female pelvic cavity. This study evaluated 149 consecutive female pelvic MRI examinations, including conventional T2W imaging with TSE (acquisition time = 2:59) and DL-accelerated T2W imaging with breath hold (DL-BH) (1:05 [0:14 × 3 breath-holds]) in the sagittal plane. In 294 randomly ordered sagittal T2W images, two radiologists independently assessed image quality (sharpness, subjective noise, artifacts, and overall image quality), made a diagnosis for uterine leiomyomas, and scored diagnostic confidence. For the uterus and piriformis muscle, quantitative imaging analysis was also performed. Wilcoxon signed rank tests were used to compare the two sets of T2W images. In the qualitative analysis, DL-BH showed similar or significantly higher scores for all features than conventional T2W imaging (P <0.05). In the quantitative analysis, the noise in the uterus was lower in DL-BH, but the noise in the muscle was lower in conventional T2W imaging. In the uterus and muscle, the signal-to-noise ratio was significantly lower in DL-BH than in conventional T2W imaging (P <0.001). The diagnostic performance of the two sets of T2W images was not different for uterine leiomyoma. DL-accelerated sagittal T2W imaging obtained with three breath-holds demonstrated superior or comparable image quality to conventional T2W imaging with no significant difference in diagnostic performance for uterine leiomyomas.

Primary Retroperitoneal Mature Cystic Teratoma (Dermoid Cyst) in Pelvic Musculature

Dermoid cysts, or mature cystic teratomas containing ectoderm-derived skin adnexa, rarely occur intramuscularly, especially within the male pelvic musculature. We present a male patient with a dermoid cyst within the obturator internus spreading into the adductor compartment and the pelvic cavity. In contrast to dermoid cysts in previous reports, the cyst appeared centered in muscle rather than simply perforating muscle via an extension. The case is also notable for the rapid recurrence of the cyst after incomplete resection and intraoperative rupture

Analysis of Variation in the Origin of the Obturator Artery in Midwestern American Donor Bodies.

The obturator artery (OA) is typically a branch of the anterior division of the internal iliac artery. However, an aberrant obturator artery origin may lead to clinical complications. Because of its locationin the pelvic cavity, the OA is at high risk of injury or laceration during a variety of pelvic surgeries. Regarding this, variations in the origins of the OA may result in bleeding that can often be overlooked, rendering treatment ineffective. Our study aimed to assess the origins and course of the OA in Midwestern American donor bodies. Sixty-two donor bodies were obtained from the Gift of Body Donation Program at A.T. Still University's Kirksville College of Osteopathic Medicine. The origin of each OA was documented and photographed. The OA was identified by observing the vessel's passage through the obturator foramen. Of 132 OAs studied, 72 (54.5%) had an aberrant OA. Further, 22 (16.7%) had an aberrant OA origin from the inferior epigastric artery, 20 (15.2%) had an aberrant OA origin from the posterior division of the internal iliac artery, 22 (16.7%) had an aberrant OA origin from dual origins of the anterior division of the internal iliac artery and the inferior epigastric artery, and eight (6.1%) had other aberrant OA origins. Overall, our results indicated anatomical variations are common in the origins and course of the OA. These data highlight the importance of considering variations in the OA and the prevalence of those variations during vascular and orthopedic procedures.

(062) The Physiological Health of the Penile Fibro-Vascular Assembly Requires the Integrity of Ten Fibro-ligaments in the Human Penis

Abstract Introduction Although the human penis has existed on earth for 3000 centuries and extensive studies have been conducted for many recent centuries, there is still room for improvement, particularly in the fibro-ligaments' role in maintaining physiological sexual health. Thus far, there needs to be more interpretation concerning these ligaments. Objective We aimed to explore the penile fibrous ligaments thoroughly to fill this research gap. Methods We excluded cadaveric penises that had both sides of the corpora cavernosa (CC) and corpus spongiosum (CS) damaged. However, penises with one undamaged side of the CC, including the Colles' fascia and the corpus spongiosum, were included. A total of 15 out of 46 penises were meticulously examined. Dissection findings were supplemented with 101 cadaveric photos and data from 263 penile vascular surgeries, 11 CT imaging scans, 8 MRI imaging scans, eight hypospadias surgeries, and eight penile elongation surgeries performed elsewhere internationally. Results Bilaterally, the penile CC is primarily anchored to the pelvis wall through the unilateral cavernosal ligament bilaterally (CL=2), while the CS is connected to the urinary sphincter. The suspensory, fundiform, and arcuate pubic ligament (two anatomically and one functionally) assist in stabilizing and holding the penile shaft to the pelvic wall. Distally, a distal ligament (DL=1) and spongiosal ligament (SL=1) extend the CC and CS to the glans penis and frenulum, ensuring urethra patency when required. The CC is encircled by a bi-layered tunica consisting of a 360° inner circular tunica and a 300° outer longitudinal coat. The ischiocavernosus muscle wraps around the penile crus and envelops the CL connecting to the ischial tuberosity. The CS is partially secured by the bulbospongiosus muscle proximally and receives the SL distally. The entire penis interconnects with the skeletal muscle of the urogenital diaphragm eventually. Conclusions The physiologically sexual health of the human penis's hydraulic system relies on the integrity of ten anatomically and six functionally fibro-muscular ligaments. Disclosure No.

