Absceso pélvico y tubo-ovárico en mujer portadora de DIU hace 16 años

We present a case of acute abdomen caused by rupture of a tubo-ovarian abscess in a 38-year-old woman who had been using an intrauterine device for 16 years. The diagnosis was made during surgery, since the intervention was performed for suspected acute appendicitis. The intervention revealed a right tubo-ovarian abscess with pelvic abscess. Culture of pelvic pus was positive for Streptococcus constellatus. The patient was treated by surgery and combined antibiotic therapy. Diagnosis was confirmed by histopathological examination.     

Utilidad de la resonancia magnética abdominopélvica en el diagnóstico de abscesos tuboováricos

We present the case of a 39-year-old woman with a tubo-ovarian abscess diagnosed by pelvic magnetic resonance imaging. We highlight the importance of this imaging technique in differentiating these abscesses from other pelvic processes, especially neoplasms.     

Abdomen agudo como primera manifestación clínica de endometriosis

Endometriosis is an inflammatory disease that can affect any woman of childbearing age. The incidence of this disease is increasing. Clinical presentations vary widely, ranging from dysmenorrhea to obstructive symptoms, adhesions, and even bowel perforation. Appendiceal endometriosis is rare and is frequently diagnosed as acute appendicitis, which manifests as recurrent abdominal pain. Acute abdomen may be the first manifestation of this gynecological disorder and should be taken into account when making the broad differential diagnosis of abdominal pain.     

Utilidad de la resonancia magnética abdominopélvica en el diagnóstico de la patología tubárica y sus causas

We present the case of a 39 year old woman with hidrosálpinx diagnosed by pelvis magnetic resonance in the context of pelvic inflammatory disease. We note the importance of this imaging technique to differentiate it from other pelvic processes, especially neoplasms.     

Abdomen agudo por rotura espontánea de un leiomioma uterino subseroso

Although pelvic pain and metrorrhagia are the disorders that are most commonly associated with uterine leiomyoma, acute hemoperitoneum due to rupture of a subserosal leiomyoma is an exceptional event that has scarcely been reported in the international medical literature. This article describes one of the few known cases of acute abdomen caused by spontaneous rupture of a subserosal uterine leiomyoma, which was treated at the Department of Gynecology of the Hospital Universitario Central de Asturias (Spain). Risk factors for this unusual entity are considered to be the patient’s age and parity, as well as the size of the myoma and certain uterine vascular malformations; however, in this specific case, some histological peculiarities of the tumor seem to be of relevance.     

Torsión anexial como causa de abdomen agudo en una paciente adolescente

Acute abdomen due to adnexal torsion in adolescence is rare. One of the main reasons this diagnosis is frequently missed at first presentation is the diverse clinical presentation. When ovarian torsion cannot be excluded, diagnostic laparoscopy should be performed.We present a rare case of ovarian and fallopian torsion in a 15-year-old girl who presented with acute lower left abdominal pain and was treated by laparoscopic surgery.     

Quiste paratubárico en la infancia. Manejo laparoscópico

Diagnosis of paratubal cysts in children is exceptional. We present the case of a 12-year-old girl with a 2-year history of intermittent abdominal pain. Imaging studies revealed a homogeneous cystic mass in the pelvis compatible with a paratubal cyst. After completing the diagnostic workup, laparoscopic cystectomy was performed by harmonic scalpel. Surgical resection is the treatment of choice in this entity, the laparoscopic approach currently being the first option.     

Revisión de la exenteración pélvica en el cáncer de cérvix. Descripción de nuestra casuística

Total pelvic exenteration is a radical intervention, involving block resection of pelvic organs, including reproductive structures, the bladder, and the rectosigmoid colon. In gynecologic oncology, this procedure is most commonly indicated for the treatment of locally recurrent cancer or lack of response to neoadjuvant therapy.     

Peritonitis neumocócica asociada a una enfermedad inflamatoria pélvica

Pneumococcal peritonitis in young women with a gynecological focus is considered to be a specific category of this infection. We report a life-threatening case in a woman with infectious pelvic disease 2 months after a caesarean section. Clinical diagnosis is difficult and mortality is high. Early detection and treatment are essential.     

Edema agudo de pulmón como complicación de una histeroscopia quirúrgica

Surgical hysteroscopy is a minimally invasive procedure that may result in potentially serious complications. The solution most commonly used for distension is glycine because of its low viscosity, low cost, transparency and compatibility with electrosurgery. However, excessive absorption of this fluid has adverse effects, ranging from mild fluid and electrolyte alterations to severe hyponatremia, acute pulmonary edema, coma, cardiovascular collapse and death. We report a case of acute pulmonary edema due to excessive absorption of glycine during hysteroscopic myomectomy.     

