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Hemoperitoneum: a diagnostic dilemma. A solid ovarian tumour mimicking ruptured ectopic pregnancy  [cached]
Wills G. Sheelaa,Jayasree Manivasakan
International Journal of Reproduction, Contraception, Obstetrics and Gynecology , 2013, DOI: 10.5455/2320-1770.ijrcog20130635
Abstract: 39 year old sterilized women presented like ruptured ectopic pregnancy with 40 days amenorrhea, pain, and shock Urine Pregnancy Test negative. Culdocentesis was positive. Ultra sonogram confirmed hemoperitoneum and TO mass. Laparotomy revealed left solid ovarian tumour with tumour mass protruding from perforated site and hemoperitoneum. Histological diagnosis was granulosa cell (GC) tumour Stage 1c. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000): 254-256]
WARFARIN TOXICITY PRESENTING AS RUPTURED OVARIAN TUMOUR WITH HEMOPERITONEUM: A CASE REPORT  [cached]
Vidyadhar B Bangal,Kunnal K Shinde,Sai K Borawake
International Journal of Biomedical and Advance Research , 2012, DOI: 10.7439/ijbar.v3i3.334
Abstract: Warfarin, a coumarin derivative, is commonly used in prevention and treatment of thromboembolic events in various clinical situations. Although, a safe drug, its toxicity may result into intraperitoneal bleeding. Warfarin induced intraperitoneal bleeding is dose dependent and may have fatal outcome. A case is reported here, who presented with massive intraperitoneal haemorrhage secondary to warfarin toxicity. She had undergone mitral valve replacement six months before the episode. Clinical and imaging suggested a pelvic mass mimicking ruptured ovarian tumour. Her prothrombin time INR was 1.1 at the time of admission. Emergency laparotomy revealed a large organised blood clot in the pouch of Douglas extending to adnexal region, mimicking ruptured ovarian tumour. Warfarin was withdrawn for few days. Patient was transfused with fresh frozen plasma and fresh whole blood. Post operative recovery was uneventful. Warfarin in low dose was restarted for thromboembolic prophylaxis.
A ruptured large extraluminal ileal gastrointestinal stromal tumor causing hemoperitoneum  [cached]
Shoji Hirasaki, Kohei Fujita, Minoru Matsubara, Hiromitsu Kanzaki, Hiromichi Yamane, Masato Okuda, Seiyuu Suzuki, Atsuko Shirakawa, Hideyuki Saeki
World Journal of Gastroenterology , 2008,
Abstract: We describe an 87-year-old woman with a large ileal gastrointestinal stromal tumor (GIST) causing hemoperitoneum. A CT scan demonstrated a large heterogeneous mass measuring about 13 cm × 11 cm in the pelvis and hemoperitoneum, with a non-uniform enhancement pattern. The mass was diagnosed as a GIST originating from the gastrointestinal tract. She underwent an urgent laparotomy and an ileal GIST with a rupture was found 130 cm from the anal to the Treitz’s ligament. Hemoperitoneum caused by ileal GIST rupture is a rare condition. Bleeding in the large tumor leading to rupture of the capsule might cause hemoperitoneum in the present case.
Successful Nonoperative Management of Spontaneous Splenic Hematoma and Hemoperitoneum due to CMV Infection
Georgios Lianos,Eleftheria Ignatiadou,Christina Bali,Haralampos Harissis,Christos Katsios
Case Reports in Gastrointestinal Medicine , 2012, DOI: 10.1155/2012/328474
Abstract: Introduction. Spontaneous splenic hematoma or splenic rupture due to CMV infection in immunocompetent adults is rare and life-threatening. Case Report. Herein we report a rare case of spontaneous splenic hematoma and hemoperitoneum due to CMV infection in a 23-year-old Caucasian male in whom conservative management was successful. Conclusion. Spontaneous splenic hematoma and spontaneous splenic rupture are extremely rare conditions during primary CMV infection. Though rare, they must be always considered by the operating surgeon, because any misinterpretation may result in unfavorable outcomes.