Management of ectopic pregnancy after in vitro fertilization/intracytoplasmic sperm injection and embryo transfer: a case series and mini-review.

Ectopic pregnancy (EP), reflecting a fertilized ovum implanted outside the normal uterine cavity, represents a frequent cause of morbidity and possibly mortality in women of reproductive age. To summarize the diagnosis and treatment of EP after in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). The medical records of patients who were diagnosed with EP after embryo transfer from 2017 to 2019, in a tertiary hospital were reviewed. Of the 24 cases analyzed, 21 (87.5%) had fallopian tube involvement, while 2 (8.3%) and 1 (4.2%) had cornual and cervical pregnancies, respectively. Clinical manifestations included vaginal bleeding (58.3%) and lower abdominal pain (16.7%); 9 (42.9%) cases had no symptoms. One cornual pregnancy was misdiagnosed as acute appendicitis and later correctly diagnosed by laparoscopic exploration. There were 2 cases of multiple-site EP and 2 of heterotopic pregnancy, including one with an intrauterine pregnancy with double chorionic and four amniotic sacs and right tubal ampullary pregnancy. Five of the 21 cases with fallopian tube involvement received conservative treatment, while the remaining 16 underwent surgeries, including laparoscopic ipsilateral salpingostomy and ipsilateral salpingectomy. Ectopic pregnancy after embryo transfer, mainly involving the fallopian tube, is very complex and is with diverse manifestations. Even with the pregnancy sac observed in the uterus, the pelvic cavity should be scanned thoroughly after embryo transfer.

Uretero-Pelvic Junction Obstruction with Calcification of Renal Pelvis Wall

A 45-year-old male presented with dull pain in right lumber region. On ultra-sonography, he had severely hydro- nephrotic right kidney with thinned out parenchyma and markedly dilated renal pelvis. On Computed Tomography, there was severe right hydronephrosis and linear calcification on the medial wall of renal pelvis confirmed further on DTPA Renal scan. It was a non-functioning kidney with a normal functioning contra-lateral kidney. The right nephrectomy was performed and a 7 x 7 cm rounded disc like calcification was seen in the medial pelvic wall. Upon histopathology, it was a dystrophic calcification of renal pelvis wall which is a rare finding.

A case series of scar endometriosis after cesarean section

Endometriosis is referred to the presence of functioning, ectopic endometrial tissue outside the pelvic cavity. Their occurrences after abdominal or pelvic surgeries especially cesarean section, at the site of scar incision, are documented. The patient experiences cyclical pain at the incision site related to the menstrual cycle. Imaging can be used to detect the lesion and medical management can be provided. However, in severe cases, total excision is recommended to avoid the chances of recurrence. Here, we present a case series of two cases of scar endometriosis after cesarean section, and both presented with cyclical pain in the abdomen. Medical management was provided for both cases.

Accuracy and Reliability of Pelvimetry Measures Obtained by Manual or Automatic Labeling of Three-Dimensional Pelvic Models

