Leiomyomatosis peritonealis disseminata in a pregnant woman.

BACKGROUND: Leiomyomatosis peritonealis disseminata (LPD) is a rare disease occurring as intraabdominal benign tumors. The underlying mechanism of LPD development in premenopausal females is still unknown, but high levels of estrogen and progesterone seem to play a major role. CASE: We present a case of a 29-year-old gravida 1, 22 6/7 weeks of gestation with symptoms of an acute abdomen. Abdominal ultrasound and MRI showed intraabdominal masses of uncertain origin most likely to be an extreme example of pseudomyxoma peritonei. Explorative laparotomy was performed, and histopathological analysis revealed benign tumors classified as leiomyomatosis. A cesarean section was performed due to increasing abdominal pain and excessive elevated inflammatory serum parameters. Postpartum, a spontaneous regression of the LPD was marked. CONCLUSION: LPD is a rare disease of young women. Excessive hormonal exposure seems to play a major role. Diagnosis is often difficult and a histopathological analysis is needed.

Early detection of a twin tubal pregnancy by Doppler sonography allows fertility-conserving laparoscopic surgery.

BACKGROUND: Vital twin tubal gestation is a rare complication in pregnancy. CASE: An asymptomatic gravida 1 female presented with increasing beta-HCG levels without an intrauterine gestation. Doppler sonography revealed cardiac motion of unilateral tubal twins. The patient was treated laparoscopically by partial tubectomy allowing a subsequent tubal re-anastomosis. CONCLUSION: Doppler sonography may detect vital ectopic pregnancies early enabling fertility-conserving surgery.

Impact of preoperative physiological risk profile on postoperative morbidity and mortality after emergency operation of complicated peptic ulcer disease.

AIM: The aim of this study was to evaluate the preoperative physiological risk profile for postoperative morbidity and mortality after emergency treatment of complicated peptic ulcer disease (PUD). METHODS: Operative notes and hospital files of 261 patients--111 female, 150 male; median age 67 years (range 17-100 years)--undergoing an emergency operation from 1993 to 2005 were analyzed retrospectively. The physiologic subscore of the POSSUM score (POSSUM-phys) was analyzed with regard to predicting postoperative complications. Follow-up was obtained from questionnaires sent to family practitioners or by patient interviews. RESULTS: The overall complication rate was 44%, and mortality was 24%. Among risk factors studied (e.g., sex, patient's age, duration of symptoms, type of surgery), a high POSSUM-phys score was the strongest predictor for postoperative sepsis, anastomotic/suture dehiscence, postoperative bleeding, and mortality. Cut points for patients at risk could be calculated. Surgical procedures (organ-preserving versus resection) had no influence when matched for POSSUM-phys score. Nevertheless, organ resections were associated with higher scores. Recurrent PUD was a rare event (7.6%). CONCLUSION: The preoperative physiologic POSSUM score is a promising instrument for identifying patients at increased risk to develop major postoperative complications after emergency surgery for complicated PUD. Prospective studies are needed to prove its applicability for adjusting treatment to individual patients.