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

Torsión aislada de la trompa de Falopio, con necrosis de un quiste paratubárico: una urgencia ginecológica infrecuente / Isolated torsion of the Fallopian tube, with necrosis of a paratubal cyst: an infrequent gynecological emergency

INTRODUCCIÓN: La torsión aislada de la trompa de Falopio ocurre en aproximadamente una de cada 50.000 a 1.500.000 mujeres, por ende, es una afección extremadamente rara. Fue originalmente descrita por Bland-Sutton en 1890. El cuadro clínico suele ser inespecífico y puede simular una amplia variedad de dolencias. CASO CLÍNICO: Paciente de 18 años de edad que acude al servicio de urgencias por dolor abdominal intenso, la cual se decide ingresar por cuadro agudo doloroso abdominal de posible etiología ginecológica, se realiza laparoscopía de urgencia por la posibilidad de un cuadro de torsión quística, durante esta se observa una imagen laparoscópica de la trompa izquierda violácea y torcida, además un quiste paratubárico hemorrágico, de color violacio; por las características laparoscópicas de la trompa y el quiste paratubárico que se relacionan con necrosis de estos elementos, se decide realizar a la paciente una anexectomía total izquierda con cistectomía del quiste paratubárico. DISCUSIÓN: La rotación de la trompa alrededor de su pedículo vascular es el evento fisiopatológico descrito, lo que provoca inicialmente la obstrucción del retorno venoso y linfático, con el consiguiente edema, ingurgitación y trombosis. Si la torsión progresa, y no se resuelve, se ve comprometida la vascularización arterial y se desencadena la necrosis del órgano y, finalmente la instauración de peritonitis, la conducta se basa en la viabilidad de la trompa: si no tiene signos de necrosis, la conducta indicada es destorcerla, si ya aparecieron signos de necrosis deberá ser extirpada.

INTRODUCTION: Isolated torsion of the Fallopian tube occurs in approximately one in every 50,000 to 1,500,000 women, therefore, it is an extremely rare condition. It was originally described by Bland-Sutton in 1890. The clinical picture is usually nonspecific and can mimic a wide variety of ailments. CLINICAL CASE: An 18-year-old patient who came to the emergency service for intense abdominal pain, which was decided to enter due to acute abdominal pain of possible gynecological etiology, an emergency laparoscopy was performed due to the possibility of a cystic torsion condition, During this, a laparoscopic image of the violaceous and crooked left tube is observed, as well as, a hemorrhagic paratubal cyst, violet in color; Due to the laparoscopic characteristics of the tube and the paratubal cyst that are related to necrosis of these elements, it was decided to perform a total left adnexectomy with cystectomy of the paratubal cyst. DISCUSSION: Rotation of the tube around its vascular pedicle is the described pathophysiological event, which initially causes obstruction of venous and lymphatic return, with the consequent edema, engorgement and thrombosis. If the torsion progresses and does not resolve, the arterial vascularization is compromised and the necrosis of the organ is triggered and, finally, the establishment of peritonitis, the behavior is based on the viability of the tube: if there are no signs of necrosis, the indicated conduct is to untwist it, if signs of necrosis have already appeared, it must be removed.

Torsión tubárica aislada como complicación de un quiste paraovárico en el Hospital Universitario de Santander, Colombia / Isolated Fallopian Tube Torsion as a Complication of a Paraovarian Cyst in the University Hospital of Santander, Colombia / Torção tubária isolada como uma complicação de um cisto paraovariano no Hospital Universitário de Santander, Colômbia