Successful Nonoperative Management of Spontaneous Splenic Hematoma and Hemoperitoneum due to CMV Infection  [PDF]
Georgios Lianos,Eleftheria Ignatiadou,Christina Bali,Haralampos Harissis,Christos Katsios
Case Reports in Gastrointestinal Medicine , 2012, DOI: 10.1155/2012/328474
Abstract: Introduction. Spontaneous splenic hematoma or splenic rupture due to CMV infection in immunocompetent adults is rare and life-threatening. Case Report. Herein we report a rare case of spontaneous splenic hematoma and hemoperitoneum due to CMV infection in a 23-year-old Caucasian male in whom conservative management was successful. Conclusion. Spontaneous splenic hematoma and spontaneous splenic rupture are extremely rare conditions during primary CMV infection. Though rare, they must be always considered by the operating surgeon, because any misinterpretation may result in unfavorable outcomes. 1. Introduction Human cytomegalovirus is a member of the herpes family of viruses and undergoes latency after primary infection [1, 2]. The primary infection is diagnosed by a strongly positive CMV IgM antibody test result or CMV IgG seroconversion. Spontaneous splenic rupture or subcapsular splenic hematoma is really an uncommon condition in primary CMV infection [3]. The management of these complications has been a matter of debate during the last years [4]. Although splenectomy is the appropriate treatment for hemodynamically unstable patients, it seems that nonoperative management in selected patients is nowadays considered the gold standard of care [5, 6]. 2. Case Report A 23-year-old Caucasian male was admitted to the emergency department of our hospital due to severe left upper quadrant abdominal pain. His medical history was free, and no recent trauma was reported. Clinical examination revealed no pyrexia, heart rate at 90 per minute, and normal blood pressure. Upon physical examination, upper abdominal tenderness was revealed. On auscultation, abdominal sounds were present. Rectal examination showed an empty rectum. The emergent laboratory tests revealed the following: WBC 24350/ , hemoglobin 14,2?g/dl, platelets 278000/ , c-reactive protein 17?mg/dl, Tbil 1,9?mg/dl, Dbil 0,28, ast 27?IU/L, alt 42?IU/L, and creatinine and electrolytes were normal. An abdominal ultrasound showed splenomegaly (17,27 8,7?cm) and free fluid in the left iliac fossa and in pelvis (Figures 1 and 2). The urgent abdominal computerized tomography (CT) confirmed an enlarged spleen and showed a splenic hematoma with the presence of free fluid in the paracolic gutters and pelvis. There was a hyperdense component within the free fluid, indicating hemoperitoneum (Figure 3). Figure 1: Abdominal ultrasound showed splenomegaly (17,27 8,7?cm) and free fluid in the left iliac fossa. Figure 2: Abdominal ultrasound showed splenomegaly (17,27 8,7?cm) and free fluid in the left iliac fossa.
Epididymal Cysts in Childhood - Conservative or Surgical Approach?
Jerzy Niedzielski, Mieczys aw Miodek, Marek Krakós
Polish Journal of Surgery , 2012, DOI: 10.2478/v10035-012-0068-2
Abstract: The aim of the study. To decide on the accurate way of treatment and to establish criteria for operation in boys with pubertal epididymal cysts (ECs). Material and methods. Results of scrotal ultrasound of 363 boys and adolescents, aged 2 months to 18 years, were reviewed retrospectively. Results. Of all 363 patients with scrotal ultrasound 59 (16.2%) at mean age of 14.03 yrs had ECs. The EC incidence increased with age and 42 out of 124 boys (33.8%) older than 14 yrs had cysts (chi2=27.627, p=0.000). Out of 59 patients, in 30 (50.8%) cysts were diagnosed incidentally at the time of scrotal US, 29 boys (49.2%) presented with scrotal mass and/or pain. 31 patients with ECs (52.5%) underwent elective surgery and the remaining 28 boys (47.5%) received conservative treatment. The age of boys with ECs who underwent surgery ranged from 8 to 18 years (mean 14.32). The age range of patients treated conservatively was 7-18 (mean 13.71). There was no statistical difference in age between boys treated surgically and conservatively (t=0.924, p=0.36). ECs resolved in 17 patients out of 28 boys treated conservatively, in remaining 11 boys the size of cysts was stabile and they remain asymptomatic. Clinical and ultrasonographic follow-up were carried out from 11 months to 5 years. Conclusions. ECs are more common in older boys (over 14 years). Management of ECs smaller than 10 mm should be conservative with clinical and ultrasound controls, leaving surgery for cysts increasing in size over 10 mm which did not involute with time.
Multiple Ruptured Epidermal Cysts on The Scalp Mistaken as Hidradenitis Suppurativa  [PDF]
Yal?in Kulahc?,Celalettin Sever,Zafer Kucukodaci,Fatih Uygur
Journal of Clinical and Analytical Medicine , 2011, DOI: 10.4328
Abstract: Epidermal cyst is one of the most common benign soft tissue tumors, and it may be easily identified and treated by surgical excision. We experienced a patient who had multiple masses on the scalp and the masses had been misdiagnosed as hidradenitis suppurativa (HS) because of persistent pain, sinus tract and fistula formation and purulent discharge. Based on physical examination, early total excision was performed. On the histopathologic examination, it was diagnosed as multiple ruptured epidermal cysts. In the case presented here, we would like to introduce an initial misdiagnosis but ultimately accurate treatment with excellent cosmetic result and highly satisfaction of the patient.
