Ioannis Thanasas

Pregnancy-related acute kidney injury (AKI) secondary to severe preeclampsia is a rare but life-threatening obstetric complication for both the mother and the fetus-newborn. A 19-year-old primigravida at 36 weeks of gestation was admitted to the hospital with malaise and severe hypertension. Due to severe preeclampsia, delivery was completed by cesarean section. The diagnosis of AKI led to the initiation of hemodialysis, which was continued until full recovery of renal function. This case highlights the rare occurrence of AKI associated with severe preeclampsia during pregnancy and discusses the diagnostic approach and management of affected patients.

Cesarean section is among the most frequently performed surgical procedures worldwide. In recent years, the increasing rate of cesarean deliveries has led to an increased incidence of post‑operative complications. The present case report describes a rare case of a post‑operative pelvic abscess located at the uterine scar following a cesarean section, managed successfully via laparotomy. The patient, a 17‑year‑old woman, was admitted 1 week after undergoing a cesarean delivery. She presented with abdominal pain, fever and chills. Blood tests revealed elevated inflammatory markers and a mild coagulation disorder, consistent with an ongoing infectious process. The results of urinalysis did not reveal any notable findings. A transvaginal ultrasound and an abdominal computed tomography scan revealed a large, mixed echogenic mass with irregular borders and the presence of intralesional air bubbles, localized at the uterine scar anterior to the bladder. Given the persistence of clinical symptoms, supportive imaging and laboratory findings, and the failure of conservative management of the post‑operative intra‑abdominal infection, surgical intervention was deemed necessary. A laparotomy was performed through the previous cesarean incision. Intraoperatively, an abscess was identified at the site of the uterine scar and was surgically drained. Samples were collected for aerobic and anaerobic cultures, and the cavity was irrigated thoroughly to remove purulent and hemorrhagic material. A drainage tube was placed before closure. The postoperative course of the patient was uneventful, with complete clinical resolution. Following the case presentation, a brief review of the current diagnostic and therapeutic strategies for this uncommon post‑operative complication is also provided. On the whole, the present case report underscores the importance of timely surgical intervention via laparotomy when image‑guided drainage or laparoscopy is not feasible.

Crohn’s disease (CD) is a chronic autoimmune disorder of the GI system that primarily affects young individuals of reproductive age and is often associated with pregnancy. This case report describes the successful outcome of a pregnancy in a 32-year-old primigravida woman with CD, who had undergone enterectomy five years prior. At the time of conception and throughout the entire pregnancy, the disease was in remission under pharmacological treatment. The pregnancy, under systematic monitoring, progressed smoothly for the mother, fetus, and neonate. After completion of the 38th week of gestation, an elective cesarean section was performed without complications. The puerperium was uneventful. Eight months later, the disease remained in complete remission. Following the case description, a brief review of the literature on CD in pregnancy is provided.

Dermoid cyst or mature cystic teratoma is the most common ovarian germ cell tumor. Clinical diagnosis is not easy. The acute abdominal pain associated with ovarian dermoid cysts usually involves adnexal torsion. Preoperative diagnosis of adnexal torsion with dermoid ovarian cyst can be based on pelvic imaging combined with clinical findings. Treatment is surgical and should be applied without delay. Cystectomy is the treatment of choice for the management of dermoid ovarian cysts that have undergone torsion and maintain adequate blood supply. Our case report concerns the emergency surgical intervention of a patient with right adnexal torsion and the presence of a large dermoid cyst. The patient came to the Emergency Department of our hospital with symptoms of an acute abdomen. Ultrasound confirmed the diagnosis of adnexal torsion with the presence of a mature cystic ovarian teratoma, and laparotomy with cystectomy was performed. Histological examination of the surgical specimen confirmed the diagnosis of twisted ovarian dermoid cyst. At this point, we must emphasize the crucial contribution of transabdominal pelvic ultrasound in the management of mature cystic ovarian teratomas accompanied by complete adnexal torsion. Early diagnosis and immediate surgical intervention in young patients who wish to preserve ovarian function in order to achieve future pregnancy are of major importance.

