Mesenteric cystic lymphangioma misdiagnosed as ovarian cyst in a 63-year-old female: A case report and review of literature.

INTRODUCTION: Cystic lymphangioma is rare benign tumor that results from a lymphatic system malformation. The mesenteric location is even more uncommon. CASE REPORT: We report the case of a menopausal 63-year-old woman who presented with a persistent painful well-defined mass of the pelvis. On ultrasound and computed tomography, the mass appeared as thick-walled unilocular homogenous cyst in favor of an ovarian cystadenoma. During laparotomy, the misdiagnosis was confirmed as the tumor was found to be embedded in the mesentery of the ileum. Subsequent histopathological examination confirmed the benign cystic lymphangioma diagnosis. DISCUSSION: Mesenteric cystic lymphangioma is rare peritoneal tumor of the adult. Clinically, it often masquerades as other abdominopelvic masses like ovarian cysts. Differential diagnosis is often challenging because of the overlapping clinical abdominal presentation and radiological features. Histopathological is the gold standard in diagnosing mesenteric cystic lymphangioma. Surgery is the mainstay treatment, and the recurrence rate is low if negative surgical margins are achieved. CONCLUSION: Mesenteric cystic lymphangioma often mimics more frequent and potentially malignant lesions. It is essential for surgeons to remain vigilant for the possibility of this diagnosis when evaluating abdominopelvic cystic masses.

Fibrothecoma a rare ovarian tumor: A case report.

INTRODUCTION AND IMPORTANCE: Fibroma, thecoma, and fibrothecoma collectively denote a range of non-cancerous sex cord-stromal tumors distinguished by the presence of fibroblastic stromal cells and/or cells resembling luteinized theca cells. CASE PRESENTATION: In this report, we present a case study of a 52-year-old patient in whom this uncommon tumor was identified via MRI, highlighting the distinctive diagnostic and treatment considerations associated with it. CLINICAL DISCUSSION: Ovarian fibrothecoma tumors are infrequent, constituting less than 4 % of all ovarian tumors. Although they may manifest at any age, they are more commonly observed in elderly and post-menopausal individuals. Diagnosis hinges on clinical and paraclinical data, yet definitive confirmation is predominantly achieved through anatomopathological examination. For younger patients, conservative surgery is usually favored, whereas peri- or post-menopausal individuals may undergo radical treatment. CONCLUSION: Ovarian Fibrothecoma, though rare, are typically benign tumors frequently found in older patients. Diagnosis primarily relies on histological examination. Fortunately, the prognosis for these tumors is generally favorable.

Ovarian vein and inferior vena cava thrombosis after vaginal delivery: A case report.

Ovarian vein thrombosis (OVT) is a rare but serious complication, most commonly occurring in the postpartum period. This article reports the case of a 40-year-old woman who presented 12 days after a normal vaginal delivery with fever and pelvic pain. An initial diagnosis of endometritis was made, and empiric antibiotic therapy was administered, but the fever persisted. An ultrasound scan was then done to rule out appendicitis, which revealed a thrombosis of the right ovarian vein extended to the inferior vena cava. Appropriate anticoagulant therapy was immediately started with spectacular clinical improvement. Ovarian vein thrombosis is difficult to diagnose as the signs are nonspecific, like fever and pelvic pain; radiological exploration, typically doppler ultrasound and computerized tomography, are therefore required. Early treatment is crucial to prevent severe complications, especially pulmonary embolism. This case emphasizes the need for heightened clinical awareness and a multidisciplinary approach to achieve optimal outcomes in managing ovarian vein thrombosis.

Endoscopic treatement by vaginoscopy of a Herlyn-Werner-Wunderlich syndrome: A case report.

INTRODUCTION: Herlyn-Werner-Wunderlich syndrome is a rare complex congenital disorder, presenting with obstructed vagina, uterus didelphys and ipsilateral renal agenesis. Hemivaginal obstruction firstly asymptomatic, leads to symptoms after menarche such as dysmenorrhea, pelvic pain or infertility. CASE PRESENTATION: A 15-year-old patient presenting with few symptoms, transvaginal ultrasound reveals an hematocolpos, we report also typical findings of this disorder on magnetic resonance imaging. DISCUSSION: The pelvic pain caused by the hematocolpos is the main symptom that leads patients to consult often urgently, the MRI is the gold standard exam to confirm diagnosis, the treatment consists on incision the septum vaginal and leads to avoid complications. CONCLUSION: Early diagnosis of this syndrome usually leads to initiate surgical treatment in order to avoid complications.

