An overlooked cause of acute urinary retention in an adolescent girl: a case report

Introduction   Massive hematocolpos resulting from an imperforate hymen is quite a rare cause of acute urinary retention, in an adolescent girl admitted to the emergency department. Materials and methods   A 12-year-old girl suffering from severe inguinal pain and dysuria together with difficulty in urination for about 1 month was admitted to the emergency department for acute urinary retention. On gynecological examination, imperforate hymen was observed to be the cause of the urinary difficulty. Pelvic magnetic resonance imaging revealed a dilated vagina exerting pressure on the bladder outlet suggestive of hematocolpos. Cruciate hymenotomy was performed. The postoperative period and three follow-up visits of the patient up to the 6th month were uneventful. Conclusion   The diagnosis of imperforate hymen can be missed if a genital examination is not performed in adolescent girls presenting to emergency departments with urinary difficulty. The purpose of this paper is to increase awareness among emergency physicians about the probability of imperforate hymen while examining adolescent girls with urinary retention and intermittent lower abdominal pain.     

Urethral varices as an unusual cause of third-trimester bleeding. A case report

A 21-year-old woman, gravida 3, para 2, presented in the third trimester of pregnancy with complaints of painless vaginal bleeding after urination. After ruling out placental and uterine sources, the diagnosis of bleeding urethral varices was made with cystoscopy. Once the source of the antepartum hemorrhage had been determined, conservative outpatient management became possible.     

An unusual cause of urinary retention in early pregnancy

Urinary retention is a rare complication of early pregnancy with few serious sequelae. A Medline search found no association between urinary symptoms and cervical pregnancy. This case describes urinary retention resulting from a cervical pregnancy and describes a proposed mechanism to explain the presenting symptoms. Cervical pregnancy should be considered as a rare cause of acute retention of urine in early pregnancy, especially in the presence of vaginal bleeding.     

Retroperitoneal hematoma from a ruptured tubal pregnancy as an unusual cause of a pelvic mass. A case report

Retroperitoneal hematoma can result from a ruptured tubal pregnancy and present as a pelvic mass. Such a case has not been described previously.     

Growing teratoma syndrome as an unusual cause of gliomatosis peritonei: a case report

BACKGROUND: Growing teratoma syndrome (GTS) is defined as enlarging peritoneal implants that occur during or after chemotherapy for malignant germ cell tumors, but are histologically mature teratomas without any malignant components. GTS is a synonym for "chemotherapeutic retroconversion", i.e., conversion from a metastatic immature teratoma to a mature tumor by chemotherapy. Gliomatosis peritonei (GP) is a rare condition associated with ovarian teratomas of any grade, in which benign glial implants develop on the peritoneal surface. CASE: We present a case of a 34-year-old woman with GTS. CONCLUSIONS: Present case supported by review of the literatures suggests that GTS can be a part of GP, because both GTS and GP are associated with benign peritoneal glial implants regardless of grade of malignancy of their original tumor.     

Acute urinary retention caused by a large peritoneal inclusion cyst: a case report

BACKGROUND: Pelvic masses have been known to cause bladder symptoms and compression. This is the first documented case of a large peritoneal inclusion cyst causing acute urinary retention from bladder outlet obstruction. CASE: A 36-year-old woman, gravida 2, para 2, presented to the gynecology clinic with an indwelling Foley catheter that was placed at an outside hospital secondary to acute urinary retention. Computed tomography, performed several days earlier for complaints of progressively worsening lower abdominal and pelvic pain, revealed a 10-cm, complex, cystic mass within the pelvis between the rectum and sigmoid colon, with anterior displacement of the bladder. The patient's past surgical history included a total abdominal hysterectomy as well as separate exploratory laparotomy for resection of a 20-cm peritoneal inclusion cyst and a prophylactic bilateral salpingo-oophorectomy. Due to the acute urinary retention and worsening pain, the decision was made to proceed with laparoscopic removal and drainage of the mass, which turned out to be consistent with a recurrent peritoneal inclusion cyst. Symptom relief was immediate. CONCLUSION: A large, recurrent, peritoneal inclusion cyst obstructed the bladder neck and presented as acute urinary retention. Laparoscopy relieved the symptoms.     

Rupture of the spleen as an unusual complication of laparoscopy. A case report

BACKGROUND: Laparoscopic surgery has many advantages but is not without complications, such as viscus perforation and intraabdominal hemorrhage. CASE: A rare and severe complication, massive abdominal bleeding due to splenic rupture, became symptomatic after an uneventful laparoscopy. Tearing away of delicate peritoneal reflections or small adhesions on the splenic capsule due to induction of pneumoperitoneum can result in sudden rupture and hemorrhage. CONCLUSION: This possibility should be remembered when laparoscopy is necessary in patients with a history of blunt abdominal trauma.     

Cystic paracervical mass as an unusual sequela of graft-versus-host disease. A case report

BACKGROUND: Bone marrow transplantation is used in the treatment of a variety of malignancies. One common sequela is graft-versus-host disease (GvHD.) CASE: A case of vaginal GvHD in a postmenopausal woman manifested as a 2-cm, cystic, paracervical mass. The patient was followed with consecutive pelvic ultrasounds and pelvic examinations until 27 months after transplantation, when the mass increased in size to 4 x 3 cm. Exploratory laparotomy with total abdominal hysterectomy revealed a 3 x 3-cm phlegmon within the proximal part of the vagina. Presumably, this resulted from vaginal GvHD, causing a midvaginal stricture with obstruction of cervical/uterine effluent. CONCLUSION: An awareness of the gynecologic manifestations of GvHD is critical for clinicians caring for women undergoing bone marrow transplantation.     