Introducción: El quiste paraovárico representa el 10 al 20% de las masas anexiales, genera síntomas cuando causa torsión de los anexos, pero es poco frecuente, la torsión aislada de las trompas tiene una incidencia de 1 en 1.5 millones de mujeres. Objetivo: Presentar un caso de torsión tubárica aislada como complicación de un quiste paraovárico en el Hospital Universitario de Santander. Caso clínico: Paciente femenino de 17 años, presenta dolor en hemiabdomen inferior; hallazgo ecográfico, quiste paraovárico derecho; mejora la sintomatología en 24 horas; egreso con recomendaciones; regresa dos meses después por exacerbación del dolor, masa anexial de 5 centímetros, laboratorios normales, ecografía reporta ovario aumentado de tamaño y trompa de paredes engrosadas; se realiza laparoscopia; se encuentra trompa derecha torcida con necrosis y quiste paraovárico derecho de 6 x 5cm. Discusión: El diagnóstico de quiste paraovárico es generalmente incidental por ecografía, cuando se complica con torsión, se presenta dolor abdominal pélvico asociado a náuseas y vómito, al examen físico el 42.9% de las mujeres presentan a la palpación una masa anexial; la paciente del caso presenta dolor abdominal, con masa anexial palpable evidenciada en ecografía, por lo cual se realiza laparoscopia. El tratamiento del quiste paraovárico es el seguimiento, sin embargo, si aumentan de tamaño o hay persistencia, debe retirarse quirúrgicamente por el riesgo de torsión de anexos. De presentar torsión el manejo depende del estado de la trompa, al realizar destorsión persiste la coloración violácea, se debe realizar salpingectomía y cistectomía procedimiento realizado en esta paciente. Conclusiones: El diagnóstico de la torsión tubárica se realiza con clínica de dolor abdominal pélvico agudo, náuseas, vómito y presencia de masa anexial al tacto vaginal. La laparoscopia es el tratamiento de elección, cuyo manejo con cistectomía y salpingectomía que depende del compromiso vascular de los anexos. [Sepúlveda-Agudelo J, Torrado-Arenas DM, Martínez-Moreno N. Torsión tubárica aislada como complicación de un quiste paraovárico en el Hospital Universitario de Santander, Colombia. MedUNAB 2017; 20(3): 393-398].

Introduction: The paraovarian cyst represents from 10% to 20% of the adnexal masses, it generates symptoms when it causes torsion of the annexes but this is rare. The isolated torsion of the fallopian tubes has an incidence of 1 in 1.5 million women. Objective: To show a case of isolated fallopian tube torsion (IFTT) as a complication of a paraovarian cyst at the University Hospital of Santander. Clinical case: A 17-year old female patient who presents pain in lower hemi-abdomen. After performing the ultrasound, a right paraovarian cyst is found. Her symptomatology improves within 24 hours. Therefore, she is discharged after telling her some recommendations. Two months later, she returns because of pain exacerbation caused by an adnexal mass of 5 centimeters. Now, her lab tests are normal but her new ultrasound reports an enlargement in the ovary and thickened fallopian tubes, so a laparoscopy is performed. This test shows that the right fallopian tube is twisted with necrosis and a right paraovarian cyst of 6 x 5cm. Discussion: The diagnosis of paraovarian cyst is usually incidental by ultrasound; but when there is a torsion complication, pelvic abdominal pain associated with nausea and vomiting is presented. When the physical examination is performed, 42.9% of women present an adnexal mass on palpation. The patient of this clinical case shows abdominal pain, including a tangible adnexal mass, which is evidenced by the ultrasound. For this reason, a laparoscopy is performed. The treatment of the paraovarian cyst is the follow-up; however, if it increases in size or there is persistence, it should be removed surgically due to the risk of torsion of its annexes. If it presents torsion, its handling will depend on the state of the tube. So, if at the moment of performing a distortion in it the violaceous color persists, a salpingectomy and a cystectomy must be performed in this patient. Conclusions: The diagnosis of fallopian tube torsion is performed if the patient has clinical symptoms such as acute pelvic abdominal pain, nausea, vomiting and presence of adnexal mass when performing a digital vaginal examination. Laparoscopy is the treatment of choice, and its management with cystectomy and salpingectomy depends on the vascular commitment of the cyst annexes. [Sepúlveda-Agudelo J, Torrado-Arenas DM, Martínez-Moreno N. Isolated Fallopian Tube Torsion as a Complication of a Paraovarian Cyst in the University Hospital of Santander, Colombia. MedUNAB 2017; 20(3): 393-398].