Trombosis de la vena ovárica con extensión a la vena cava inferior en el posparto

Ovarian vein thrombosis is a complication that can appear during the postpartum period or after pelvic surgery. This complication is a rare but serious entity requiring early diagnosis and treatment and should be suspected in patients with fever and acute abdominal pain at the beginning of the postpartum. Imaging diagnosis with contrast computed tomography remains the gold standard. Administration of broad-spectrum antibiotics and heparin therapy produces immediate clinical improvement.     

Rotura uterina espontánea durante el segundo trimestre asociado a placenta pércreta. Caso clínico y revisión de la literatura

We report a case of histologically-confirmed uterine rupture due to placenta percreta at 20 weeks of gestation. We provide a review of case reports of this event occurring at less than 28 weeks of pregnancy.     

Tumoración anexial gigante en paciente con obesidad mórbida: abordaje multidisciplinario

Objective

To describe the clinical and therapeutic management of giant adnexal masses in morbidly obese patients at high surgical risk.

Subjects and methods

We report the case of a patient with a body mass index of over 60 and a 13-kg ovarian fibroma occupying the entire abdominal cavity.

Results

Due to the impossibility of using accessory imaging techniques, we employed a laparoscopic approach to exclude malignancy. Hysterectomy with bilateral salpingo-oophorectomy was performed by a multidisciplinary team without complications.

Conclusions

Morbidly obese patients with giant adnexal masses can be safely and effectively managed by a multidisciplinary team.     

Cáncer de mama tras enfermedad de Hodgkin: presentación de 2 casos clínicos

Women treated for Hodgkin’s disease have an exceptionally high risk of breast cancer as a second malignancy.     

Enfermedad pélvica inflamatoria de curso atípico. Métodos diagnósticos y cribado de Chlamydia trachomatis

Clinical diagnosis of «atypical» pelvic inflammatory disease (PID) is highly complex. Chlamydia trachomatis is the most frequently involved microorganism in the pathogenesis of atypical PID. We report a case of «atypical» PID recently diagnosed and treated in our department. The efficacy of currently available conventional diagnostic procedures (laboratory analyses, ultrasonography, computed tomography) is discussed. Finally, some clinical data related to the tests and laboratory techniques used to confirm diagnosis are discussed.     

Versión cefálica externa en presentación de nalgas: una técnica ancestral muy actual

Breech presentation occurs in 3-4% of pregnancies and is a routine indication for cesarean section. The external version is a maneuver that has been performed since Hippocrates’ time. Nevertheless, despite decreasing the cesarean section rate, this technique is only offered to a small percentage of patients due to lack of awareness and the shortage of experienced obstetricians. The success rate ranges from 40-74%. Factors that can influence the success of the maneuver are gestational age, the amniotic fluid index, presentation, and the location of the placenta. The use of tocolytics and effective analgesia can facilitate the maneuver and improve the success rate. When a standardized protocol is followed and the technique is performed by an experienced gynecologist, the external cephalic version has an excellent safety profile and is an effective option that avoids surgery.     

Manifestación atípica de hígado graso agudo del embarazo

Acute fatty liver of pregnancy is an uncommon but highly serious entity. The classical features are abdominal pain, nausea, vomiting, and elevated liver enzymes. Acute fatty liver of pregnancy can also present with atypical features with insidious onset and other clinical manifestations that are infrequent in this entity.     

Metástasis linfática subcapsular paraaórtica en tumor de los cordones sexuales con diferenciación anular

We present a case of ovarian sex cord tumor with annular tubules not associated with Peutz-Jeghers syndrome and with micrometastasis in a paraaortic node. The tumor was diagnosed as an ultrasonographic finding in a 15-year-old patient who consulted for primary amenorrhea. Unilateral annexectomy was initially performed but, in view of the definitive pathological analysis, a second surgical staging was performed with preservation of the uterus and contralateral adnexa. Postoperative follow-up consisted of periodic ultrasound examination and serum inhibin determinations. After 3 years of follow-up the patient is asymptomatic and disease free, with normal menstrual cycles.     

Tumor ovárico secretor de andrógenos en una mujer posmenopáusica

We report the case of a woman with established menopause and Sertoli-Leydig cell tumor. The first symptom was excess facial hair and increased serum androgen level. The patient rapidly developed the characteristic symptoms of hyperandrogenism with high testosterone level. Computed axial tomography and ultrasound did not identify the tumor, but hormone suppression-stimulation suggested the gynecological origin of the tumor. Postsurgical outcome was favorable with normalization of androgen levels and progressive reduction of symptoms of hyperandrogenism.