Autoamputated adnexa presents as a peritoneal loose body

Preservation of ovarian tissue embedded in omentum following torsion and auto-amputation of the left ovary and fallopian tube in a 14-year-old girl: A case report

INTRODUCTION

Autoamputation of the ovary and fallopian tube is a scarce phenomenon particularly in adolescents but could adversely affect fertility by causing ovarian damage and loss of tubal function.

CASE PRESENTATION

A case of autoamputation of the left adnexa as a result of chronic torsion in the setting of an ovarian dermoid cyst in an adolescent girl is presented. The patient had also a large dermoid cyst in the contralateral ovary which was in danger of another torsion and loss of ovarian reserve and tube. Her left fallopian tube was absent and left ovary was embedded in the omentum. She was successfully managed through laparoscopic surgery. Bilateral cystectomy was performed and the ectopic ovarian tissue was saved.

CLINICAL DISCUSSION

Chronic torsion sometimes results in ectopic displacement of the affected ovary. While some patients may be asymptomatic, many of these cases express episodes of acute or chronic abdominopelvic pain. Hence, a prolonged pain or discomfort, even of low intensity, should not be overlooked particularly in younger patients with bilateral ovarian cysts.

CONCLUSION

Ovarian dermoid cysts in adolescents could possibly undergo chronic torsion resulting in autoamputation of the adnexa and ectopic displacement of the ovary. With prompt diagnosis and intervention, ovarian tissue and fertility could be preserved.

Peritoneal loose body presenting as a hepatic mass: A case report and review of the literature

Peritoneal loose body (PLB) is a rare clinical entity. It is generally agreed that the most common origin of the loose bodies is appendix epiploica. We here report a case of PLB that looks like a "boiled egg," which was misdiagnosed preoperatively as a lesion of hepatic origin and was confirmed by operation and postoperative pathology. PLBs are rare entities, a good understanding of their specific imaging features can help prevent misdiagnosis, but sometimes an accurate preoperative diagnosis is still difficult to achieve. Exploratory laparoscopy is a recommended method for management of PLBs.

A rare peritoneal egg: Case report with literature review

The occurrence of peritoneal loose bodies has been known for hundreds of years. Although rarely, they attain a diameter of more than 5 cm and are then named “giant” peritoneal bodies (gPLBs). Even these huge peritoneal bodies are generally symptom free, but may be linked with chronic symptoms like abdominal pain or discomfort. Many a times, these gPLBs are misinterpreted as intraabdominal tumors or foreign bodies and unnecessary surgical interventions are carried out. We report a rare case of a 75-year-old male, who presented to our tertiary care center emergency department with history of chronic intermittent abdominal discomfort with acute diarrhea and peri-anal pain. Contrast enhanced computed tomography of the abdomen and pelvis revealed round to oval mass in the pelvis measuring 6.2 cm × 5.8 cm. On laparoscopy, a hard, free floating object with the appearance of a boiled egg could just be scooped out from the pelvis. The postoperative pathological examination revealed laminated strands of hyalinized fibro collagenous tissue with central fat necrosis confirming the diagnosis of gPLB. Postoperative period was uneventful. Peritoneal bodies are rare intraabdominal bodies which are either detected incidentally or present with vague symptoms and require interdisciplinary management.

Deciding to Remove or Leave a Peritoneal Loose Body: A Case Report and Review of Literature

BACKGROUND Peritoneal loose bodies, also known as peritoneal mice, are rare findings and they present either with nonspecific symptoms or are found incidentally during exploration and autopsy. Usually, they have no clinical significance and require no specific treatment. We report a case of a giant peritoneal loose body found incidentally in the abdominal cavity of a patient who presented with abdominal pain and hematuria. CASE REPORT Our patient was a 58-year-old man who presented with abdominal pain and hematuria. Abdominal non-contrast computed tomography (CT) and subsequent CT abdomen and pelvis with intravenous and oral rectal contrast were performed preoperatively, showing a well-circumscribed and calcified lesion of undetermined etiology in the abdominal cavity. The lesion was removed laparoscopically with no complications. Histopathologically, the lesion was reported as calcified tissue with fat necrosis, most likely an infarcted appendix epiploicae. CONCLUSIONS Loose peritoneal bodies can present a challenging diagnostic problem to the surgeon, with confusing findings that can point towards malignancy. It often requires a number of investigations; however even with these investigations, operative exploration, either open or laparoscopic, can be the ultimate diagnostic and therapeutic modality, and the mobility of these calcified lesions may give a preoperative clue to the etiology. It is important to distinguish peritoneal loose bodies from neoplastic or metastatic lesions and to consider it in the differential diagnosis of a calcified mobile pelvic mass. Laparoscopic surgery is safe and effective in the retrieval of symptomatic peritoneal loose bodies.

