Computed tomography of a canine omental torsion secondary to a chronic abdominal gossypiboma and concurrent incidental broad ligament torsion.

A 5-year-old female spayed Dogue de Bordeaux was referred for concerns of an abdominal mass and peritoneal effusion. Abdominal radiographs identified a mid-ventral abdominal soft tissue opaque mass containing a radiopaque marker consistent with a gossypiboma. Contrast-enhanced abdominal CT identified two whirl signs associated with the abdominal gossypiboma. Exploratory laparotomy confirmed an omental torsion with encapsulated gossypiboma and concurrent incidental torsion of the remnant of the right broad ligament. Based on a literature review, omental torsions are an unreported complication of gossypibomas in canids.

The changes in ocular torsion after unilateral lateral rectus recession-medial rectus resection for intermittent exotropia.

We aim to explore the alterations of objective ocular torsion after unilateral lateral rectus recession-medial rectus resection (R&R) for intermittent exotropia (IXT). Seventy-two IXT patients undergoing R&R between March and June 2023 were enrolled. Ophthalmological examinations were performed before surgery and at 1 week and 1 month after surgery, mainly including prism and alternate cover test and optical coherence tomography. The mean disc-foveal angle of eyes showing intorsion significantly increased from - 1.5 ± 0.9° preoperatively to 2.0 ± 2.0° at 1 week (P = 0.0227) and 2.2 ± 1.6° at 1 month postoperatively (P = 0.0054). The mean disc-foveal angle of eyes exhibiting extorsion significantly reduced from 12.8 ± 1.9° preoperatively to 9.8 ± 3.1° at 1 week (P < 0.0001) and 9.7 ± 2.7° at 1 month postoperatively (P < 0.0001). The improvement of ocular extorsion at postoperative 1 month was more pronounced in patients with extorsion in operative eye compared to those with extorsion in inoperative eye (P = 0.0101). The improvement of ocular torsion was observed following R&R for IXT, with a greater effect noted in cases where the surgery was performed on the eye exhibiting extorsion.

A propósito de un caso: útero miomatoso gigante torsionado / Torsion of a giant miomatous uterus: report of a clinical case autores

OBJETIVO: Reportar el caso de una torsión de útero, trompas y ambos ovarios a nivel de cuello uterino. Describir la patogenia, sintomatología y tratamiento, como un caso infrecuente y potencialmente grave, en la práctica clínica diaria. MATERIAL Y MÉTODOS: Analizar el curso de esta extremadamente rara patología, en una mujer postmenopáusica de 59 años. Se trata de un caso raro de torsión uterina en un útero no gestante, reportando los hallazgos en los exámenes previos a la cirugía y los hallazgos intraoperatorios e histopatológicos postcirugía. La resonancia magnética fue fundamental en el diagnóstico de la paciente y la laparotomía realizada demostró una torsión de cuerpo uterino de 360 ° a nivel de cérvix, y un gran mioma pediculado con signos de necrosis. Hemos revisado los últimos artículos de esta rara patología RESULTADOS Y DISCUSIÓN: La paciente fue operada. Se realizó una histerectomía total mediante una laparotomía media supra e infraumbilical. Los ovarios no tenían signos de necrosis. CONCLUSIONES: Debemos tener en cuenta esta posibilidad diagnóstica, en pacientes con aumento de tamaño uterino y clínica de dolor abdominal, ya que aunque es muy infrecuente, su diagnóstico es importante, ya que puede ser peligroso para la vida de la paciente.

OBJECTIVE: To report a case of torsion of the uterus, fallopian tubes and both ovaries around the uterine collum and the symptomatology, pathogenesis and treatment of this uncommon pathology. MATERIAL AND METHODS: The article analyses the course of this extremely rare pathology in a postmenopausical woman of 59 years. It is a rare case like a non gravid uterine torsion in a postmenopausical woman. We have the exams previous to the surgery, the finds intraoperative and the histolopathological reports postsurgery. RMN was the most important in diagnosis and the laparotomy showed a 360° an uterus increased on size and a big pedunculated myoma with signs of necrosis We have reviewed the latest articles on this strange pathology RESULTS AND DISCUSSION: The patient was operated. A infra-supra medium laparotomy was practiced and a total hysterectomy was made. Ovarians had not signs of necrosis. CONCLUSIONS: We must take into account, in patients with pathologies that increase uterine size and abdominal pain, the possibility of uterine torsion. Although it is a very infrequent pathology, its diagnosis is important, since it can be dangerous for the life of the patient

