RESUMEN
Objective: Adnexal torsion is a common gynecological emergency whose prompt diagnosis is essential because a delay may lead to ovarian dysfunction. Although the whirlpool sign is reliable for diagnosing ovarian cyst torsion, technical difficulties hinder its use by sonographers. Here we developed a systematic approach to visualizing this sign by focusing on the fact that torsion arises from the space between the uterus and the pelvic wall. One must determine the origin of the torsion via transverse imaging of the uterus and follow the twisted ligaments to the ovarian cyst.Patients and Methods: Two women aged 56 (Case 1) and 28 years (Case 2) visited our hospital with lower abdominal pain. Transvaginal ultrasonography showed a 7-cm right ovarian cyst in Case 1 and a 5-cm cyst in the Douglas pouch in Case 2; normal bilateral ovaries and the whirlpool sign were detected in both cases. Under laparoscopic guidance in Cases 1 and 2, an ovarian cyst and a paraovarian cyst were confirmed and removed.Results: Our step-by-step method allowed us to identify the whirlpool sign and confirm adnexal torsion, leading to prompt surgery in both cases.Conclusion: Using a systematic procedure helps less experienced practitioners detect the whirlpool sign.
RESUMEN
Objective To analyze the clinical features and prognosis of patients with acute epidural hematoma in the whirlpool sign.Methods 36 cases of CT scan showed a whirlpool sign of acute subdural hematoma patients were selected as the observation group.During the same time period,50 acute epidural hematoma patients without the whirlpool sign were selected as the control group.All patients received operation treatment.The Glasgow coma score (GCS),amount of hemorrhage and prognosis were compared between the two groups.Results The preoperative GCS score of the observation group was significantly lower than that of the control group (P ＜ 0.05).In the operation,the blood loss of the observation group was significantly increased compared with the control group (t =3.232,3.164,P ＜ 0.05).Control group CT evaluation of preoperative and intraoperative measurement had no significant difference(P ＞0.05).In the observation group,11 patients died,the mortality rate was 30.5％ (11/36).In the control group,6 patients died,the mortality rate was 12.0％ (6/50),the difference between the two groups was statistically significant (x2 =4.134,P ＜ 0.05).The patients were followed up for 6 months,the excellent and good rate of ADL score in observation group was 64.0％,which was significantly lower than 84.1％ in the control group (x2 =3.989,P ＜ 0.05).Conclusion Acute epidural hematoma patients with thewhirlpool signshowed progressive disease,high mortality,poor prognosis,and active countermeasures should be taken.
RESUMEN
Adnexal torsion is a gynecological emergency caused by the twisting of the ovary on its pedicle, causing lymphatic and venous stasis later in the evolution ischemia and necrosis when left untreated. There is no specific clinical sign or manifestation, nor any sensitive biochemical marker available for diagnosing adnexal torsion or ischemia. The best imaging tool in the diagnosis of torsion is the gynecologic ultrasound. The purpose of this review is to gather the ultrasound signs (coiling, whirlpool, ovary size, Doppler, etc.) found to make the diagnosis of this pathology easier.
La torsión anexial es una emergencia ginecológica causada por la torsión del ovario sobre el pedículo, lo que lleva a estasia linfática y venosa, más tarde en la evolución isquemia y necrosis, cuando no es tradada. No hay signos ni manifestaciones específicas, no hay marcadores bioquímicos para el diagnóstico de torsión anexial o isquemia. La mejor herramienta, en cuanto a exámenes de imágenes, es la ecografía ginecológica. El propósito de esta revisión es recolectar los hallazgos ecográficos (enbobinado, remolino, tamaño ovárico, Doppler, etc.) encontrados en la torsión para hacer más fácil el diagnóstico de esta patología.
Asunto(s)
Humanos , Femenino , Anomalía Torsional , Ovario/anomalías , Ovario , Anexos Uterinos/anomalías , Anexos UterinosRESUMEN
Small bowel volvulus in adults is very rare and occasionally occurs due to congenital midgut malrotation. The most common cause of small bowel volvulus is adhesions (74%), and other causes are Crohn's disease (7%), neoplasia (5%), hernia (2%), radiation (1%), and miscellaneous (11%). Presenting symptoms may be acute or present periodically during a longer period of time with a condition that is intermittent or recurrent because of spontaneous detorsion of the volvulus. Diagnostic imaging studies are plain abdominal film, ultrasonography, abdominal CT, and angiography. Abdominal CT is the most accurate. The most frequent CT finding is "Whirlpool sign." Other findings are bowel-loop dilatation, bowel-wall thickening, beak signs, mesenteric alterations, and extraluminal fluid. The mortality rate associated with small bowel volvulus in adults is 10~67%. We report a case of small bowel volvulus in adults.