Two giant peritoneal loose bodies were simultaneously found in one patient: A case report and review of the literature

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The giant peritoneal body with a diameter >5 cm has rarely been described in the literature.

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We report a case of two giant loose bodies(gPLB) which are simultaneously found in one patient.

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Two gPLB lie respectively in the peritoneal cavity and in the pelvic cavity, measuring 10.4*8.3 cm and 7.6*6.0 cm, weight 182.5 g and 98.4 g.

Introduction

Peritoneal loose body(PLB) is usually small, therefore giant Peritoneal loose body(gPLB) with a diameter >5 cm has rarely been described in the literatures. We report a case of two gPLB simultaneously found in one patient.

Presentation of case

A healthy 79-year-old man palpated himself a solid mass with alternating localizations in his peritoneal cavity 6 months ago. It was not the complaint of frequency of urinatior until he saw the doctor a week ago. Surprisingly, two oval-shaped masses were simultaneously discovered by computed tomography (CT). One was in the peritoneal cavity, measuring 10.4*8.3 cm, weight 182.5 g, another was in the pelvic cavity, measuring 7.6*6.0 cm, weight 98.4 g. The case was confirmed by surgical operation.

Discussion

The gPLB is considered as uncommon. Two gPLB which were simultaneously discovered in one patient have never been reported in the literatures. The small PLB is usually asmptomatic, occasionally, the gPLB can cause symptoms with acute retention of urine or intestinal obstruction. It is crucial to diagnosis the peritoneal loose body.

Conclusion

Two gPLB that situated in one patient are rare findings. Clinically, if a solid mass alternating localizations cound be palpated in the Peritoneal cavity, CT or other imaging shows an oval-shaped mass with calcifications in the central region, PLB should be considered. Surgical removal is recommended for the patient with acute retention of urine or intestinal obstruction or unclear diagnosis.

Autoamputation of an ovarian mature cystic teratoma: a case report and a review of the literature

Background

Torsion is known to be the most frequent complication of ovarian teratomas. Torsion of the adnexa usually manifests with severe abdominal pain and is treated as an acute surgical emergency. However, it may be asymptomatic. Autoamputation of an ovary, along with other adnexal structures, due to previous torsion is extremely rare.

Case presentation

A parasitic ovarian teratoma that underwent torsion, autoamputation, and reimplantation was found incidentally during laparoendoscopic single-site surgery (LESS). The amputated tumor was located in the omentum of the right upper abdomen of a patient with concomitant torsion of a left ovarian teratoma. The right ovary and tube were absent even though she had no surgical history. This finding could be interpreted as an autoamputation of the adnexa due to torsion of a previous ovarian cyst arising from the right ovary. We removed all masses by LESS.

Conclusions

Although both ultrasonography and computed tomography were performed preoperatively in our patient, the correct diagnosis of autoamputation and exact localization of the teratoma were extremely difficult. Physicians should consider the possibility of an autoamputated ovarian cyst even if preoperative radiography shows no calcification.

Symptomatic giant peritoneal loose body in the pelvic cavity: A case report

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Giant peritoneal loose bodies occur rarely and have not often been described.

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They can cause acute or chronic abdominal pain with changing localizations.

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It is important to define its entity and to discern it from other manifestations.

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Proper anamnesis, examination and preoperative investigations are crucial.

