A 30-year-old woman (gravida 0) visited our hospital with a complaint of right lower abdominal pain. Transvaginal ultrasonography revealed a 5-cm swollen right ovary, which was suspected to be a mature cystic teratoma. Pelvic examination revealed moderate pain. Contrast-enhanced computed tomography showed a 44-mm cystic mass containing fat and calcified material in the right pelvis. Since torsion was suspected, emergent laparoscopic surgery was performed. Intraoperative findings were a swollen right ovary without torsion or congestion. Two small pedunculated 1- and 2-cm diameter paratubal cysts that grew from almost the same place of the ampulla of the right fallopian tube were observed. The thin stalk of the 1-cm paratubal cyst was entangled around the stalk of the 2-cm paratubal cyst, with its head congested. Through a small abdominal laparoscopic incision, the tumor of the right ovary and the two paratubal cysts were excised. Histopathological examination revealed that the right ovarian tumor was a mature cystic teratoma, and the two paratubal cysts had no malignancy. This case showed that only a 2-cm tumor with congestion caused the acute abdomen.
Objective: To evaluate whether decreased abdominal air pressure and continuous administration of muscle relaxants may help relieve severe postoperative shoulder pain.Design: Retrospective cohort study.Settings: Single-center general hospital.Patients: A total of 158 patients who had undergone laparoscopic gynecological surgery were included in the study.Patients were devided into three groups based on the surgical conditions used as follows: standard pneumoperitoneum pressure (10 mmHg) without muscle relaxants, standard pneumoperitoneum pressure with muscle relaxants, and low pneumoperitoneum pressure (eight mmHg) with muscle relaxants.Interventions: Reduction of pneumoperitoneum pressure and continuous administration of muscle relaxants.Main outcome: There were no differences in patient characteristics or surgical procedures among the three groups.However, low pneumoperitoneum pressure decreased the frequency of severe postoperative shoulder pain when compared to the application of standard pneumoperitoneum pressure (p= 0.001; odds ratio = 0.28; 95% confidence interval= 0.13-0.61).Results: Low pneumoperitoneum pressure decreased the frequency of severe postoperative shoulder pain compared to the use of standard pneumoperitoneum pressure. Conclusion:Reduction of pneumoperitoneum pressure reduces the frequency of severe postoperative shoulder pain after laparoscopic gynecological surgery.
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