Extirpación laparoscópica de quiste paraovárico gigante en pediatría / Laparoscopic removal of giant paraovarian cyst in pediatrics

El quiste paraovárico se desarrolla en el ligamento ancho, entre la trompa de Falopio y el ovario. Son estructuras redondeadas de pared lisa, llenas de líquido seroso, que se ubican en el mesosálpinx, el ligamento ancho o sobre la propia trompa uterina. Tienen una incidencia aproximada de 1 en 1 500 0002 son frecuentes en la tercera y cuarta década de la vida; raramente se presentan en la edad pediátrica. Generalmente, son benignos y tiene un crecimiento lento y progresivo, suelen ser asintomáticos por lo que el diagnóstico suele ser incidental. En casos de quistes de gran volumen, los síntomas son dolor pélvico o la tumoración ab-dominal. Usualmente son diagnosticados clínicamente y se confirman por imágenes ultrasonográficas. La importancia de este caso es la poca frecuencia de estos tumores en la edad pediátrica y su identificación oportuna por parte de los profesionales de la salud

The paraovarian cyst develops in the broad ligament, between the fallopian tube and the ovary. They are rounded structures with a smooth wall, filled with serous fluid, which are located in the mesosalpinx, the broad ligament or on the uterine tube itself. They have an approximate incidence of 1 in 1,500,0002 and are common in the third and fourth decades of life; they rarely occur in childhood. Generally, they are benign and have a slow and progressive growth, they are usually asymptomatic, so the diagnosis is usually incidental. In cases of large volume cysts, the symptoms are pelvic pain or abdominal mass. They are usually diagnosed clinically and confirmed by ultrasonographic images. The importance of this case is the infrequency of these tumors in the pediatric age and their timely identification by health professionals

Hematoma espontáneo del ligamento ancho luego de un parto vaginal normal: reporte de caso / Spontaneous hematoma of the broad ligament after a normal vaginal delivery: case report / Hematoma espontâneo do ligamento largo após um parto vaginal normal: apresentação de um caso clínico

La hemorragia posparto es una de las principales causas de muerte materna con una elevada morbimortalidad. El hematoma del ligamento ancho representa una entidad inusual, de difícil diagnóstico y alta sospecha clínica. Se presenta el caso clínico de una paciente con un hematoma del ligamento ancho espontáneo luego de un parto vaginal. Se optó por una conducta activa con laparotomía y antibioticoterapia obteniendo una buena evolución con egreso hospitalario a los 30 días. Se realiza la discusión del caso luego de revisar la bibliografía disponible.

Postpartum hemorrhage is one of the main causes of maternal death with high morbidity and mortality. The broad ligament hematoma represents an unusual entity, difficult to diagnose, in which clinical suspicion is determinant. The clinical case of a patient with a spontaneous broad ligament hematoma after a vaginal delivery is presented. An active management with laparotomy and antibiotic therapy was chosen, obtaining a satisfactory evolution with hospital discharge at 30 days. The case is discussed, after reviewing the available bibliography.

A hemorragia pós-parto é uma das principais causas de morte maternal com alta morbidade e mortalidade. O hematoma do ligamento largo representa uma entidade incomum, de difícil diagnóstico e alto suspeita clínica. A presentamos o caso clínico de uma paciente com hematoma espontâneo do ligamento largo, após parto vaginal. Foi optada por conduta ativa com laparotomía e antibioticoterapia, obtendo boa evolução com alta hospitalar após 30 dias. O caso é discutido depois de revisar a bibliografia disponível.

Angiomyolipoma of the broad ligament

Angiomyolipoma is a benign mesenchymal neoplasm of the renal parenchyma, accounting for 1% of all renal parenchymal tumors. However, this entity may rarely occur in extrarenal sites. Extrarenal angiomyolipoma has been documented in various sites of the body, but angiomyolipoma of the broad ligament was reported in only two cases. We report the reputed third case of angiomyolipoma of the broad ligament in a 33-year-old female, who presented clinically with abdominal distension. With a working diagnosis of low-grade neoplasm, an en-bloc excision of the left broad ligament mass was performed. Based on histopathology and immunohistochemistry, a diagnosis of the classical variant of angiomyolipoma of the left broad ligament was made. The post-operative period was uneventful with no recurrence after 6 months of follow-up.