(1) Background: The morphology of the pelvic cavity is important for decision-making in obstetrics. This study aimed to estimate the accuracy and reliability of pelvimetry measures obtained when radiologists manually label anatomical landmarks on three-dimensional (3D) pelvic models. A second objective was to design an automatic labeling method. (2) Methods: Three operators segmented 10 computed tomography scans each. Three radiologists then labeled 12 anatomical landmarks on the pelvic models, which allowed for the calculation of 15 pelvimetry measures. Additionally, an automatic labeling method was developed based on a reference pelvic model, including reference anatomical landmarks, matching the individual pelvic models. (3) Results: Heterogeneity among landmarks in radiologists’ labeling accuracy was observed, with some landmarks being rarely mislabeled by more than 4 mm and others being frequently mislabeled by 10 mm or more. The propagation to the pelvimetry measures was limited; only one out of the 15 measures reported a median error above 5 mm or 5°, and all measures showed moderate to excellent inter-radiologist reliability. The automatic method outperformed manual labeling. (4) Conclusions: This study confirmed the suitability of pelvimetry measures based on manual labeling of 3D pelvic models. Automatic labeling offers promising perspectives to decrease the demand on radiologists, standardize the labeling, and describe the pelvic cavity in more detail.

Recurrence in the pelvic side wall after lateral lymph node dissection for rectal cancer.

49 Background: Locally advanced rectal cancer poses a persistent challenge due to the risk of local recurrence, which impacts patient outcomes and quality of life. To address this, lateral pelvic lymph node dissection (LPND) has emerged as a surgical approach to improve local control. However, comprehensive studies evaluating the outcomes and patterns of recurrence after LPND are limited. This retrospective study aimed to fill this gap and provide insights into the effectiveness of LPND. Methods: We conducted a retrospective analysis of 515 patients diagnosed with stage II-III lower rectal cancer who underwent TME and LPND between January 2005 and August 2022. Clinicopathological data were collected, and tumor staging followed the TNM classification system. Recurrence patterns, survival rates, and factors influencing lateral pelvic recurrence were assessed. Results: In our cohort, 18.8% of patients had pathologically positive lateral lymph nodes. Patients with lateral lymph node metastasis exhibited significantly lower 5-year relapse-free survival (31.6%) and overall survival (47.8%) rates compared to those without metastasis (69.5% and 84.7%, respectively). Local recurrence occurred in 20.1% of all patients, with 6.7% experiencing lateral pelvis recurrence (LPR) and 17.4% central pelvis recurrence. Multivariate analysis identified age over 75, lateral lymph node metastasis, and adjuvant chemotherapy as independent risk factors for LPR. Conclusions: Lateral pelvic lymph node dissection remains a valuable tool in managing locally advanced rectal cancer. Our findings underscore the importance of surgeon expertise in performing LPND and the potential benefits of combining treatments to further reduce lateral recurrence. LPND should continue to be explored and refined to enhance patient outcomes in this challenging clinical scenario.

Finite Element Analysis of Pelvic Floor Biomechanical Models to Elucidate the Mechanism for Improving Urination and Defecation Dysfunction in Older Adults: Protocol for a Model Development and Validation Study.

The population is constantly aging, and most older adults will experience many potential physiological changes as they age, leading to functional decline. Urinary and bowel dysfunction is the most common obstacle in older people. At present, the analysis of pelvic floor histological changes related to aging has not been fully elucidated, and the mechanism of improving intestinal control ability in older people is still unclear. The purpose of this study is to describehow the finite element method will be usedto understand the mechanical characteristics of and physiological changes in the pelvic cavity during the rehabilitation process, providing theoretical support for the mechanism for improving urination and defecation dysfunction in older individuals. We will collect magnetic resonance imaging (MRI) and computed tomography (CT) data of the pelvic cavity of one male and one female volunteer older than 60 years and use the finite element method to construct a 3D computer simulation model of the pelvic cavity. By simulating different physiological states, such as the Valsalva maneuver and bowel movement, we will verify the accuracy of the constructed model, investigate the effects of different neuromuscular functional changes, and quantify the impact proportions of the pelvic floor muscle group, core muscle group, and sacral nerve. At present, we have registered the study in the Chinese Clinical Trial Registry and collected MRI and CT data for an older male and an older female patient. Next, the construction and analysis of the finite element model will be accomplished according to the study plan. We expect to complete the construction and analysis of the finite element model by July 2024 and publish the research results by October 2025. Our study will build finite element models of the pelvic floor of older men and older women, and we shall elucidate the relationship between the muscles of the pelvic floor, back, abdomen, and hips and the ability of older adults to control bowel movements. The results of this study will provide theoretical support for elucidating the mechanism for improving urination and defecation dysfunction through rehabilitation. Chinese Clinical Trial Registry ChiCTR2400080749; https://www.chictr.org.cn/showproj.html?proj=193428. DERR1-10.2196/56333.