Dermoid cyst or mature cystic teratoma is the most common ovarian germ cell tumor. Clinical diagnosis is not easy. The acute abdominal pain associated with ovarian dermoid cysts usually involves adnexal torsion. Preoperative diagnosis of adnexal torsion with dermoid ovarian cyst can be based on pelvic imaging combined with clinical findings. Treatment is surgical and should be applied without delay. Cystectomy is the treatment of choice for the management of dermoid ovarian cysts that have undergone torsion and maintain adequate blood supply. Our case report concerns the emergency surgical intervention of a patient with right adnexal torsion and the presence of a large dermoid cyst. The patient came to the Emergency Department of our hospital with symptoms of an acute abdomen. Ultrasound confirmed the diagnosis of adnexal torsion with the presence of a mature cystic ovarian teratoma, and laparotomy with cystectomy was performed. Histological examination of the surgical specimen confirmed the diagnosis of twisted ovarian dermoid cyst. At this point, we must emphasize the crucial contribution of transabdominal pelvic ultrasound in the management of mature cystic ovarian teratomas accompanied by complete adnexal torsion. Early diagnosis and immediate surgical intervention in young patients who wish to preserve ovarian function in order to achieve future pregnancy are of major importance.

The present case report concerns a postmenopausal patient who presented to the gynecological outpatient clinic of the hospital with a two-year history of a pedunculated mass located in the vulvar region, which had gradually increased in size. During the preceding six months, the patient reported discomfort and difficulty during ambulation and sitting, as well as intermittent mild vulvar pain not associated with any local trauma. Clinical examination revealed a pedunculated vulvar lesion with a maximum diameter of approximately 45 mm, oval-shaped, semi-firm in consistency, and non-tender on palpation. Based on the clinical findings, a strong presumptive diagnosis of a vulvar fibroepithelial stromal polyp was made, and surgical excision of the lesion was decided. Histopathological examination of the surgical specimen confirmed the diagnosis of a vulvar fibroepithelial stromal polyp with superficial dermal vascular thrombosis. The postoperative course was uneventful. No evidence of disease recurrence was observed six months following surgery. The patient remains under regular follow-up with annual clinical evaluations to date. This case report highlights the unusual occurrence of a vulvar fibroepithelial stromal polyp with superficial vascular thrombosis in a postmenopausal patient without a history of hormone replacement therapy or tamoxifen use. Additionally, the main risk factors are reviewed, and the contemporary diagnostic approach to this rare pathological entity is discussed, emphasizing the pivotal role of surgical management and the necessity of distinguishing it from malignant vulvar conditions.

This study presents a rare case of emergency surgical management via exploratory laparotomy of a large torsed ovarian fibroma in a young female patient. A 17-year-old patient with no history of sexual activity and under chronic antipsychotic medication presented to the emergency department with signs of acute surgical abdomen and fever up to 37.9°C. Laboratory markers of inflammation were elevated. An emergency computed tomography scan revealed a large, solid echogenic pelvic mass of unclear origin. The clinical and laboratory findings, along with the imaging results, led to the decision to perform an emergency exploratory laparotomy. Intraoperatively, a large, solid ovarian mass in torsion, along with the ipsilateral fallopian tube, was identified. A right salpingo-oophorectomy was performed. Histological examination confirmed the diagnosis of a torsed ovarian fibroma. The immediate postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. This article also includes a brief narrative review of the literature regarding ovarian fibromas with torsion, focusing on their rarity, diagnostic challenges, management, and prognosis.

