Retroperitoneal vascular aberrations increase the risk of vascular injury during lymphadenectomy in gynecologic cancers.

PURPOSE: To investigate the frequency of aberrations of retroperitoneal great vessels in patients with gynecologic cancers who were scheduled for pelvic and paraaortic lymphadenectomy, and to document the vascular complications which occurred during lymphadenectomy as well as the relationship of these vascular complications with vascular aberrations. METHODS: Patients with gynecologic cancers underwent a routine preoperative abdominal multi-detector computer tomography, and an intraoperative search for aberrations of the great vessels in the retroperitoneal region was undertaken. Intraoperative vascular complications were recorded and their relations to vascular aberrations were analyzed. RESULTS: The rate of vascular aberrations detected preoperatively by multi-detector computed tomography was 24.3 %. Vascular injuries occurred in six patients (16.2 %) during lymphadenectomy. Rate of intraoperative vascular injuries was significantly higher in patients who had vascular aberrations of retroperitoneal great vessels (44.4 vs. 7.1 %, p = 0.022). CONCLUSIONS: Aberrations of retroperitoneal vessels are not uncommon and may increase the risk of vascular complications during lymphadenectomy. The risk of these complications may be decreased if aberrations are detected preoperatively.

Conservative management of a retroperitoneal hemorrhage following a ruptured renal angiomyolipoma in pregnancy.

Retroperitoneal hemorrhage following ruptured renal angiomyolipoma is usually managed surgically or by embolization. But when the same episode occurs in pregnancy, surgery which predisposes to preterm delivery and its subsequent sequelae, the unknown influences of radiation exposure on the fetus makes the management of such cases very challenging. A 21-year-old woman was seen in the emergency unit at the 25th week of her pregnancy with complaints of sudden onset left flank pain radiating to the back, nausea and hematuria. Abdominal magnetic resonance imaging (MRI) revealed masses consistent with angiomyolipoma in the upper pole of the left kidney with evidence of recent bleeding and the center of the right kidney measuring 11.5 × 9.5 cm and 3.5 cm, respectively. The patient received three units of red blood cell concentrate due to fall in hematocrit level resulting in hemodynamically stable condition until term. At term, an infant weighing 3510 g was delivered through elective cesarean section. To avoid iatrogenic preterm delivery and unnecessary fetal exposure to radiation, conservative management of ruptured angiomyolipoma in pregnancy may be considered as a treatment option in hemodynamically stable patients.

Hematocolpos causing severe urinary retention in an adolescent girl with imperforate hymen: an uncommon presentation.

INTRODUCTION: Hematocolpos is rarely presented as a pelvic mass which mechanically compresses the bladder and the urethra thereby causing urinary retention. CASE REPORT: A 12-year-old girl referred with the history of lower abdominal pain and retention of urine for 24 h. The patient had not started her menses yet. Three weeks before she also complained of discomfort on passing urine, frequency and urgency and was taken to a local outpatient clinic where she was given antibiotics with the diagnosis of urinary tract infection, she had also the history of intermittent urinary catheterization (three times before) in an emergency department because of acute severe urinary retention. Transabdominal ultrasonography revealed a pelvic semi-solid mass suggestive of hematocolpos. Pelvic examination revealed a pale blue imperforate hymen bulging from the vaginal introitus outwards. A cruciate incision was made over the hymen. Postoperative period was uneventful. CONCLUSION: In case of acute severe urinary retention in an adolescent girl, the clinicians should keep in mind that imperforate hymen may be a causative factor and this condition may easily be treated surgically.