Giant ovarian mucinous cystadenoma in Derna, Libya

Giant mucinous cystadenomas of the ovary are seldom documented in literature within developed countries, primarily due to the widespread availability of diagnostic technologies. However, in developing nations, such situations pose a challenge owing to limited access to diagnostic tools and constrained resources. Herein, we present the case of 35-year-old women, who reported a three-year history of a progressively enlarging giant mucinous cystadenoma which was initially mistaken for obesity, accompanied by abdominal distension and pain, and was not diagnosed during the cesarean section performed three weeks prior to the significant increase in size. Cystectomy performed, the resected cyst measured 25x23x17 cm, with no evidence of ascites. Subsequent histopathological analysis confirmed the diagnosis of mucinous cystadenoma. The patient experienced a complete postoperative recovery without any complications. Notably, the presence of vague gastrointestinal symptoms unrelated to the actual diagnosis underscores the importance of considering giant ovarian cysts as a potential differential diagnosis for ambiguous abdominal symptoms, given the varied clinical presentations they may manifest. This case underscores the necessity for multidisciplinary collaboration among various specialists to facilitate early diagnosis. Furthermore, it emphasizes the indispensable role of histopathological examination in ensuring accurate diagnosis and appropriate management of ovarian cysts

Abdominal pain in the female patient: A case of concurrent acute appendicitis and infected ovarian cyst

Background: Abdominal pain is a common presentation in women of child bearing age. It has a broad diagnosis that includes disorders of the gastrointestinal, gynaecological, vascular, urogenital, and pulmonary systems. It may be caused by infections, inflammatory, anatomic or neoplastic processes. Its management varies by aetiology, and accurate diagnosis is key to avoiding inappropriate treatment. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynaecologic diseases, which can add to the diagnostic dilemma. Method: We report a case of concurrent acute appendicitis and infected ovarian cyst in a 49 year old P6+4A6 who presented with recurrent abdominal pain for 4 years duration. Result: She had oophorectomy and appendicectomy. She did well post operatively and was discharged to outpatient department after stitches removal. Conclusion: Abdominal pain, being from various aetiology in women of child bearing age, detail history, thorough physical examination, and necessary imaging investigations need to be done to avoid misdiagnosis and inappropriate treatment.

Corpus luteum rupture mimicking acute appendicitis

Acute abdomen is a common presentation in women in the reproductive age. It may be caused by diverse conditions. The case below presented with classical signs and symptoms of appendicitis. Haemoperitoneum seen at laparotomy suggested a diagnosis of ectopic pregnancy .The diagnosis of ruptured corpus luteum cyst (RCLC) was made only after histology. The symptoms, signs and diagnosis of RCLC are discussed. The case highlights the need for circumspection in the diagnosis of the cause of acute abdomen. The current trend favours conservative management of RCLC thus the need for a high index of suspicion is emphasized to avoid unnecessary surgery.

Bilan d'activite coelioscopique dans un hopital secondaire. cas de l'hopital general d'Ayame (Cote d'Ivoire)

Objectif. Etablir le bilan de l'activite colioscopique a l'Hopital General d'Ayame Methode. Il s'agissait d'une etude retrospective et descriptive qui s'etait realisee a l'hopital general d'Ayame et qui concernait tous les actes coelioscopiques effectues dans le service de gynecologie et d'obstetrique du 02 janvier 2013 au 30 juin 2014. Nous avions etudie les caracteristiques socio-demographiques des patientes; les indications; les actes operatoires (diagnostiques et therapeutiques) et la morbidite postoperatoire. Resultats. Il a ete realise 45 interventions percoelioscopiques; soit 21% de l'activite chirurgicale gynecologique de l'hopital. Les patientes avaient un age moyen de 33;1 ans avec des extremes de 24 et 44 ans. Il s'agissait en majorite de nulligestes et primigestes (66%); de nullipares (71%); de cadres et de niveau scolaire superieur (48;8%); residant a Abidjan (66;6%) et vivant maritalement (75%). L'infertilite et la seconde consultation post-myomectomie etaient les indications avec respectivement 67% (30 cas) et 33% (15 cas). Les constatations per operatoires pour infertilite etaient dominees par les adherences periannexielles; les kystes ovariens et les obstructions tubaires avec des frequences respectives de 33%; 27% et 23%. L'adhesiolyse et la kystectomie representaient les actes chirurgicaux les plus realises dans des proportions respectives de 53;3% (24 cas) et 13;3% (6 cas). Dans tous les cas de seconde consultation postmyomectomie; nous avions note des adherences parmi lesquelles predominaient les type II (60%). Aucune complication operatoire n'avait ete observee. Conclusion : la colioscopie est realisable en dehors des structures sanitaires de niveau tertiaire. Une mise a niveau du personnel pourrait ameliorer sa pratique

Is the Use of a GnRH Antagonist Effective in Patients with Polycystic Ovarian Syndrome? A South African Perspective

Introduction. Polycystic ovarian disease (PCOS) can account for up to 35 - 40 of the female factor causes of infertility. These patients present as medically complex cases and are challenging to manage and treat successfully. They are resistant to treatment and are often offered controlled ovarian stimulation (COS) and in vitro fertilisation (IVF) technology. Aim. The aim of this study was to assess whether there was a difference in the pregnancy outcomes of women with PCOS when a standard gonadotrophin-releasing hormone (GnRH) antagonist (cetrorelix) protocol was used for ovarian stimulation; compared with non-PCOS patients undergoing IVF. Methods. A retrospective patient record audit was performed on 142 patients with PCOS and 501 non-PCOS patients undergoing a similar cetrorelix-based COS treatment protocol during a specified time period. Results. The main primary outcome was an ongoing pregnancy at 12 weeks; achieved in 34 of patients in the PCOS group and 27 in the non-PCOS group. This was not significantly different (p=0.07). No patient in the PCOS group experienced severe hyperstimulation syndrome. Conclusion. There was no significant difference in pregnancy rates in patients with PCOS undergoing GnRH-antagonist ovarian stimulation compared with non-PCOS patients. The fact that no hyperstimulation syndrome occurred makes this an attractive option for women with PCOS

Kyste de l'ovaire : quand faut-il operer?

La decision d'operer un kyste de l'ovaire repose sur une appreciation medicale du delai et des chances de l'expectative d'une part; et de la necessite et du benefice de l'acte chirurgical d'autre part. Et afin qu'une telle appreciation ne court pas le risque de l'arbitraire; on retiendra cependant les principes suivants: on ne doit pas se presser d'operer un kyste fonctionnel qui est appele a disparaitre de lui-meme; le kyste de l'ovaire avant la puberte ou apres la menopause doit susciter la mefiance; il faut l'operer; le kyste de l'ovaire accompagne d'une activite hormonale typique tres marquee ou atypique doit etre opere ; et au cours de la grossesse; l'operation d'un kyste ne doit; dans la mesure du possible; etre envisagee qu'au-dela du premier trimestre