Introdução: o cisto paraovariano representa 10 a 20% das massas anexiais, gera sintomas quando provoca a torção dos anexos, mas é raro, a torção isolada dos tubos tem uma incidência de 1 em 1,5 milhão de mulheres. Objetivo: Apresentar um caso de torção tubária isolada como complicação de um cisto paraovariano no Hospital Universitário de Santander. Caso clínico: paciente do sexo feminino de 17 anos, apresenta dor em hemiabdomen inferior; com ultra-som foi descoberto um cisto paraovariano direito; no prazo de 24 horas, melhora a sintomatologia; sai de alta, com recomendações. Retorna dois meses depois, por causa da dor intense e uma massa anexial de 5 centímetros (cm), como resultado nos laboratórios normais. O ultra-som revelou o aumento do tamanho do ovário e o bico afundado; é realizada uma laparoscopia; O tronco torcido direito é encontrado com necrose e cisto paraovariano direito de 6 x 5cm. Discussão: O diagnóstico do cisto paraovariano geralmente é descoberto por incidente, ao se fazer a ultrassonografia, quando é um caso complicado com torção, a dor abdominal pélvica está associada a náuseas e vômitos; no exame físico, 42,9% das mulheres apresentam palpação, uma massa anexial. A paciente, no caso apresenta dor abdominal, com uma massa anexial palpável evidenciada no ultra-som, razão pela qual a laparoscopia é realizada. O tratamento do cisto paraovariano é o acompanhamento, no entanto, se eles aumentam de tamanho ou haja persistência, ele deve ser removido cirurgicamente devido ao risco de torção de anexos. Se a torção persiste, o tratamento depende do estado do tubo e, se ao realizar a distorção, a cor violácea persiste, a salpingectomia e a cistectomia devem ser realizadas nessa paciente. Conclusões: o diagnóstico de torção tubária é feito com sintomas de dor abdominal pélvica aguda, náuseas, vômitos e presença de massa anexial ao toque vaginal. A laparoscopia é o tratamento de escolha, cujo manejo com cistectomia e salpingectomia depende do comprometimento vascular dos anexos. [Sepúlveda-Agudelo J, Torrado-Arenas DM, Martínez-Moreno N. Torção tubária isolada como uma complicação de um cisto paraovariano no Hospital Universitário de Santander, Colômbia. MedUNAB 2017; 20(3): 393-398].

Quiste paraovárico gigante en la infancia: Reporte de un caso / Giant paraovarian cyst in childhood: Case report

Introducción: Los quistes paraováricos son de diagnóstico infrecuente en la edad pediátrica. Objetivos: Dar a conocer un caso clínico de quiste paraovárico gigante en la infancia y su manejo a través de una técnica laparoscópica modificada. Caso Clínico: Paciente de 13 años con cuadro de dolor abdominal intermitente de 15 días de evolución, localizado en el hemiabdomen izquierdo, asociado a aumento de volumen abdominal progresivo. Las imágenes diagnósticas no fueron concluyentes, describiendo una formación quística gigante que ocupaba todo el abdomen, sin precisar su origen. Exámenes de laboratorio y marcadores tumorales dentro de los parámetros normales. Se realizó quistectomía transumbilical videoasistida, un procedimiento laparoscópico modificado, con intención diagnóstica y terapéutica con resultado exitoso. Estudio histológico compatible con quiste paraovárico gigante. El examen citológico resultó negativo para células tumorales. La paciente permaneció asintomática durante el seguimiento postoperatorio. Conclusiones: La quistectomía transumbilical videoasistida es una técnica segura y constituye una excelente alternativa diagnóstica y terapéutica para el tratamiento de quistes paraováricos gigantes.

Introduction: Paraovarian cysts are very uncommon in children. Objective: To present a case of giant paraovarian cyst case in a child and its management using a modified laparoscopic-assisted technique. Case report: A 13-year-old patient with a 15 day-history of intermittent abdominal pain, located in the left hemiabdomen and associated with progressive increase in abdominal volume. Diagnostic imaging was inconclusive, describing a giant cystic formation that filled up the abdomen, but without specifying its origin. Laboratory tests and tumor markers were within normal range. Video-assisted transumbilical cystectomy, a modified laparoscopic procedure with diagnostic and therapeutic intent, was performed with a successful outcome. The histological study reported giant paraovarian cyst. Cytology results were negative for tumor cells. The patient remained asymptomatic during the postoperative follow-up. Conclusions: The video-assisted transumbilical cystectomy is a safe procedure and an excellent diagnostic and therapeutic alternative for the treatment of giant paraovarian cysts.

Acute abdomen due to ovarian congestion caused by coiling of the fallopian tube accompanied by paratubal cyst around the utero-ovarian ligament

Torsion of uterine adnexa is an important cause of acute abdominal pain in females. The main organ which can cause torsion is the ovaries, but torsions of the fallopian tube, subserosal myoma, paratubal cyst, and even the uterine body have been reported. The incidence of isolated fallopian tubal torsion is very rare. Even more rarely, it can coil around nearby organs such as the utero-ovarian ligament, showing similar clinical manifestations with those of adnexal torsion. We experienced an extremely rare case of acute abdomen induced by ovarian congestion triggered by the fallopian tube accompanying a paratubal cyst coiling around the utero-ovarian ligament. The right paratubal cyst was misinterpreted as being part of a cystic component of the left ovary on preoperative sonographic examination, and the coiling of the right fallopian tube accompanying the paratubal cyst was misdiagnosed as torsion of the right ovary. We report this rare case with a brief literature review.