Graft Calcification Caused by a Torsion of the Hepatic Vein after a Living-Related Donor Liver Transplantation

Abstract: The torsion of vessels after liver transplantation rarely occurs. Likewise, calcification of a liver graft has seldom been reported. This report details a case which had torsion of the left hepatic vein on the seventh day after living-related donor liver transplantation. The torsion was reduced soon after re-exploration; however, congestion with partial necrosis of the graft occurred. On the follow-up imaging studies, some resolution of necrosis and graft regeneration were found, yet geographic calcification of the liver graft appeared. The patient died of pneumonia after 13 weeks, post-operation. The avoidance such torsion of vessels is necessary and important.(AU)

Torsión secundaiia del omento mayor: una causa poco frecuente de dolor en herniia inguinal complicada / Secondary torsion of the greater omentum, an unusual cause of complicated inguinal hernia

Introducción: La torsión del omento mayor en el interior de un orificio herniario es una entidad muy infrecuente como complicación de una hernia. Caso clínico: Presentamos el caso de un paciente varón de 43 años que acude a Urgencias por cuadro de dolor en fosa ilíaca derecha (FID). El estudio mediante tomo-grafía computarizada muestra un patrón "en remolino" en la grasa mesentérica que se introduce en el orificio inguinal derecho, sugerente de hernia complicada secundaria a torsión de omento mayor. Los hallazgos quirúrgicos y anatomopatológicos confirman el diagnóstico. La torsión de omento mayor es una causa poco frecuente de complicación de hernia inguinal.

Background: Secondary torsion of the greater omentum due to a complicated hernia is uncommon. Case report: We report a 43 years old male presented to the emergency room for pain in the right lower quadrant of the abdomen. An abdominal CT scan showed that mesenteric fat was herniating through the right inguinal orifice with a whirling pattern, suggesting a complicated hernia secondary to torsion of the greater omentum. The patient was operated and the preoperative diagnosis was confirmed.

Quiste ovárico fetal: diagnóstico prenatal y manejo quirúrgico postnatal exitoso / Prenatal diagnosis of fetal ovarian cyst

Los quistes ováricos son el tumor abdominal mas frecuente en las recién nacidas. Presentan complicadones agudas y a largo plazo. La más frecuente es la torsión anexial que presenta dificultades diagnósticas en la etapa neonatal. El diagnóstico prenatal es fundamental para el manejo oportuno de las pacientes. Existen diferentes alternativas terapéuticas donde la cirugía mínimamente invasiva y conservadora juega un importante rol. Presentamos el caso de una recién nacida macrosómica con diagnóstico prenatal de quiste ovárico no complicado que sufrió torsión durante los primeros días de vida y se resolvió exitosamente en forma quirúrgica conservadora gracias a un manejo multidisciplinario.

Ovarian cysts are the most common abdominal tumor in female newborns. They could develop acute or long term complications. The most frequent complication is adnexal torsion, which presents with diagnostic difficulties in the neonatal period. Prenatal diagnosis is essential for the prompt management of patients. There are different treatment options where conservative and minimally invasive surgery plays an important role. We report a female newborn with prenatal diagnosis of macrosomia and uncomplicated ovarian cyst, which suffered adnexal torsion during the first days of life and was successfully resolved with a conservative surgical management by a multidisciplinary staff.