Introduction

Giant peritoneal loose bodies (gPLB) occur rarely and therefore only few have been described. Often they are found incidentally and have no clinical relevance, whereas symptomatic forms may require surgical removal.

Presentation of case

We report the case of a male patient suffering from abdominal discomfort with alternating localizations for several years, actually presenting with a proctitis. With elevated inflammatory markers, a conspicuous resistance in the lower abdomen and in order to evaluate further affection of the colon, an abdominal CT-scan was performed. It revealed a spherical mass in the lesser pelvis. A colonoscopy confirmed the proctitis, showing no further pathologies. Due to the symptoms and the uncertain entity of the mass, a diagnostic laparoscopy was performed and a boiled egg-like structure (diameter 5.2 cm) was removed. The patient recovered well and was free of symptoms.

Discussion

The patient had two potential reasons for his symptoms, one of them being a suspected leftover foreign body years after an appendectomy. The proctitis was treated conservatively but without complete remission of the abdominal discomfort. Therefore, a diagnostic laparoscopy was performed and the mass turned out to be a gPLB.

Conclusion

To obtain a fast diagnosis and to perform an adequate conservative or surgical therapy, the knowledge about the rare entity of a gPLB is necessary. An exact anamnesis, clinical examination and the knowledge about the diagnostic values of radiological and endoscopic investigations are crucial.

Giant peritoneal loose body in the pelvic cavity confirmed by laparoscopic exploration: a case report and review of the literature

A 51-year-old previously healthy male underwent a routine medical examination. Computed tomography and ultrasonography showed an oval-shaped mass that was about 50 × 40 mm in size in the left iliac fossa. Prior to surgery, the lesion was suspected to be a teratoma with core calcification or stromal tumor derived from the rectosigmoid colon. During the procedure, a yellow-white, egg-shaped mass was discovered that was completely free from the pelvic cavity in front of the rectum. The giant, peritoneal loose body was taken out through the enlarged port site. Histological examination showed that the mass consisted of well-circumscribed, unencapsulated, paucicellular tissue, with an obviously hyalinized fibrosclerotic center. A giant peritoneal body is extremely rare. We report such a case and review previously published literature.

Autoamputation of a pedunculated, subserosal uterine leiomyoma presenting as a giant peritoneal loose body

Peritoneal loose bodies (PLBs) are defined as fibrotic or calcified-free bodies within the peritoneal cavity; they commonly autoamputate from appendices epiploicae that have undergone torsion. Pedunculated, subserosal uterine leiomyomas (PSULs) are subserosal uterine leiomyomas connected to the uterus via a pedicle. In the present report, we describe the case of a PLB that originated from the autoamputation of a PSUL, confirmed based on histological evidence consistent with a uterine leiomyoma and the laparoscopic findings of a broken pedicle. This case clearly demonstrates the potential for a uterine leiomyoma to be the source of a PLB. Our findings contribute to the understanding of the etiological relationship between PLBs and uterine leiomyomas.

First report of MRI findings in a case of an autoamputated wandering calcified ovary

An autoamputated wandering calcified ovary (AWCO) is an extremely rare cause of abdominal calcification in the pediatric population. We present the magnetic resonance imaging (MRI) features of AWCO in a child. To our knowledge, the MRI features of AWCO have not been previously described in the published literature. Our case report indicates that the MRI findings are characteristic in the diagnosis of an AWCO and can completely obviate the need for invasive procedures in this mostly benign disease. An AWCO should be considered in all cases of mobile calcific opacities on radiographs in female patients. We advise that MRI be conducted in all suspected cases of AWCO for accurate and noninvasive diagnosis, and regular follow-up should be performed with ultrasound. The findings in our case report have the potential to change the course of investigations and management in suspected cases.

The auto-amputated adnexa: a review of findings in a pediatric population

STUDY OBJECTIVE

To quantify our experience and that of the literature with diagnosis and management of the auto-amputated adnexa in a pediatric population.

DESIGN

Case series and literature review.

SETTING

Tertiary care medical center.

PARTICIPANTS

Case series of pediatric patients (<18 years of age) with surgically documented adnexal auto-amputation collected from our medical center and the literature.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

Auto-amputated adnexa.