H1 Magnetic Resonance Spectroscopy of Cystic Ovarian Lesions

On H1 MRS (magnetic resonance spectroscopy), malignant tumors show higher concentration of metabolite than benign lesions. Lactate double peak was detected in malignant tumor and endometriosis, and more prominent high concentration was demonstrated in endometriosis. Tuboovarian abscesses and salpingitis do not show prominent peak. Dermoid cysts show high levels of lipid peak. Paratubal cyst and follicular cyst can be showed the lipid peak, however, the concentration of lipid is lower than that of dermoid cyst. H1 MRS of ovarian cystic lesions can give valuable information about the presence of metabolites of ovarian cystic lesions.

The Clinical Manifestation of the Gynecologic Emergency in Postmenopausal Women / 대한폐경학회지

OBJECTIVES: The objective of this study was to assess the clinical characteristics of postmenopausal women who were admitted to the emergency room. METHODS: This study was conducted at a university hospital. The retrospective study of medical records comprised 26 patients who were admitted to the emergency room, between September 2010 and August 2011. RESULTS: The age of the twenty-six patients was 51-90 years. Abdominal pain and vaginal bleeding were the main complaints. The final diagnoses were 6 cases of postmenopausal atrophic vaginitis, 6 cases of ovarian cyst, 5 cases of pelvic inflammation disease, 3 cases of post-conization bleeding, 1 case of menopausal symptoms, 1 case of atrophic endometrium, 1 case of uterine prolapse, 1 case of pyometra, and acute pyeolonephritis with stone. Among the 6 cases of ovarian cyst, 5 cases performed an operation. Pathologic findings revealed 2 cases of simple cyst, 1 case of paratubal cyst, 1 case of teratoma, and 1 case of granulosa cell tumor. CONCLUSION: The incidence of post-menopausal distress in women is increasing, and the numbers of post-menopausal women being admitted to the emergency room are also increasing, so attention needs to be paid to the case of postmenopausal women in the future.

The review of laparoscopic adnexa tumor surgery through Douglas pouch / 대한산부인과내시경학회지

OBJECTIVE: To evaluated the result of laparoscopic surgery of adnexal tumors and removing excised tissue through Douglas pouch incision. METHODS: 110 patient who had visited Chosun University Hospital department of Obstetrics and Gynecology between January, 2011 to April, 2012 were involved in the study. Patient had laparoscopic surgery on the adnexal tumor and excised tissue was removed through Douglas pouch incision by single surgeon. RESULTS: The mean age of patients were 41.5 years. The size of the tumor varied from 3 cm to 27 cm in size using ultrasonography. The mean operation time was 61.3 minutes and the mean admission period was 4.2 days. 82 patient had salpingo-oophorectomy or oophorectomy, 19 had ovarian cystectomy, 2 had wedge resection and 4 had tumor enucleation. Histologic result reveal endometriosis in 23 patients (20.9%). teratoma in 21 (19%), serous cystadenoma in 14 (12.7%) and mucinous cystadenoma in 10 (9.1%). Other histologic finding includes hemorrhagic cyst, luteal cyst and paratubal cyst. There was no complication including bladder or rectal injury, suture site infection. CONCLUSION: Laparoscopic surgery of adnexal tumor and removal by Douglas pouch incision is a simple, safe and efficient method that could be considered as an alternative minimally invasive technique.

Ectopic Epididymis in Testicular Appendices: Report of Two Cases

We report two cases of ectopic epididymal ducts and efferent ductules in the testicular appendices (TAs) of adult men with normally descended testes. In both cases, a sessile TA was incidentally found at the upper pole of the right testis during the scrotal hydrocelectomy. Microscopically, a few closely arranged tubules were detected within the TA. In the first case, the tubules were lined with a pseudostratified columnar epithelium with numerous, long microvilli, and were surrounded by a smooth muscle coat. In contrast, in the second case, the tubules had a wavy luminal surface, because ciliated columnar cells alternated with groups of cuboidal cells. In both cases, strong CD10 immunoreactivity was observed in the luminal border of the lining epithelium. Surgical pathologists should be aware of the presence of both ectopic epididymal ducts and efferent ductules that can occur in TAs, in order to avoid misinterpretation as transected, functional reproductive structures.