Primary broad ligament adenocarcinoma

Primary broad ligament carcinoma is a very rare occurrence with 28 reported cases worldwide, to date. The epidemiology, treatment strategy and prognosis are still uncertain because of the scarcity of cases. Currently, all broad ligament carcinomas are managed similar to epithelial ovarian cancer. We report the case of a 43-year-old female with a prolonged complaint of abdominal pain and intermittent urinary retention, requiring frequent catheterization. She was diagnosed with obstructive right hydroureteronephrosis. The abdominal Contrast Enhanced Computed Tomography (CECT) revealed a well-defined heterogeneous lesion of 2.1х3х3.2cm size in the right lateral and posterior wall of the cervix. An ultrasound (USG)-guided Fine Needle Aspiration Cytology (FNAC) of the mass was done and it was suspected to be malignant. The patient underwent total abdominal hysterectomy, right salpingo-oophorectomy, pelvic lymph-nodal sampling, and peritoneal washing. Histological examination depicted an endometrioid adenocarcinoma of the broad ligament. She received adjuvant chemotherapy, followed by hormonal therapy. It has been five years since her surgery, and she is now alive and disease free.

Internal Hernia through a Defect in the Broad Ligament of Uterus: Laparoscopic Management Using a Self-Anchoring Barbed Suture

The occurrence of internal hernia through a defect in the broad ligament is a very rare condition, which may cause small bowel obstruction. This is a case of a 50-year-old woman who developed intestinal obstruction induced by internal hernia and who had undergone laparoscopic myomectomy 7 years prior to visiting our emergency room. Abdominopelvic computed tomography showed luminal narrowing of the ileum and dilatation of the pelvic loop of the small bowel at the left side of the uterus. We detected internal hernia through the defect in the broad ligament and managed it successfully by performing a laparoscopic procedure using a barbed suture, V-Loc (Covidien, Mansfield, MA).

Síndrome de Allen Master: causa excepcional de abdomen agudo en el embarazo / Allen Master syndrome: exceptional cause of acute abdomen in pregnancy

Se presenta un caso de abdomen agudo en una gestante de 20 semanas, por una torsión anexial. Ante la ausencia de signos ecográficos compatibles con patología en los primeros momentos y el empeoramiento clínico, se solicitó una RMN que permitió la aproximación diagnóstica y facilitó la indicación urgente de cirugía abdominal. En el curso de la laparotomía se diagnosticó una hernia interna del anexo, con marcado componente vascular a través de un defecto del ligamento ancho, que obligó a la anexectomía. Tras el diagnóstico y el tratamiento realizado, la gestación continúa con buenos resultados materno-fetal. Estos orificios han sido presentados excepcionalmente como causa de hernias internas digestivas, urológicas y anexiales, siendo controvertido su origen, congénito, inflamatorio o traumático. Se repasan las pruebas complementarias indicadas en el manejo diagnóstico del dolor abdominal en el embarazo, incluyendo las últimas recomendaciones de la European Society of Urogenital Radiology-ESUR.

A case of acute abdomen in a pregnant 20 weeks is presented with an adnexal torsion. In the absence of pathologic ultrasound signs with in the early stages and clinical worsening, was requested an MRI that allowed the diagnostic approach and the indication for urgent abdominal surgery. During laparotomy was observed an internal adnexal hernia through a defect in the broad ligament, with marked vascular component which forced the adnexectomy. After the diagnosis and treatment performed, the pregnancy continues with good maternal and fetal outcomes. These defects were presented exceptionally as a cause of digestive, urological and adnexal internal hernias. The origin remains controversial, congenital, inflammatory or traumatic. Complementary tests in the diagnostic management of abdominal pain in pregnancy are reviewed, including the latest recommendations of the European Society of Urogenital Radiology-ESUR.

Broad Ligament Fibroid: A Case Series.

Fibroids are most common benign tumors of the uterus, mostly situated in the body of the uterus. Rarely, they arise from extra-uterine sites with broad ligament fibroids being uncommon. Although by clinical examination and newer imaging modalities, we can easily know about size, number, and origin of these tumors and any anatomical distortion of surrounding vital organs, but some time it is very difficult to differentiate pre-operatively between large broad ligament leiomyomas and ovarian/adnexal pathology specially if cystic degeneration or necrosis is present in leiomyoma. We report four patients with broad ligament fibroids to emphasize the importance of their location, the diagnostic difficulties, and surgical complications they can pose.