Parietal endometriosis: An uncommon cause of c-section scar pain - A case report.

INTRODUCTION: Parietal endometriosis is the most common form of extra-pelvic endometriosis. It develops on the surgical scar of c-section or hysterectomy. It is one of the causes of scar pain. CASE PRESENTATION: A 26 years old patient presents with recurring pain and swelling of a Pfannenstiel scar 6 years after a caesarean section. Physical examination revealed a firm tender subcutaneous nodule that appeared at MRI as a heterogenous parietal mass infiltrating the rectus abdominis muscles. The patient underwent a wide excision of the nodule. DISCUSSION: Parietal endometriosis can be the cause of debilitating scar pain even in patients with no history of deep endometriosis. It presents as firm parietal nodule that can become large and infiltrative if left untreated. Diagnosis is purely histological. Surgery remains the treatment of choice and requires a wide excision. CONCLUSION: Parietal endometriosis, potentially more common due to rising number of caesarean sections, should be considered with persistent scar pain. Surgery is the preferred treatment, offering a conclusive diagnosis.

Cesarean Delivery of a Parturient with Lumboperitoneal Shunt under Spinal Anesthesia.

Lumboperitoneal shunt may be indicated as a treatment for idiopathic intracranial hypertension aiming to facilitate the dynamic flow of cerebrospinal fluid into the peritoneum for patients. Parturients with lumboperitoneal shunt are a few, making it difficult to choose the analgesic or anesthetic technique for delivery. We present the case of a successful spinal anesthesia for a cesarean delivery in a parturient who was diagnosed with idiopathic intracranial hypertension that was treated by lumboperitoneal shunt.

Placenta percreta as a cause of uterine rupture in the second trimester: Case report.

INTRODUCTION: Placenta accreta spectrum is a very life-threatening obstetrical condition whose rate increased significantly the past years due to the increase of caesarean deliveries. In some rare cases, it can cause uterine rupture which needs to be diagnosed and managed quickly to avoid catastrophic outcomes. CASE REPORT: We present a case of a 33-year-old patient who was admitted to the emergency room for signs of shock at 29 weeks of a poorly supervised pregnancy, secondary to a spontaneous uterine rupture on a previously scarred uterus by a caesarean delivery two years prior to the events. She presented with massive haemoperitoneum with no vaginal bleeding. Foetus was in bradycardia. Quick total hysterectomy allowed favorable maternal and foetal outcome. DISCUSSION: Placenta accreta spectrum (PAS) occurs when the placenta becomes abnormally adherent to the myometrium and serosa rather than the uterine decidua. Its most important complication is hemorrhage after delivery of the placenta. In rare cases it can lead to spontaneous uterine rupture at any trimester, as it was the case of our patient. Antepartum diagnosis by ultrasound examination is recommended to avoid complications and improve management. It should be carefully done in high-risk patients of PAS. PAS is associated with high maternal and foetal morbidity and mortality. Definitive diagnosis is obtained after pathology examination of the specimen. CONCLUSION: Uterine rupture should be considered a differential diagnosis for abdominal pain in any trimester, in case of shock even in the absence of vaginal bleeding, especially when associated to abnormal placentation. Quick diagnosis, management and intervention improves survival rate and decreases maternal and foetal morbidity.

Adnexal torsion caused by tuberculous pyosalpinx: An uncommon case report of urogenital tuberculosis.

BACKGROUND: According to the World Health Organization, TB is a global public health problem and it remains in 2020 the deadliest infectious disease in the world, ahead of Covid19 (Global Tuberculosis Report 2020, 2020). Morocco is an endemic area with more than 30,000 new cases of all forms of tuberculosis each year (Plan stratégique national 2018-2021 de lutte antituberculeuse, 2018). UGTB is the second most frequent localization after lymph node involvement and is responsible for 30 to 40% of all extrapulmonary cases. CASE PRESENTATION: We hereby present the uncommon case of a 27-year-old virgin woman with unremarkable medical and surgical histories, who presented at the emergency department for left-sided pelvic pain of acute installation. An exploratory laparotomy using a Pfannenstiel incision, demonstrated a peritoneal effusion of low abundance with a twisted left ovary and a huge pyosalpinx. Detorsion was then carefully performed, with improvement in color of the ovary and decrease in edema within 10 min. Histopathological study of the Fallopian tube biopsy revealed granulomatous abscessificated salpingitis with genital tuberculosis. Thus, the patient received her anti-tuberculosis treatment with a course of 6 months of 2HRZE/4HR. CONCLUSIONS: In view of the resurgence of cases of tuberculosis of all forms, the importance of prevention and screening should not be underestimated, especially in endemic areas. In fact, only BCG at birth and the correct treatment of any primary tuberculosis infection, whatever its location, will make it possible to reduce the consequences of this affection and avoid the tragedy of the home without children.

