BackgroundWhile ovarian mature cystic teratomas are benign ovarian germ-cell tumors and the most common type of all ovarian tumors, the formation of fistulas into surrounding organs such as the bladder and the intestinal tract is extremely rare. This report documents a case of ovarian mature cystic teratoma with a rectal fistula, thought to be caused by local inflammation.Case descriptionA pelvic mass was diagnosed as an ovarian mature cystic teratoma of approximately 10 cm in diameter on transvaginal ultrasound and magnetic resonance examinations. Endoscopic examination of the lower gastrointestinal tract to investigate diarrhea revealed an ulcerative lesion with hair in the rectal wall adjacent to the ovarian cyst, and formation of a fistula from the ovarian teratoma into the rectum was suspected. Laparotomy revealed extensive inflammatory adhesions between a left ovarian tumor and the rectum. Left salpingo-oophorectomy and upper anterior resection of the rectum were performed. The final pathological diagnosis was ovarian mature cystic teratoma with no malignant findings, together with severe rectal inflammation and fistula formation with no structural disorders such as diverticulitis of the colon or malignant signs.DiscussionThe formation of fistulas and invasion into the neighboring organs are extremely rare complications for ovarian mature cystic teratomas. The invasion of malignant cells into neighboring organs due to malignant transformation of the tumor is reported as the cause of fistula formation into the neighboring organs. A review of 17 cases including the present case revealed that fistula formation due to malignant transformation comprised only 4 cases (23.5 %), with inflammation as the actual cause in the majority of cases (13 cases, 76.5 %).ConclusionAlthough malignancy is the first consideration when fistula formation is observed between ovarian tumors and surrounding organs, in mature cystic teratoma, local inflammation is more likely than malignant transformation.
Edwardsiella tarda (E. tarda) is a rare pathogen in humans, especially during the peripartum period. Only a few cases of fatal neonatal infection with E. tarda have been reported. Herein, we describe a case of maternal septicemia caused by E. tarda following peripartum chorioamnionitis. The mother developed septic shock, disseminated intravascular coagulation and a post-cesarean wound hematoma with abscess. Her condition improved with multidisciplinary therapy including blood transfusion, antimicrobial agents, recombinant thrombomodulin and surgical debridement. E. tarda was isolated from the maternal blood, cesarean wound and neonatal skin, pharynx and gastric fluid. This case demonstrates that peripartum infection with E. tarda is a rare but life-threatening condition, not only for the neonate but also for the mother.
Highlights
Vaginal cancer is very rare and generally only occurs in the elderly.
Stage I vaginal cancer was diagnosed in a 38-year-old patient at 13 weeks of gestation after tumor removal.
After refusing an abortion and radical surgery, the patient continued with pregnancy.
The tumor recurred and invaded the surrounding tissue, the baby was delivered, and the patient began radiation therapy.
The patient passed away 8 months after delivery due to deterioration.
Introduction: A unicornuate uterus with a noncommunicating rudimentary horn is a rare congenital uterine malformation that causes lower abdominal pain and dysmenorrhea due to endometriosis and uterine hematoma. We encountered a case of a unicornuate uterus with a noncommunicating rudimentary horn that was safely treated through laparoscopic removal of the rudimentary horn. The treatment strategy was determined following evaluation of preoperative 3D-reconstructed computed tomography (CT) images.Case presentation: A 34-year-old patient's (gravida 1, para 1) past pregnancy history included an emergency caesarean section due to uncontrollable uterine contractions at 24 weeks of gestation. Her menstruation resumed, and at 10 months postpartum, she noted left lower abdominal pain. The patient was diagnosed with right unicornuate uterus with a noncommunicating rudimentary horn and accompanying dysmenorrhea. Surgical treatment was planned.Preoperatively, 3D-reconstructed CT images were acquired, and a defect in the left external iliac artery was confirmed.Due to the abnormal course of the left uterine artery, identification of the left ureter was delayed during the surgery.However, a careful surgery was possible due to the preoperative confirmation of the 3D-reconstructed CT, and laparoscopic removal of the left rudimentary horn and left salpingectomy were performed.
Conclusion:In recent years, minimally invasive laparoscopic surgery has been a favorable choice for the removal of rudimentary horns. It is important to confirm the course of the uterine artery and ureter before surgery. In this case, 3D-reconstructed CT was effective for establishing treatment strategies.
Introduction: Pelvic inflammatory disease (PID) affects 4% of women, especially in younger age groups and occasionally, in patients with diabetes. We report a case of PID treated with laparoscopic surgery in a patient with uncontrolled type 2 diabetes mellitus.Case: A 46-year-old nulliparous woman with diabetes visited our department for investigation and treatment of PID in year X-4. Bilateral adnexal hypertrophy was observed, and she was in remission with antibiotics. Subsequent recurrences were managed on an outpatient basis. In year X, the patient was hospitalized for antibiotic treatment because of severe recurrent PID. Blood tests showed elevated HbA1c (11.4%), prompting initiation of insulin. After 10 days, pre-prandial and 2 hour post-prandial blood glucose levels were controlled at 80-110 mg/dL and 140-180 mg/dL, respectively. However, no improvement in inflammatory response was observed; hence, surgical intervention was required. Emergency laparoscopy for left adnexal resection, right salpingectomy, and adhesion detachment was performed with an operation time of 3 hours and 23 minutes and an estimated blood loss of 400 mL. The patient was discharged 5 days post-operation.Discussion: Around 60% of PID patients, with ≥ 10 cm adnexal abscess, require surgery. In patients with diabetes, it is crucial to maintain a perioperative blood glucose level of < 200 mg/dL to prevent complications. In addition, successful surgery is best achieved through the minimally invasive laparoscopic approach, which markedly reduces the risk of developing surgical site infections.
Laparoscopic myomectomy (LM) is currently widely used as surgical treatment for uterine fibroids; however, it may be technically challenging in some patients with cervical fibroids in whom laparotomy needs to be performed.Reportedly, preoperative uterine artery embolization and intraoperative cutting and ligation of the uterine artery reduce intraoperative bleeding during myomectomies. Notably, maintaining maximal uterine blood flow is necessary in patients who desire fertility preservation; unfortunately, currently, no such method is available.We describe two patients in whom LM was safely performed using a polyvinyl chloride Nelaton catheter for temporary intraoperative ligation and occlusion of the uterine artery. No major complications were observed intra-or postoperatively in either case. Laparoscopic surgery can be safely performed even in patients undergoing myomectomy for cervical fibroids if intraoperative bleeding is minimal and well controlled. Temporary ligation and occlusion of the uterine artery using a Nelaton catheter reduces intraoperative bleeding and is a simple, minimally invasive, inexpensive and effective strategy in such cases.
Objective: Atypical endometrial hyperplasia (AEMH) is a precancerous lesion of the endometrium, which is often treated with laparoscopic hysterectomy. However, we report some cases in which a postoperative diagnosis of endometrial cancer (EMC) was made although AEMH had been diagnosed preoperatively. In the present study, we retrospectively investigated the clinical features of EMC patients diagnosed with AEMH preoperatively. Method: We retrospectively evaluated the characteristics (age, gravidity and parity, body mass index [BMI], menstrual history, medical history of diabetes, and family history of malignancy), blood test results (preoperative serum CA125 levels), and imaging study results (measurement of endometrial thickness by ultrasonography) of patients who had been
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