Peritoneal cyst. A case report

Cystic mesothelioma is a rare benign tumor of the abdominal and pelvic peritoneum, consisting of solitary or multiple cysts. No more than 130 cases are reported. Several risk factors such as chronic peritoneal irritation, caused by foreign bodies, infection or endometriosis, were hypothesized but the pathogenesis is still unknown. A 51-year menopausal woman was submitted to ultrasonography because of abnormal uterine bleeding. The scan revealed a right ovarian cyst (size 81 x 64 mm) with the feature of serous cyst. In the anamnesis a cystectomy of the right ovary and appendectomy were reported. At laparoscopy, then converted in laparotomy, a cyst arising from peritoneum of the posterior surface of the uterus was found. The right ovary was normal. The histopathological finding was: serous simple cyst of peritoneum. Ultrasonographic diagnosis was not confirmed by surgery; in fact, sometimes, it may be difficult to establish the origin of pelvic cystic mass, from ovary or peritoneum, by ultrasonography. It is mandatory to suggest a laparoscopy and/or laparotomy in case of pelvic cystic mass that does not regress in the time even after administration of oral contraceptives.     

An unusual cause of postoperative fever: a case report.

A typical gynecologic approach to postoperative fever and its theoretical as well as practical shortcomings is discussed. Difficulties in establishing a specific diagnosis in the gynecologic patient with postoperative fever are explored. A case of exacerbation of dermatomyositis in the immediate postoperative period illustrates the failings of our current approach to postoperative fever.     

Delayed,massive bleeding as an unusual complication of laser conization. A case report

BACKGROUND: Although delayed bleeding following cervical conization is a common complication of this surgical procedure, the amount of blood loss is usually not life threatening. CASE: A 27-year-old woman underwent conization with a KTP laser for the treatment of microinvasive cervical adenocarcinoma. Eight days later the patient experienced sudden, massive genital bleeding at her workplace. The source of the bleeding was identified as a descending branch of the left uterine artery exposed to the wound surface. Hemostasis was achieved completely with direct surgical ligature of the exposed blood vessel. The patient's blood loss during the course of the events was estimated to be 3.2 L, for which she received 1.4 L of packed red blood cells. She had an uneventful postoperative recovery. There was no bleeding or recurrence of the disease during 4 years of follow-up. CONCLUSION: Clinicians should be alert to the possibility of massive bleeding as a delayed surgical complication of cervical conization.     

Umbilical cord cyst presenting as an omphalocele at 15 weeks' gestation. A case report

A small, cystic structure was identified on a routine ultrasound scan performed for dating at 15 weeks' gestation. Originally it was thought to be an omphalocele, but further examination confirmed its origin in the cord several centimeters distal to the fetus. Close scrutiny of ultrasonograms is important since technical capabilities permit high-resolution scans during early gestation.     

Parovarian cyst presenting as a groin hernia. A case report.

An inguinal hernia containing a parovarian cyst is extremely rare. This phenomenon occurred in a 77-year-old woman who presented with a right groin hernia. The hernia contained a cystic mass that arose between the leaves of the broad ligament and passed with the round ligament through the deep inguinal ring. Through a midline incision the hernial content was mobilized, reduced through the inguinal ring and removed from the abdomen with both ovaries, tubes and uterus. The mass was found to be a parovarian cyst of the mesothelial type.     

Cervical varices unrelated to placenta previa as an unusual cause of antepartum hemorrhage: A case report and literature review

Objective

Ruptured cervical varicose veins can cause significant vaginal bleeding during the third trimester of pregnancy. The etiology is not uncommon, yet receives little discussion in current literature. We here report such a case with complete evaluations, managements and follow ups; while analyzing similar cases published.

Peritonitis caused by a ruptured, infected mesenteric cyst initially interpreted as an ovarian cyst. A case report

BACKGROUND: Mesenteric cysts are rare intraabdominal lesions of childhood that may vary in presentation from an asymptomatic mass to an acute abdomen. CASE: We encountered a rare case of peritonitis caused by a ruptured, infected mesenteric cyst of the mesocolon in a female child that had been initially interpreted as a ruptured ovarian cyst. CONCLUSION: When confronted with a large unilocular or septated echolucent mass in the lower abdomen in female children, gynecologists should consider a mesenteric cyst in the differential diagnosis.     

Hemolytic disease of the newborn as an unusual consequence of drug abuse. A case report

Severe Rhesus isoimmunization occurred in a primigravida following self-injection of her partner's blood as a consequence of drug abuse. This case demonstrated the value of the true sinusoidal fetal heart rate pattern as an indicator of severe fetal compromise.     

Echinococcal ovarian cyst. A case report

BACKGROUND: Echinococcal disease, although known to occur in most organs and body areas, is extremely rare in the female reproductive system. A literature search revealed only three anecdotal non-English language case reports of ovarian echinococcosis. CASE: A 20-year-old woman presented with epigastric pain. Abdominal ultrasonography and computed tomography showed three multicystic masses, one intrahepatic, one intraperitoneal and the third situated in the left ovary. Serologic examination confirmed the diagnosis of echinococcal disease. Marked regression of all the cysts occurred following a short course of albendazole. CONCLUSION: Echinococcal cysts should be included in the differential diagnosis of multicystic ovarian lesions if the patient has cysts elsewhere and is from an endemic area.