Torsión omental secundaria a hernia inguinal / Omental torsion secondary to inguinal hernia

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Manejo laparoscópico de quistes ováricos complicados o persistentes durante el embarazo / Laparoscopic management of complicated or persistent adnexal cysts during pregnancy

Antecedentes: El incremento en el hallazgo de quistes anexiales durante el embarazo sería el mayor uso de técnicas de reproducción asistida con hiperestimulación ovárica controlada. La complicación más frecuente sigue siendo la torsión anexial. Objetivo: Revisar el manejo de quistes anexiales complicados o persistentes, durante el embarazo, con resolución laparoscópica. Método: Revisión retrospectiva de 9 pacientes consecutivas, ingresadas al Departamento de Obstetricia y Ginecología Clínica Las Condes. Resultados: La edad gestacional de ingreso fue entre 5+5 y 27 semanas. Cinco casos fueron producto de fertilización asistida y cuatro espontáneos. Ocho (85,6 por ciento) embarazadas, ingresaron por dolor abdominal agudo. Otro caso ingresó a cirugía electiva por quiste ovárico persistente. Los quistes tenían entre 6 y 13 cm. En 5 se realizó sólo destorsión ovárica, en 1 ooforectomía y en 1 quistectomía. Se realizó punción, destorsión y fijación a ligamento útero ovárico, bilateral, en la otra paciente. Se registró un caso de fiebre en el postoperatorio. El alta hospitalaria fue a las 48 horas en 6 (67 por ciento), a las 72 en 2 y a las 96 en 1. El estudio biópsico diferido en 3 pacientes demostró: 1 quiste seroso paratubario, 1 quiste luteínico parcialmente hemorrágico y 1 infarto anexial. Todos los embarazos evolucionaron normalmente. Conclusión: Nuestra experiencia confirma que en el embarazo la laparoscopía es una buena opción al requerir una cirugía por quiste anexial complicado o persistente.

Background: Recent reviews show an increase in the finding of adnexal cysts during pregnancy. One reason could be the use of assisted reproductive techniques with controlled ovarian hyperstimulation. Objective: To review the experience in managing via laparoscopy complicated or persistent adnexal cysts during pregnancy. Method: Retrospective review of 9 consecutive patients, admitted at the Department of Obstetrics and Gynecology, Clínica Las Condes. Results: The gestational age was between 5+5 and 27 weeks. Five were the product of assisted fertilization and four spontaneous. Eight (85.6 percent) pregnant women were admitted by emergency room because of acute abdominal pain and another one went through elective surgery for persistent ovarian cyst. Preoperative diagnosis of the 8 patients admitted by emergency: adnexal cyst complicated with torsion in 6 (1 adnexal infarction) and 2 cases of acute abdomen. The cysts were between 6 and 13 cm. Type of surgery: in 5, only distortion; ovarian oophorectomy in 1 and cystectomy in one. Puncture, detorsión and bilateral fixation of uterine ovarian ligament, in another patient. One case required conversion to laparotomy with adnexectomy. Postoperative fever was observed in one patient. Discharge was at 48 hrs in 6 (67 percent) cases, at 72 hrs. in 2 and 96 hrs. in 1. Deferred biopsy performed in 3 patients showed: paratu-barian serous cyst, partially hemorrhagic luteal cyst, adnexal infarction. All pregnancies went on normally. Premature births are not reported. Conclusion: Our experience suggests that laparoscopic approach is a valid option for complicated or persistent adnexal cysts in pregnant women.

Torsión del apéndice cecal asociada a invaginación intestinal / Torsion of the vermiform appendix associated with intussusception

La torsión del apéndice vermiforme es muy rara; en la literatura sólo han sido referidos 25 casos. El aquí informado es el primero asociado a invaginación intestinal. Se trató de una niña de dos meses de edad quien súbitamente dio muestras de dolor. En la exploración quirúrgica se encontró invaginación ileocecal apretada, que fue corregida. Cuatro días después fue necesario reoperar, encontrando torsión y perforación del apéndice cecal; se practicó apendicectomía. Por datos de obstrucción y peritonitis se requirió nueva exploración quirúrgica en la que se encontró dehiscencia del muñón y perforación cecal. Una vez corregidas estas complicaciones, la paciente evolucionó satisfactoriamente y fue dada de alta en buenas condiciones.

BACKGROUND: Vermiform appendix torsion is a rare condition, with only 25 cases recorded in the international literature. Our patient is the first case associated with intussusception. CASE REPORT: A 2-month-old female infant suddenly developed severe abdominal pain due to ileoceal intussusception. During surgical exploration, a tight intussusception was reduced. Three days later, a new laparotomy was required and we found torsion and perforation of the vermiform appendix. The patient underwent appendectomy, but there was dehiscence of the appendiceal stump and cecal perforation requiring a new surgical exploration. The patient had an uneventful recovery.