Paratubal serous borderline tumor / 부인종양

Although paratubal cysts are well-characterized incidental findings, paratubal serous borderline tumors are very rare, with only one case report in the literature. We describe here a 27-year-old, nulliparous, married woman with a paratubal serous borderline tumor. The patient presented with a huge pelvic mass accompanied by flank pain and underwent paratubal cystectomy and fertility-sparing surgical staging procedures. Thirteen months after surgery, she delivered a healthy baby at term. She is well, without evidence of disease, 20 months after surgery. Because paratubal serous borderline tumors are very rare, their optimal management must be extrapolated from their ovarian counterparts.

Torsion of the paratubal cyst in an adolescent female: A case report / 대한산부인과학회지

Torsion of the paratubal cyst is a rare but significant cause of acute or recurrent lower abdominal pain in adolescent females that is difficult to recognize preoperatively. Early diagnosis is very important in adolescent because of the risk of decreased fertility if it is not treated at an early stage. We report a case of torsion of the paratubal cyst that has resulted in hemorrhagic infarction of the paratubal cyst and fallopian tube in an adolescent female with brief review of literatures.

Two cases of paratubal cysts manifesting as huge pelvic masses in young women / 대한산부인과학회지

Paratubal cysts come from paraovarium of the broad ligament between the fallopian tube and ovary. Overall, these cysts constitute 10% of all adnexal masses and are commonly incidental findings upon surgical exploration for other reasons. They more commonly occur in women between 30 and 40 years of age. We report two cases of rapidly growing, huge paratubal cysts in young women, which are presented with brief review of literature.

Clinical Experiences of Laparoscopic Surgery in Children

PURPOSE: The indications for pediatric laparoscopic surgery are increasing according to the improvement of laparoscopic procedures and instruments and the increased knowledge of its safety and benefits. We summarized the analysis of the outcomes and the feasibility of performing laparoscopic surgery in children. METHODS: We retrospectively analyzed 183 consecutive children (114 males and 69 females) who underwent laparoscopic surgery between June 2001 and July 2007. The following information was obtained: the surgical indications, operative procedures and surgical outcomes. RESULTS: The laparoscopic procedures for each disease were as follows, appendectomy for acute appendicitis (n=143), reduction for barium reduction-failed intussusceptions (n=15), splenectomy for symptomatic hereditary spherocytosis (n=5), salphingoophorectomy for torsion of a parovarian cyst and ovarian tumor (n=2), diverticulectomy or segmental resection for symptomatic Meckel's diverticulum (n=3), cholecystectomy for symptomatic gall stones & adenomyomatosis (n-4), repair for Morgagni hernia (n=1), Nissen's fundoplication for paraesophageal hernia (n=1), Heller myotomy and Dor fundoplication for achalasia (n=1), diagnostic purpose for peritoneal tuberculosis (n=3) and lymphoma (n=1), excision for retroperitoneal neuroblastoma (n=1), peritoneal drainage for postoperative abscess (n=1) and removal of a foreign body in the peritoneal cavity (n=2). The mean age was 9.9 years (range: 4 months to 15 years). There was one conversion for a perforated appendicitis. There were 3 cases of laparoscopic assisted reductions for intussusception. There were three wound infections in the patients with complicated appendicitis. CONCLUSION: Laparoscopic procedures for various pediatric surgical disorders were feasible under the appropriate indications.

Quiste paraovárico complicado: causa rara de dolor abdominal / Complicated paraovarian cyst: rare cause of abdominal pain

: We report the ultrasonographic and laparoscopic findings in a case of twisted parovarian cyst related with a Morgagni hydatid, without involving of the tube and ovary. The 11 years old patient consulted for an acute abdominal pain that made suspect the clinical existence of acute appendicitis. The identification of normal appendix and ovaries, and the finding of a complex cyst structure close to the ovary, led to the laparoscopic surgery, that identified a twisted hydatid at the right side and a non twisted cystic structure at the left side. We discuss this pathology as an eventual and rare cause of acute abdominal pain in females.

Se presentan los hallazgos ultrasonográficos y laparoscópicos en un caso de quiste paraovárico torcido correspondiente a una hidátide de Morgagni sin compromiso de la trompa ni del ovario. La paciente de 11 años consultó, al servicio de urgencia por un dolor abdominal agudo que hizo plantear clínicamente la existencia de una apendicitis aguda. La identificación de un apéndice y ovarios normales, junto al hallazgo de una estructura quística compleja próxima al ovario llevaron a la cirugía laparoscópica que identificó la hidátide torcida a derecha y una estructura quística similar no torcida a izquierda. Se discute esta patología como una eventual y rara causa de dolor abdominal agudo en el sexo femenino.