RESULTS

In addition to the 3 cases discussed from our institution, 91 cases of auto-amputated adnexa were identified in the literature dating back to 1943, for a total of 94 cases. Forty-nine percent (46/94) of the cases involved girls in a pediatric population (<18 years of age). Of these, the majority (n = 26) were identified in a subgroup of girls who were diagnosed with an adnexal cyst by antenatal ultrasound. Most of these neonates were asymptomatic at birth or had a palpable abdominal mass (n = 6) and at the time of surgical exploration were found to have an auto-amputated adnexa. 34 out of 46 cases were analyzed in detail. The right adnexa were involved in 56% of the cases. The most common presenting complaint verbalized by the older girls was pain; however, 8 cases were identified in asymptomatic girls undergoing unrelated diagnostic testing.

CONCLUSION

The auto-amputated adnexa is a rare finding in the pediatric population, but it must be considered as a possible explanation for the incidental finding of absence of the fallopian tube or ovary in the subgroup of patients who undergo surgery for any reason. Patients with an antecedent history of pelvic pain either chronic or intermittent in nature may be diagnosed with torsion or less frequently auto-amputation of the adnexa. A fetal "pelvic mass" or "ovarian cyst" may predispose the adnexa to torsion and subsequent auto-amputation either in-utero or post-delivery. Many of these antenatally diagnosed cysts and even subsequent auto-amputations are completely asymptomatic, however, and do not compromise fertility assuming the contralateral adnexa are normal. Thus expectant management is appropriate for small (less than 4 cm), asymptomatic simple cysts and even suspected auto-amputated adnexa in an asymptomatic patient.

A giant peritoneal loose body

Peritoneal loose bodies (PLBs) are usually discovered incidentally during laparotomy or autopsy. A few cases of giant PLBs presenting with various symptoms have been reported in the literature. Here, we describe a case of a giant PLB incidentally found in the pelvic cavity of a 50-year-old man. Computed tomography revealed a free ovoid mass in the pelvic cavity that consisted of central dense, heterogeneous calcifications and peripheral soft tissue. The mass was an egg-shaped, hard, glistening concretion measuring 7.5×7.0×6.8 cm and weighing 160 g. This concretion consisted of central necrotic fatty tissue surrounded by concentrically laminated, acellular, fibrous material. Small PLBs usually do not require any specific treatment. However, if PLBs cause alimentary or urinary symptoms due to their large size, surgical removal may be recommended. It is essential for clinicians to be aware of this entity and its characteristic features to establish the correct diagnosis.

Giant peritoneal loose body in the pelvic cavity

We report a case of a large peritoneal loose body diagnosed on computed tomography. The most common causes of a peritoneal loose body are thought to be torsion and separation of the appendices epiploicae. Peritoneal loose bodies are usually small, 0.5 to 2.5 cm in diameter. However, "giant" peritoneal loose bodies, larger than 4 cm in diameter, are an uncommon disease and present with various symptoms, and are difficult to diagnose preoperatively. Especially, abdominal large peritoneal loose bodies are frequently misdiagnosed as tumorous disease preoperatively. In our case, the loose body appeared as a round pelvic mass with central calcifications and a distinct fat plane separating it from adjacent organs. Preoperatively, we suspected a tumorous lesion from the wall of the upper rectum; however, at laparoscopy, a large peritoneal loose body was detected. An extraction of the giant peritoneal loose body was performed laparoscopically.

Laparoscopic retrieval of a peritoneal mouse

A 67-year-old Caucasian male was referred by the urology service with a history of incomplete bowel emptying. He complained of tenesmus. MRI scan suggested a leiomyoma lying anterior to the rectum. He underwent examination under anaesthesia and attempted endorectal ultrasound and biopsy. However, the lesion seemed to migrate cranially and was impalpable. At laparoscopy, a mobile, unattached, 5.5 × 5 × 3.5, cream-coloured ‘egg was retrieved from the retrovesical space. Histology confirmed a hyalinised fibrocollagenous lesion lined with mesothelium. A comprehensive review of the literature is presented.