The present study describes a rare case of torsion of an ovarian fibroma in a woman of reproductive age, where a severe diagnostic dilemma arose in differentiating it from a solid ovarian cancer. A 48‑year‑old female patient presented to the hospital with a 1‑week history of low‑grade fever and mild, continuous abdominal pain, accompanied by nausea and a mild sensation of abdominal bloating. The pain, which was not associated with signs of peritoneal irritation, was more pronounced in the right iliac fossa. The levels of inflammatory and tumor markers were found to be slightly elevated. A computed tomography scan and magnetic resonance imaging of the right adnexal region revealed a large heterogeneous mass with cystic‑necrotic areas inside, free fluid collection in the pelvis, and multiple slightly enlarged para‑aortic and iliac lymph nodes. These imaging findings, combined with the lack of clinical and laboratory improvement following treatment with antibiotics, led to the decision to proceed with a laparotomy, without having ruled out the diagnosis of solid ovarian cancer. Intraoperatively, the torsion of an ovarian fibroma was identified. A total abdominal hysterectomy with bilateral salpingo‑oophorectomy was performed. An immunohistochemical examination confirmed the diagnosis of ovarian fibroma. Following an uneventful post‑operative course, the patient was discharged from the clinic on the 4th day post‑operatively. The present case report highlights an unusual clinical manifestation of ovarian fibroma torsion, which entailed milder symptom intensity and characteristics resembling ovarian malignancy instead. The aim of the present study was to report this uncommon manifestation, explore its differential diagnosis from malignancy and provide a brief review of the current diagnostic and treatment algorithms for clinicians faced with similar cases in their practice. In this manner, it is hoped that the present study may contribute to the improvement of the diagnostic accuracy and treatment efficacy for similar cases.

This report describes a rare case of small bowel perforation associated with iatrogenic uterine perforation during endometrial curettage, which was successfully treated despite delayed diagnosis. A 62-year-old patient, in septic condition and exhibiting symptoms of acute abdomen, was admitted to our hospital five days after undergoing diagnostic endometrial curettage due to postmenopausal metrorrhagia. Inflammatory markers were elevated. An emergency computed tomography (CT) scan revealed the presence of pneumoperitoneum and multiple fluid collections with air-fluid levels throughout the peritoneal cavity. Emergency laparotomy was performed, with severe fecal peritonitis secondary to small bowel perforation being observed. No primary uterine perforation site was confirmed intra-operatively, although histological examination of the endometrial curettage material confirmed the presence of smooth muscle tissue and debris of intestinal epithelium. Salvage surgery for neglected peritonitis was carried out, including enterectomy that involved the perforation site and creation of two ileostomies (end ileostomy and mucus fistula). The patient's worsening condition prompted admission to the intensive care unit (ICU), where she remained for 22 days and was subsequently transferred to the surgical ward, where she remained for another 15 days. She was discharged from the ward in good condition with instructions for follow-up assessment and scheduling of bowel restoration surgery. Based on the description of this rare case, the diagnostic approach and therapeutic options for this rare complication are discussed. Special emphasis is placed on the benefits of early diagnosis, which significantly contributes to ensuring the best prognostic outcome.

Background/Objectives: Tubal dysfunction may be a contributing factor in up to 35% of infertility cases, rendering tubal patency assessment a vital component of the infertility workup. In this review we examined the diagnostic efficacy and tolerability of hysterosalpingo-foam sonography (HyFoSy) and compared it to hysterosalpingography (HSG) and hysterosalpingo-contrast sonography (HyCoSy). Methods: Online databases were systematically searched and evaluated according to the PRISMA 2020 guidelines. Statistical heterogeneity was assessed. Diagnostic sensitivity, specificity and inter-method agreement were evaluated, along with mean pain scores. Results: This analysis included data from 9 studies and 1354 patients with conclusive diagnostic data from 2422 tubes and 1294 patients with data on intra-procedural pain. With regard to HyFoSy and HyCoSy comparison, pooled sensitivity was 87% and 69%, respectively (p = 0.074), while pooled specificity was 95% and 85%, respectively, favoring HyFoSy (p < 0.001). HyFoSy was more tolerable with regard to pain, but this was not statistically significant. Regarding the HyFoSy and HSG comparison, pooled Cohen’s k was 0.38, indicating fair-moderate agreement. In subsequent analysis, with HSG as a reference standard, HyFoSy demonstrated low sensitivity (61%) but high specificity (87%). With regard to experienced pain, HyFoSy and HSG had a difference of 2.4 units on a 10-point scale, favoring HyFoSy (p < 0.001). Conclusions: HyFoSy was superior to HyCoSy and may be used as a first-line tubal assessment method, with HSG being utilized in inconclusive cases. However, further research is still required due to the small number of available studies.