[Ballantyne syndrome associated with fetal cardiac rhabdomyoma: a case report]. / Syndrome de Ballantyne associée à un rhabdomyome cardiaque fœtal: à propos d´un cas.

Ballantyne syndrome or mirror syndrome was first described in 1892. It is a disorder affecting pregnant women describing the association of fetal anasarca complicated by more or less generalized maternal edema and albuminuria (and sometimes anemia). It is a rare clinical entity. Diagnosis is based on a triad consisting of fetal hydrops, generalized maternal edema and placentomegaly. It can be associated with fetal hydrops from any cause. Diagnostic should be suspected in patients with maternal edema syndrome associated with fetal anasarca. Guarded fetal prognosis can be associated with high maternal morbidity; hence the need for early diagnosis, resting on a clear determination of its cause, and aimed to implement antenatal treatment improving maternal and fetal prognosis. We here report a unique case of Ballantyne syndrome which has never been described in the literature. The study involved a 32-year-old female patient with fetal hydrops caused by fetal cardiac rhabdomyoma.

[Congenital high airway obstruction syndrome (CHAOS): a case report]. / Syndrome congénital d´obstruction des voies aériennes supérieures (syndrome du CHAOS): à propos d'un cas.

Congenital upper airway obstruction syndrome is a rare malformation that can be fatal to a newborn baby. It is defined as a complete or almost complete obstruction of the upper airways. CHAOS rate is unknown. We here report the case of a 24-year-old primiparous patient with no medical or surgical history. First-trimester ultrasound didn't show any abnormality. During the second trimester, ultrasonography showed extensive subcutaneous edema, hypertrophied lung with hyperechoic appearance, hypoplastic heart and large-volume ascites associated with severe oligoamnios. After having excluded the most common causes, including isoimmunization (indirect negative Coombs), infections (negative serologies) kariotiping was not performed because the patient refused it. The results of ultrasonography suggested fetal hydrops secondary to CHAOS syndrome, because of pathognomonic signs of pulmonary hypertrophy with inverted or convex diaphragm. MRI was requested; it suggested CHAOS syndrome associated with other malformations: laryngeal atresia, microphthalmia with hypertelorism and deviation of the nasal septum with lack of visualization of the thymic tissue, no clear identification of the bladder, absence of right kidney and hypoplastic left kidney. The outcome of pregnancy was marked by premature labour at the 24th week of amenorrhea. The baby had a birth weight of 1475g, polimalformations such as sexual ambiguity, distended abdomen and polydactyly . The newborn died 3 min after birth. Karyotyping was performed which showed 46XX.

Hydatid cyst of the breast: case report.

INTRODUCTION: The hydatid cyst of the breast is a rare pathology even in countries endemic to tuberculosis, however there remains a differential diagnosis evoked in front of any breast tumor. The clinic, mammography and ultrasound sometimes allow us to suspect the hydatid nature of the lesion. The definitive diagnosis remains histological and the treatment is always surgical. From one case, we recall the important role that cytology can play in preoparatory diagnosis. CASE PRESENTATION: We report an observation of 59-year-old patient who lives in a tuberculosis endemic area of morocoo. the patient presented to our institute with palpable nodule in the right breast associated with pain of long duration. Clinical examination shows 2 masses occuping the entire upper outer quadrant of the right breast. Radiological explorations (mammography + ultrasound) objectified: A voluminous opacity of the QSE of the right breast corresponding on ultrasound to two cystic with anechoic content. the first classified ACR2 BIRADS. the second has ultimately echogenic content with a sloping portion producing the appearance of pseudo vegetation,classified ACR3 BIRADS. A fine needle aspiration of the cyst only showed the presence of altered polynuclear, without evidence of tumor cells. Treatment consisted of surgical excision such as perikystectomy and pathology examination demonstrated breast hydatidosis.postoperative evolution was favourable. Patient was put on medical treatment based on albendazole immediately.The patient was monitored for one year without local or distant recurrences. CONCLUSION: Although hydatid disease of the breast remains a rare localization of tuberculosis disease, it should nevertheless be considered as a differential diagnosis of breast tumors. Ultrasound, cytology and MRI play an important preoperative diagnostic role. Treatment is essentially based on surgical pericystectomy associated with medical treatment based on albendazole.

