ABSTRACT
History A previously healthy 28-year-old man developed right lower quadrant pain while traveling. The pain progressed over the course of 2-3 days, and his family took him to a local emergency department. He was found to have an elevated white blood cell count of 12.2 × 109/L (reference range, [3.9-10.3] × 109/L), with a predominance of neutrophils. Contrast material-enhanced computed tomography (CT) of the abdomen and pelvis was performed, and findings were abnormal. The patient elected to leave the emergency department without undergoing treatment, and he returned home via airplane. He presented to his primary care physician for further evaluation later that same day. His physician noted a mildly distended abdomen that was diffusely tender on palpation, with rebound tenderness in the right lower quadrant. The patient was admitted to our hospital, and the general surgery department was consulted. The CT images that were obtained at the outside institution were submitted to our radiology department for interpretation.
Subject(s)
Contrast Media , Diverticulitis/diagnostic imaging , Meckel Diverticulum/diagnostic imaging , Radiographic Image Enhancement/methods , Tomography, X-Ray Computed , Diagnosis, Differential , Diverticulitis/surgery , Humans , Male , Meckel Diverticulum/surgeryABSTRACT
Group A streptococcal (GAS) necrotizing fasciitis is a potentially life-threatening infection. We report on a patient with a history of prolonged pessary use with traumatic removal who developed ascending GAS infection in her gynecologic organs that tracked along the round ligament to her anterior abdominal wall.
Subject(s)
Fasciitis, Necrotizing/microbiology , Genital Diseases, Female/microbiology , Pessaries/adverse effects , Streptococcal Infections/microbiology , Streptococcus pyogenes , Abdominal Wall/microbiology , Abdominal Wall/surgery , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgery , Female , Genital Diseases, Female/surgery , Humans , Streptococcal Infections/drug therapy , Streptococcal Infections/surgerySubject(s)
BRCA2 Protein/analysis , Cystadenoma/diagnosis , Cystadenoma/genetics , Neoplasms, Second Primary/diagnosis , Neoplasms, Second Primary/genetics , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/genetics , Apoptosis Regulatory Proteins , Breast Neoplasms/pathology , Breast Neoplasms/therapy , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/therapy , Cystadenoma/therapy , Early Diagnosis , Female , Humans , Middle Aged , Ovarian Neoplasms/therapy , Positron-Emission Tomography , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: A case of primary neuroblastoma arising from the broad ligament with excellent response to neoadjuvant bleomycin, etoposide, and cisplatin (BEP) is reported. CASE: A 48-year-old woman, G0, who presented with acute renal failure, an enlarged pelvic mass, and abdominal pain was diagnosed with adult neuroblastoma arising from the broad ligament of the uterus. She received three cycles of neoadjuvant therapy consisting of bleomycin, etoposide, and cisplatin (BEP) given every 3 weeks and had an excellent initial response. She then underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and appendectomy, with pathologic analysis revealing small residual disease on the broad ligament of the uterus and omentum. The patient died of recurrent disease 20 months after her initial diagnosis. CONCLUSIONS: The clinical management of cancer in the broad ligament of the uterus must be tailored to the pathologic diagnosis. Although our patient had an excellent initial response to BEP, further study is needed to identify a treatment that can reduce recurrences and improve clinical outcomes.