Quiste ovárico en pacientes infantiles: revisión de 22 casos / Ovarian cyst in infantile patients: report of 22 cases

Se revisa en la literatura médica sobre el quiste ovario. Se estudian 22 casos ingresados en dos hospitales pediátricos; se analizan sus componentes clínicos, fundamentalmente, y se destacan las causas de diagnóstico preoperatorio erróneo. Se señala la necesidad de exploración selectiva en casos de dolor abdominal bajo, sobre todo si se han descartado otras enfermedades más frecuentes. Se llama la atención sobre la frecuencia de torsión y se analizan los factores que la propician. Se establece comparación con publicaciones foráneas(AU)

Massas anexiais na gestação / Adnexal masses in pregnancy

O advento da ultrassonografia (US) durante o pré-natal tem contribuído para o aumento da detecção de massas anexiais na gestação. A maior parte dos tumores tem resolução espontânea por volta da 16ª semana de gestação, sendo associada a cistos funcionais. Massas que persistem após esse período podem acarretar riscos de torção, ruptura e obstrução do canal de parto, necessitando, muitas vezes, de uma intervenção cirúrgica de emergência. A ocorrência de tumores malignos é rara. Além da US, que é utilizada como primeira modalidade para o diagnóstico, o estudo do CA-125 e do B-hCG deve ser realizado. Esses marcadores estão normalmente aumentados durante a gestação. No entanto, na presença de massas tumorais, os níveis são bem mais alterados. O manejo dessa patologia na gravidez é desafiante para o médico e acarreta ansiedade para a paciente. A cirurgia, quando indicada, deverá ser realizada entre o segundo e terceiro trimestres da gestação, levando-se em conta os riscos de complicações para a mãe e o feto. Estudos mostram que, havendo indicações precisas de tratamento adjuvante na gravidez, seu uso não deve ser adiado, pois, em longo prazo, o prognóstico para fetos expostos à quimioterapia intra-útero parece ser bom.

The advent of routine prenatal ultrasonography (US) has increased the detection of adnexal masses during pregnancy. The majority of tumors spontaneously resolve around the 16ª week of gestation, usually being associated with functional cysts. Masses that last after this period can complicate on risks of torsion, rupture of obstruction of labor, requiring emergent surgical intervention. The prevalence of malignant tumor is rare. Besides the use of US, which is the primary diagnostic modality, the study of tumor markers, such as CA-125 and B-hCG, must be done. Their levels are already elevated during pregnancy. However, in the presence of certain types of tumors, these levels are much more altered. The management of this pathology during pregnancy is quite challenging to the medical team and involves psychological issues to the patient. When indicated, the surgery must be taken place between the second and third trimester, always considering the risks of complications to the mother and the fetus. Several studies report that if there are strong indications for adjuvant therapy, it should not be delayed, because the longterm fetal outcomes appear to be good for those fetuses exposed to chemotherapy in utero.

Torsión tubárica tras ligadura de trompas / Fallopian tube torsion after tubal sterilization

La torsión tubárica es un proceso muy infrecuente, aunque hay casos descritos en mujeres de cualquier edad y en diversas situaciones. Los casos más frecuentes son los producidos en mujeres en edad fértil tras un proceso de esterilización tubárica, ya que el frecuente hidrosalpinx posquirúrgico predispone a este desenlace. El diagnóstico habitualmente se realiza tarde, en el momento de la cirugía, es decir, tras necrosis y posterior salpinguectomía

Fallopian tube torsion is a very uncommon event, even though many cases have been described in all ages and in a wide range of situations. This entity most frequently occurs in women of fertile age after tubal sterilization, because postsurgical hydrosalpinx is a predisposing factor. Diagnosis is often made late, at the moment of surgery, with a finding of tubal necrosis. Usually, salpingectomy is subsequently performed

Torsión de la trompa debido a la presencia de un quiste para-tubario / Tube torsion due to the presence of a para-tubal cyst

Se presenta un caso de torsión de la trompa de Falopio debida a la presencia de un quiste para-tubario. Se comentan las dificultades del diagnóstico diferencial y se hace hincapié en el valor de la laparoscopia en el diagnóstico precoz de la situación