Laparoscopic pyelotomy combined with ultrasonic lithotripsy via a nephroscope for the treatment of complex renal stones.

The purpose of the study was to introduce a novel surgical approach of combining laparoscopic pyelotomy with ultrasonic lithotripsy via a nephroscope for the treatment of complex renal stones. Between May 2021 and April 2023, 32 patients underwent laparoscopic pyelotomy combined with ultrasonic lithotripsy via a nephroscope and their perioperative variables were retrospectively collected and outcomes were assessed. Dissection and incision of the anterior renal pelvis wall was performed via a laparoscope. A 19.5F nephroscope was introduced into the renal pelvis through a laparoscopic trocar from the incision. Stones were fragmented and sucked out using a 3.3mm ultrasonic probe placed through the nephroscope. All operations were completed successfully and the stone-free rate at 3 days after operation was 87.5% (28/32). Four (12.5%, 4/32) patients with staghorn stones had a small residual stone in the lower calyx after operation and did not require reintervention. No patient required perioperative transfusion and four (12.5%, 4/32) patients with struvite stones developed postoperative fever, which was successfully treated with intravenous antibiotics. The mean follow-up time was 14.0 ± 7.2months, with no patient developing long-term complications. This approach offers a safe and effective treatment option for complex renal stones, as the method exhibits a high clearance rate with few complications.

A case of congenital multiple pancreatic cysts in a female child: Case report

Congenital pancreatic cysts are rare in the paediatric age group; they can be isolated or associated with other malformations. Prompt diagnosis and appropriate management are crucial to prevent complications. One and a half year old female presented with an abdominal mass. Surgical exploration revealed multiple cystic lesions occupying most of the abdominal and pelvic cavities originating from the pancreas. A complete surgical excision was done, and the histopathological examination confirmed the presence of islands of well-defined pancreatic tissue with scattered dilated ducts. True congenital pancreatic cysts are rare anomalies to occur, and there is female predominance for such conditions; early diagnosis and treatment are essential to prevent complications.

A clinical case of enzootic bovine leukosis in a Holstein cow with minor clonality of B-cell in the peripheral blood.

A 4-year 9-month-old Holstein-Friesian dairy cow presented with anorexia. On physical examination, swelling of superficial lymph nodes, pelvic masses, and prolonged urination posture after urinating a small amount were noted. Hematological examination revealed no lymphocytosis. The bovine leukemia virus proviral load was relatively high. At necropsy, enlarged lymph nodes, a large mass in the pelvic cavity, and mass lesions in several organs were observed. Histopathological examination revealed the proliferation of neoplastic lymphocytes, which were immune-positive for CD79α and negative for CD3. B-cell clonality test indicated the presence of monoclonality in the urine, masses, and lymph nodes and minor clonality in the peripheral blood. These findings led to a diagnosis of EBL with minor clonality of B-cell in the peripheral blood.

The value of surgery and the prognostic factors for patients with recurrent low-grade endometrial stromal sarcoma: a retrospective study of 38 patients.

As an indolent malignant tumor, the long-term management of low-grade endometrial stromal sarcoma (LGESS) patients required awareness, especially the management of recurrences. Unfortunately, few studies focused on the treatment of recurrent LGESS. Our study aimed to investigate the prognostic factors and the value of recurrent surgery on recurrent LGESS. This retrospective study consecutively recruited patients with pathologically diagnosed recurrent LGESS at our center from April 1, 2004 to April 1, 2020. After a median follow-up of 137.0 months (95% confidence interval=85.4-188.6), the 5-year cumulative survival rate of the cohort of 38 patients with recurrent LGESS was 71.1%. The median overall survival (OS) and post-recurrence survival (PRS) was 156 and 89.0 months. Survival analysis showed that patients with younger age, positive estrogen receptor (ER) and optimal abdominopelvic debulking in the first recurrent surgery had better prognosis (p<0.05). Multivariate analysis showed that optimal abdominopelvic debulking in the first recurrent surgery was the only independent prognostic factor for OS and PRS (OS=216.0/35.0 months, hazard ratio [HR]=5.319, p=0.034; PRS=not reached/4.0 months, HR=10.900, p=0.006). There was no significant difference in OS and PRS between patients recurred only once and those recurred at least twice (p>0.05). The prognosis of recurrent LGESS was favorable. Optimal debulking of no residual tumor in abdominal and pelvic cavity should be the first choice of treatment for recurrent patients, while preservation of ovary or fertility should not be recommended.