Uterine Lipoleiomyoma in Peri or Postmenopausal Women

Lipoleiomyoma is an uncommon neoplasm of the uterus, composed of smooth muscles intermixed with mature adipocytes. These tumors are considered a benign variant of uterine leiomyomas. Herein, we report six cases of lipoleiomyoma experienced in our institution from January 2005 to March 2015. The patients ranged in age from 45 to 70 years; the etiology may be related to estrogen deficiency occurring after menopausal transition. Except for one lipoleiomyoma in the broad ligament, all others were found in the uterine corpus. The presenting symptoms were nonspecific, and most cases were incidentally diagnosed during surgery for other reasons. We performed preoperative imaging studies, including abdominal and pelvic computed tomography and magnetic resonance imaging. Preoperatively, four patients were diagnosed as having a pelvic mass and one patient was diagnosed as having a right ovarian mature teratoma. In one case, we found a gynecologic malignancy (cervical cancer 1A1). Histologically, there was no gross or microscopic contiguity between the lipoleiomyoma and the malignancy. Lipoleiomyomas seem to have a benign clinical course. In our study, there were no recurrences of or deaths attributed to the lipoleiomyomas during a mean follow-up period of 16.17 +/- 23.80 months.

The Usefulness of Laparoscopy in the Treatment of Incarcerated Internal Hernia through a Defect in the Broad Ligament

Hernias through the broad ligament are rare with a reported incidence of only 4-7% of cases of internal hernias. Here, we report on a rare case of incarcerated internal hernia through a spontaneous defect in the broad ligament which was repaired using a laparoscopic technique. A 41-year-old female was admitted with colic abdominal pain. Laparoscopic exploration was performed for the diagnosis of intestinal obstruction. Laparoscopic examination confirmed an approximately 10-cm-long ileal loop herniated in the anterior to posterior direction through a left broad ligament defect. A large defect in the broad ligament was closed by an intracorporeal continuous running suture. The patient was highly satisfied with the cosmetic result. In conclusion, laparoscopy could be particularly helpful during pelvic surgery, which usually requires large skin incisions to ensure a good field of view. This approach was cosmetically effective, decreased the postoperative complications, and promoted early recovery to usual activity.

Retroperitoneal Leiomyoma of the Uterus Mimicking Sarcoma in Perimenopausal Woman: Case Report

Leiomyomas are very common benign tumors in the uterus and it is rare condition to present the retroperitoneal leiomyoma. The author reported a 48-year-old female patient who presented right pelvic mass with urinary incontinence and lower abdominal discomfort. Based on the preoperative imaging, provisional diagnosis was mesenchymal sarcoma. In the intraoperative findings, huge mass abutting to the uterus was observed in retroperitoneal space beneath the right broad ligament. After the exposure the retroperitoneal space, we encountered the well-demarcated tumor measuring 8 x 6 cm in diameter and this tumor attached the right surface of the uterus with fibrotic tissue. Pathologic findings demonstrated retroperitoneal uterine leiomyoma.

Full term broad ligament pregnancy through a Cesarean scar

A broad ligament pregnancy is an extremely rare condition. Diagnosis is often missed and finally made during laparotomy. We present a case which remained undiagnosed throughout her pregnancy till she reached term and unfortunately had intrauterine foetal demise when she reported to our hospital. On clinical suspicion, ultrasound and magnetic resonance imaging evaluation was done which picked up the diagnosis of abdominal pregnancy. On laparotomy a broad ligament pregnancy was found with a rent in the previous Cesarean scar towards the gestational sac in the broad ligament.

Foramen congénito del ligamento ancho con hernia enteral interna y sufrimiento intestinal reversible: presentación de dos casos / Two cases of congenital foramina in the broad ligament of the uterus with small bowel hernias and reversible intestinal distress

Se trata de dos pacientes con un foramen congénito del ligamento ancho que permitió el paso de un asa de intestino delgado y posteriormente causó un cuadro de obstrucción intestinal completa con sufrimiento de asa reversible. Se descartaron antecedentes quirúrgicos, traumáticos e infecciosos que pudieran simular un anillo intraperitoneal congénito.