Successful laparoscopic management of hemoperitoneum due to spontaneous venous rupture overlying a uterine fibroid  [PDF]
Kyousuke Takeuchi, Makoto Sugimoto, Taro Tsujino, Riichiro Nishino
Open Journal of Obstetrics and Gynecology (OJOG) , 2012, DOI: 10.4236/ojog.2012.22032
Abstract: Spontaneous venous rupture overlying a uterine fibroid is a rare cause of hemoperitoneum. A 38-year-old woman presented to the emergency department with acute onset of abdominal pain. The ultrasound revealed multiple fibroids and free fluid in the peritoneum. There was a significant drop of the hemoglobin and hematocrit. The patient underwent emergent exploratory laparoscopy. A subserosal uterine leiomyoma was found, with a bleeding vein on its basis and massive hemoperitoneum. Laparoscopic myomectomy was successfully performed with local injection of vasopressin and intraoperative autologous blood transfusion. This case suggests that spontaneous intraperitoneal haemorrhage associated with uterine fibroids, although rare, should be considered in women with hypovolemic shock and a pelvic mass.
Benign ovarian cysts in reproductive-age women undergoing assisted reproductive technology treatment  [PDF]
Guy Rofe, Ron Auslender, Martha Dirnfeld
Open Journal of Obstetrics and Gynecology (OJOG) , 2013, DOI: 10.4236/ojog.2013.37A1005
Abstract:

The scope of this review is to focus on the management of benign ovarian cyst in the reproductive-age group of women undergoing ART. Ovarian cysts are a common occurrence in this patient population. The differential diagnosis includes functional cysts, dermoid cysts, endometrioma. The appropriate evaluation includes medical history and physical examination, laboratory tests and imaging. The treatment options include conservative follow-up, medical treatment and surgery. This review will explore the differential diagnosis, appropriate work-up and treatment options to the various cyst types encountered.

Ruptured Granulosa Cell Tumor of the Ovary as a Cause of Acute Abdomen in Postmenopausal Woman  [PDF]
Tufan Oge,S. Sinan Ozalp,Omer T. Yalcin,Sare Kabukcuoglu,Emine Arslan
Case Reports in Oncological Medicine , 2012, DOI: 10.1155/2012/451631
Abstract: Acute abdomen with hemoperitoneum is a very rare entity in postmenopausal women due to gynecologic conditions. A 54-year-old, postmenopausal woman was brought to emergency department with severe abdominal pain. Physical examination revealed acute abdomen findings with 15?cm pelvic mass on the right adnexal region. Immediate exploratory laparotomy was performed. During laparotomy 1000?cc of bloodstained fluid, ruptured and actively bleeding large mass arising from right ovary was observed. Right salpingo-oopherectomy was performed in emergency conditions, and pathology report revealed an adult type of granulosa cell tumor. After this result, staging surgery was performed and patient was diagnosed as granulosa cell tumor stage 1?c. Cisplatin, etoposide, and bleomycin chemotherapy was given. Clinicians should be aware of granulosa cell tumors which may occur at any age and prone to rupture. Frozen section will be helpful in order to avoid incomplete surgeries especially in postmenopausal women presented with intra-abdominal bleeding. 1. Introduction Granulosa cell tumors of the ovary are rare neoplasms that originate from sex-cord stromal cells and they comprise 2–5% of all ovarian cancers [1]. Women may present with an asymptomatic mass or symptoms related to hyperestrogenism like abnormal uterine bleeding, breast tenderness, and postmenopausal bleeding in adult form of the disease. Although acute abdomen with hemoperitoneum is a common gynecologic emergency, it is a very rare entity in postmenopausal women due to gynecologic conditions. Lee et al. reported that tumor rupture occurred in 17.6% of cases before surgery diagnosed as adult granulosa cell tumor but the pain did not present as a cause of acute abdomen [1]. To the best of our knowledge, there are four cases of hemoperitoneum because of ruptured granulosa cell tumor [2–5]. We report a 54-year-old postmenopausal woman who presented with acute abdomen and hemoperitoneum because of ruptured granulosa cell tumor. 2. Case Report A 54-year-old, gravida 3, para 2 woman was brought to emergency department with severe right lower abdominal pain. The patient who was at menopause for 2 years had a postmenopausal bleeding history for two months, and she had abdominal distension for three months. Physical examination revealed abdominal tenderness and acute abdomen findings with stable vital signs, and pelvic examination revealed nearly 15?cm pelvic mass on the right adnexal region. Her hemoglobin count was 11.7?gr/dl. Abdominal ultrasound and pelviabdominal tomography examination confirmed the mass in the
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