A case of parovarian tumor of borderline malignancy / 부인종양

Parovarian cysts, generally known as hydatid cysts of Morgagni, are small round cysts attached by a pedicle to the fimbriated end of the tube. Due to the rarity of this lesion, there are controversies concerning the origin, clinical behavior, treatment and prognosis of these tumors. Parovarian borderline malignancy mostly occur in young women, main complaints are abdominal enlargement and pelvic pain. we experienced one case of parovarian borderline malignancy and report this case with a brief review of literature.

Laparoscopic Surgery in Children; Early Experience

PURPOSE: The application of laparoscopic surgery in children has expanded tremendously in recent years. However, the feasibility of the technique is somewhat controversial. We summarize our experience of laparoscopy in children and describe the surgical techniques used in these cases. METHODS: Between June 2001 and May 2004, 58 children (33 male, 25 female) underwent laparoscopic surgery at the Department of Surgery, Daegu Fatima hospital. All the clinical data was collected retrospectively. RESULTS: The laparoscopic procedures for each indications were a laparoscopic reduction for a barium reduction failed intussuception (n=15), laparoscopic appendectomy for acute appendicitis (n=30), laparoscopic splenectomy for symptomatic hereditary spherocytosis (n=4), laparoscopic salphin-go-ophorectomy for torsion of parovarian cyst and ovarian tumor (n=2), laparoscopic diverticulectomy for symptomatic Meckel's diverticulum (n=2), laparoscopic Hellor myotomy and Dor fundoplication for achalasia (n=1), diagnostic purpose for peritoneal tuberculosis (n=2) and the laparoscopic removal of a foreign body in the peritoneal cavity (n=2). The mean age was 7.9 years (range from 4 months to 14 years). In intussusception, the laparoscopic reduction was successful in 12 patients (80%), with a conversion to an open procedure occurring in 3 cases (20%). There were no other open con-versions. There were no postoperative wound complications except for two wound problems in patients with acute perforated appendicitis. The operative time and duration of the hospital stay was suitable. CONCLUSION: The laparoscopic procedure in various disorders of infants and children is safe and avoids the necessity of open surgery under the appropriate indication.

Parovarian cyst torsion at pregnancy 29+4 wks / 대한산부인과학회지

Adnexal torsion in the third trimester is very rare. Because of changes in uterine size and anatomical position of abdominal organs, the diagnosis of adnexal torsion during pregnancy is difficult to establish on the basis of symptoms, physical findings, or radiologic technique. Delayed diagnosis and management can lead to serious complications, so a rapid, reliable, and accurate imaging is needed to evaluate pregnant women with acute abdomen. Ultrasonography has been the initial imaging modality of choice in evaluation of obstetric patient, but it is technically difficult in the third trimester. MR imaging can provide a broad evaluation of the pelvic organs and enables diagnosis of many causes of acute abdomen, especially in the third trimester. We have experienced a case of Parovarian cyst torsion at pregnancy 29+4 wks and reviewed it briefly.

A case of primary parovarian cystadenocarcinoma of borderline malignancy / 대한산부인과학회지

Parovarian tumors may be of mesothelial, mesonephric (Wolffian), or paramesonephric (Mullerian) origin. An estimated 10% of adnexal masses are parovarian cysts, most commonly mesothelial or paramesonephric in origin. Benign neoplasms such as cystadenomas may occasionally develop in parovarian cysts. Malignancy has been reported in 2.0% to 2.8% of parovarian cystic masses, but it seems to be even less frequent in masses smaller than 5 cm. The histologic appearance of the tumor is identical with that of tumors of ovarian origin. However, their similarity of biologic behavior is uncertain. The appropriate therapy for this unusual lesion has not been fully defined, since a minimal amount of follow-up data is available on the few cases which have been reported. We had experienced a case of papillary serous cystadenocarcinoma of borderline malignancy arising from a parovarian paramesonephric cyst and report this case with a brief review of literature.

A Case of Parovarian Serous Cystadenocarcinoma of Borderline Malignancy / 대한산부인과학회잡지

Although parovarian cysts constitute 10-20% of all adnexal masses, malignant parovarian tumors are extremely rare. Due to the rarity of this lesion, there are controversies concerning the origin, clinical behavior, and prognosis of these tumors. Currently, it is suggested that these paovarian tumors should be treated similarly to their ovarian counterparts. We experienced one case of parovarian serous cystadenocarcinoma of borderline malignancy, and report this with a brief review of the literatures.