We report two cases of congenital foramina in the broad ligament through which segments of the small intestine passed producing intestinal obstruction with reversible bowel distress. Surgical, traumatic and infectious causes that could simulate congenital intraperitoneal bands were ruled out.

High malignant female adnexal tumor of probable wolffian origin (FATWO): A case report / 대한산부인과학회지

Female adnexal tumors of probable Wolffian origin (FATWO) are rare. Although the histological features of the benign tumors are recognized, features of malignancy are not well defined in published work because these tumors are particularly rare. In this study, we report a 52-year-old woman with a High malignant FATWO. The frozen biopsy of the fragile uterine mass, located at the left broad ligament, revealed a malignant FATWO with high mitotic figure (up to 36/10 HPF). The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy, and paraaortic and pelvic lymph node dissection. Pathologic findings were consistent with malignant FATWO infiltrating to the unilateral salpinx without lymph node metastasis. The patient received three cycles of adjuvant treatment with paclitaxel and carboplatin. There was no clinical evidence of recurrence during the 12 months of follow-up; the patient is currently still being followed-up.

Lipoleiomyoma of broad ligament mimicking ovarian cancer in a postmenopausal patient: case report and literature review / 부인종양

Lipoleiomyoma is a very rare tumor which is composed of adipocytes and smooth muscle cells. It is most commonly located in uterine corpus although cervical, ovarian, and retroperitoneal locations were also reported. Lipoleiomyoma located in broad ligament is extremely uncommon and only five cases were reported to date. Here, we report the sixth case of lipoleiomyoma of broad ligament which was diagnosed in a postmenopausal woman who was subjected to exploratory laparotomy with a preoperative diagnosis of a solid adnexal mass suggesting an ovarian malignancy.

Disseminated peritoneal leiomyomatosis arising after laparoscopic myomectomy / 대한산부인과학회지

Disseminated peritoneal leiomyomatosis is rare condition characterized by multiple subperitoneal nodules of benign smooth muscle proliferations. It is associated with high level of estrogen such as pregnancy, oral contraceptives or estrogen producing ovarian tumor, and occasionally associated with operation history of myomectomy or hysterectomy. Clinical course of disseminated peritoneal leiomyomatosis is usually benign, but malignant changes also rarely have been reported. We experienced a case of disseminated peritoneal leiomyomatosis who has history of laparoscopic myomectomy 10 years ago. The patient was a 35-year-old woman, and her chief complaint was palpable masses in lower abdomen. She underwent laparoscopic surgery which revealed numerous solid masses on the surface of peritoneum, descending colon, rectosigmoid colon, uterus, round ligament, and broad ligament. We present it with a brief review of literature.

Manchester repair. An alternative to hysterectomy

Local data regarding Manchester repair are not available in the current literature. We report a retrospective case series of 7 women who presented with uterine prolapse, and underwent Manchester repair from January 1997 to May 2008 at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. All of these women were multiparous [para 3 +/- 1] and wanted to avoid hysterectomy, and become pregnant. The duration of the procedure was 119 +/- 16 minutes. No operative complications were observed. The mean duration of follow up was 5 +/- 2 years. All of the women were satisfied with the procedure. Two [28.6%] patients subsequently became pregnant and had a successful vaginal delivery. Manchester repair is a valid alternative to hysterectomy for women with a second degree uterine prolapse who want to preserve their fertility

A case of primary clear cell carcinoma of broad ligament / 대한산부인과학회지

Primary broad ligament tumors are a rare entity, although secondary involvement of broad ligament by a malignancy arising elsewhrere in the abdomen/pelvis is common. Among the primary broad ligament tumors, leiomyoma is the most frequent histopathological type followed by serous papillary cystadenoma of borderline malignancy. Primary sarcomas and high-grade carcinomas have been extremely rarely reported. Because of the rarity of disease, its treatment policy, follow-up strategy and prognosis are yet to be established and it is managed as an ovarian malignancy. We had experienced a case of clear cell adenocarcinoma arising from broad ligament and report this case with a brief review of literature.