Mesenteric chylous cysts simulating a pelvic disease: a case report.

Mesenteric chylous cysts, also known as retroperitoneal chylomatous cysts, mesenteric lymphangiomas or chyloma of the mesentery, are extremely rare and their aspecific clinical presentation can mimic other diseases. In addition, imaging techniques, which are rarely helpful in the correct diagnosis, can demonstrate aspecific features. The Authors report the case of a 62-year-old woman admitted to the hospital for two incidental abdominal masses diagnosed during a yearly monitoring examination and considered to be large adnexal masses. The abdominal masses were removed at laparotomy. Both frozen section and final histopathological examination showed mesenteric chylous cysts. Mesenteric chylous cysts are usually a benign abdominal pathology. As illustrated by this case, even if they are extremely rare, they should be not underrated. The Authors review the literature, confirming the rarity of the disease and defining its characteristics.

Placenta Previa Percreta: A Case Report of Successful Management via Conservative Surgery.

Placenta percreta is one of the most serious complications of placenta previa and is frequently associated with severe obstetric hemorrhage usually necessitating hysterectomy. We present a case of placenta previa percreta diagnosed by ultrasound and magnetic resonance imaging techniques, in which we accomplished conservative management of postpartum hemorrhage. The management we propose includes the following steps: preventive catheterization of the descending aorta via transhumeral access; Stark cesarean delivery; uterotonics drugs; Affronti endouterine square hemostatic sutures; intrauterine application of Bakri balloon and partial filling with 100 mL of normal saline; B Lynch suture, hysterorrhaphy, and filling a Bakri balloon with up to 500 mL of normal saline; reversible radiological embolization; and/or surgical ligation of the uterine arteries. The bleeding stopped following placement of Affronti sutures combined with external (B-Lynch suture) and internal (Bakri balloon) uterine compression. Our experience indicates that this conservative method can be considered an option in the management of selected cases of pregnancy at high risk for intrapartum hemorrhage.

B-Lynch suture, intrauterine balloon, and endouterine hemostatic suture for the management of postpartum hemorrhage due to placenta previa accreta.

OBJECTIVE: To report our experience with a new conservative management approach to treat postpartum hemorrhage (PPH) due to placenta previa accreta. METHODS: A retrospective study of 9 patients with placenta previa accreta who underwent a conservative management protocol. The protocol consists of preventive radiological catheterization of the descending aorta, cesarean delivery, use of Affronti endouterine square hemostatic sutures, and placement of an intrauterine Bakri balloon in conjunction with B-Lynch suture. In the event of failure of the protocol, subsequent management employs ligation and/or reversible embolization of the uterine arteries followed by hysterectomy if unsuccessful. RESULTS: Conservative management of PPH was successful in all 9 patients evaluated and avoided the need for ligation and/or reversible embolization of the uterine arteries. CONCLUSION: Management of PPH is dictated by several considerations including hemodynamic status and desire to preserve fertility. The initial results of this conservative protocol for treatment of PPH in high-risk patients with placenta previa accreta are encouraging.

Ovarian torsion in in vitro fertilization-induced twin pregnancy: combination of Doppler ultrasound and laparoscopy in diagnosis and treatment can quickly solve the case.

OBJECTIVE: To diagnose and treat adnexal torsion in pregnancy. DESIGN: Case report. SETTING: Obstetrics and Gynecology Department of Perugia Hospital. PATIENT(S): A 38-year-old woman, gravida 2, para 1 with bichorial twin pregnancy in the 10th week of gestation who was admitted for abdominal pain. She conceived after an IVF attempt. Even if symptoms compared 2 days before the admission, they aggravated just 2 hours before. INTERVENTION(S): An ovarian torsion was suspected, and Doppler ultrasound showed a complete absence of vascular flow. The dimension of the right ovary and the absence of ovarian blood flow were strong arguments in favor of the diagnosis of adnexal torsion, and laparoscopic ovarian adnexectomy was performed. MAIN OUTCOME MEASURE(S): The ovarian torsion was confirmed, and right adnexectomy was necessary. RESULT(S): The patient had a quick convalescence and was discharged on the third postoperative day. She had no more pain. She underwent a cesarean section for placenta previa. She and her children have remained well. CONCLUSION(S): Considering the increased number of IVF pregnancies, an ovarian torsion should be less uncommon than in the past. Doppler ultrasound should be considered as a first-line exam. The complete absence of vascular flow in the ovary may be an indication for adnexectomy. An ovarian torsion in pregnancy should be treated laparoscopically.