[Uterine necrosis following uterine compressions in combination with vascular ligation during postpartum hemorrhage: a case report]. / Nécrose utérine suite à une combinaison de compressions utérines et de ligature vasculaire lors d'une hémorragie post-partum: à propos d'un cas.

Delivery hemorrhage is the leading cause of maternal mortality in Morocco. It is an obstetric emergency requiring early, effective and multidisciplinary management in patients with severe postpartum bleeding resistant to medical treatment. Advances in interventional radiology and especially, in surgical techniques have provided safe and effective alternatives to hemostasis hysterectomy . We here report a case of uterine necrosis following conservative surgical treatment of delivery hemorrhage based on B-Lynch uterine compression suture combined with Tsirulnikov triple vascular ligation. The patient had sepsis on day 4 after delivery associated with fever and pelvic pain and biological inflammatory syndrome which worsened 48 hours after the onset of abdominal contracture. Abdomopelvic scanner, showed gas bubbles in the uterine myometer suggestive of necrosis. Exploratory laparotomy was performed, which objectified complete necrosis of the uterus. Uterine compression sutures are surgical techniques which play a major role in the therapeutic armamentarium of postpartum hemorrhage during cesarean section. It allows, in addition to or as an alternative to vascular ligation, the preservation of patient's fertility, but it also requires maximum caution and monitoring of complications, the most serious of which is uterine necrosis.

Management of a transverse vaginal septum complicated with hematocolpos in an adolescent girl: Case report.

INTRODUCTION: The transverse septum of the vagina or vaginal septum is a rare abnormality of the female genital tract. The most frequently advanced etiology is a defect in the fusion and/or channelling of the urogenital sinus and Mullerian conductors. This structural obstruction can completely obstruct the vagina and thus can cause a haematocolpos associated with cyclic pelvic pain shortly after menarche in adolescent girls. The diagnosis of a vaginal septum is based on a careful clinical gynaecological examination and especially on ultrasound scan via the abdominal or transrectal (see Transperineal) and in more complex cases on MRI. The treatment is surgical and must be carried out as early as possible. CASE REPORT: We report the management of a case of a 16 year old girl who presented a haematocolpos complicating a complete transverse vaginal septum. The treatment consisted of making a transverse incision in the centre of the transverse septum of the vagina, draining the hematocolpos and visualising the cervix. A circumferential excision of the septum was made and the remaining vaginal edges were then sutured by a simple tarring of the entire circumference with Vicryl 2.0. A sponge soaked in oestrogen cream was placed in her vagina to prevent stenosis and removed the day after the operation. The patient was followed in our department for 2 years without any recurrence of vaginal stenosis or hematocolpos. CONCLUSION: The transverse vaginal septum remains a rare anomaly of the female genital tract, the reasons for its discovery are extremely variable according to its shape and location. Haematocolpos remains the main consequence of these septums. The management is essentially based on surgery while taking into account the risks of postoperative stenosis and the repercussions on the upper genital tract.

Abdominal pregnancy with a healthy newborn: a new case.

Abdominal pregnancy is a rare form of ectopic pregnancy with very high morbidity and mortality for both the mother and the fetus. Diagnosis and management can pose some difficulties especially in low-resource centers. We report a case of abdominal pregnancy with a healthy newborn. A 34-year-old Moroccan woman, G4P3 (3 alive children), presented with shortness of breath and progressive abdominal distension and pain at 37 weeks' gestation. An emergency laparotomy was performed with the impression of abdominal pregnancy. Intraoperatively, the fetus was seen in an intact amniotic sac in her abdomen, the placenta was strongly adhered to the fundus and enveloped the left adnexa. A total hysterectomy with a left adnexectomy was performed. The patient and neonate progressed well and were discharged. Term abdominal pregnancy is an extremely rare diagnosis. The life-threatening complication is bleeding from the detached placental site. High index of suspicion is vital in making prompt diagnosis in such situations.