BACKGROUND Leiomyomas or fibroids commonly originate from the uterus;extrauterine leiomyomas are rare and most often arise from the broad ligament.Diagnosing broad ligament leiomyomas becomes particularly challenging ...BACKGROUND Leiomyomas or fibroids commonly originate from the uterus;extrauterine leiomyomas are rare and most often arise from the broad ligament.Diagnosing broad ligament leiomyomas becomes particularly challenging when they undergo degenerative changes because their clinical and radiological features often mimic those of ovarian tumors.We report a rare case of a giant broad ligament fibroid with cystic degeneration,which was initially mistaken for an ovarian mass.CASE SUMMARY A 49-year-old woman presented with mild abdominal distension and pain as the only symptoms.Upon abdominal examination,a large mass measuring approximately 30 cm and extending from the pelvic cavity to just below the xiphoid process was identified.Both transvaginal ultrasound and contrast-enhanced computed tomography suggested an ovarian origin of the mass.However,laparotomy confirmed that the mass originated from the right broad ligament.The mass was separated from the uterus and bilateral ovaries,with no involvement of the uterus or ovaries.The mass was completely resected with respecting the patient’s desire to retain her uterus and adnexa.Postoperative histopathological examination confirmed leiomyoma with cystic degeneration.CONCLUSION Broad ligament myomas mimic ovarian tumors;accurate diagnosis and careful operation are critical to avoid complications and ensure safety.展开更多
We report a case of 28-year-old woman presenting with small bowel obstruction. She had neither prior surgery nor delivery. An upright abdominal radiograph revealed several air-fluid levels in the small bowel in the mi...We report a case of 28-year-old woman presenting with small bowel obstruction. She had neither prior surgery nor delivery. An upright abdominal radiograph revealed several air-fluid levels in the small bowel in the midabdomen and the pelvic cavity. Computed tomography demonstrated a dilated small bowel loop in the Douglas＇s fossa, but no definite diagnosis could be made. Supportive therapy with draining the intestinal fluid by a long intestinal tube did not result in improvement, which suggested the possibility of a strangulated hernia. Exploratory laparotomy revealed mobile cecum and a 20-cm length of the ileum herniated into a defect of the right broad ligament. As a gangrenous change was recognized in the incarcerated bowel, its resection was carried out, followed by endto-end anastomosis and closure of the defects of the broad ligament. The postoperative course was uneventful. Intestinal obstruction is a very common cause for presentation to an emergency department, while internal hernia is a rare cause of obstruction. Among internal hernias, those through defects of the broad ligament are extremely rare. Defects of the broad ligament can be either congenital or secondary to surgery, pelvic inflammatory disease, and delivery trauma. In conclusion, we emphasize that hernia of the broad ligament should be added to the list of differential diagnosis for female patients presenting with an intestinal obstruction. Early diagnosis and surgical repair reduce morbidity and mortality from strangulation.展开更多
BACKGROUND Retroperitoneal leiomyoma is a rare benign tumor.Retroperitoneal leiomyomas located in the latissimus uterine ligament are even rarer.Retroperitoneal leiomyomas have similar characteristics to uterine leiom...BACKGROUND Retroperitoneal leiomyoma is a rare benign tumor.Retroperitoneal leiomyomas located in the latissimus uterine ligament are even rarer.Retroperitoneal leiomyomas have similar characteristics to uterine leiomyomas in terms of tissue,which results in confusion during diagnosis.CASE SUMMARY A 47-year-old female with 3 years of pain in the right lower quadrant and discovery of a pelvic mass 13 d ago underwent open abdominal exploration.In the right broad ligament,a solid mass with well circumscribed boundaries,approximately 15 cm×10 cm×10 cm in size was bluntly peeled off.The pathological result was a spindle cell tumor,morphologically considered to originate from smooth muscle.Immunohistochemical results supported a deep soft tissue leiomyoma.CONCLUSION Retroperitoneal leiomyoma is a rare benign tumor,and surgical treatment can have a good therapeutic effect.展开更多
BACKGROUND Closed loop ileus caused by entrapment of bowel in a defect of the broad ligament is a rarity.Only a few cases have been reported in the literature.CASE SUMMARY We present the case of a 44-year-old,healthy ...BACKGROUND Closed loop ileus caused by entrapment of bowel in a defect of the broad ligament is a rarity.Only a few cases have been reported in the literature.CASE SUMMARY We present the case of a 44-year-old,healthy patient with no prior history of abdominal surgery who developed a closed loop ileus due to an internal hernia secondary to a defect in the right broad ligament.She first presented to the emergency department with diarrhea and vomiting.As she had had no previous abdominal surgery,she was diagnosed with probable gastroenteritis and discharged.The patient subsequently returned to the emergency department due to a lack of improvement in her symptoms.Blood tests showed an elevated white blood cell count and a closed loop ileus was diagnosed on an abdominal computer tomography scan.Diagnostic laparoscopy revealed an internal hernia entrapped in a 2 cm large defect in the right broad ligament.The hernia was reduced and the ligament defect was closed using a running,barbed suture.CONCLUSION Bowel incarceration through an internal hernia may present with misleading symptoms and laparoscopy may reveal unexpected findings.展开更多
BACKGROUND The treatment of large pelvic masses in postmenopausal women is a challenge in clinical practice.Although ultrasound or magnetic resonance imaging can be used to determine the size and location of the mass,...BACKGROUND The treatment of large pelvic masses in postmenopausal women is a challenge in clinical practice.Although ultrasound or magnetic resonance imaging can be used to determine the size and location of the mass,it is still difficult to achieve a preoperative diagnosis.The majority of cellular leiomyomas are diagnosed by histopathology after surgery.We report the differential diagnosis and surgical management of a rare case of cellular leiomyoma in the broad ligament of the uterus.CASE SUMMARY A 52-year-old Chinese woman without sexual history was admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine for the first time.The patient had a 1-year history of progressive abdominal enlargement as well as a 2-year history of menopause,and complained of frequent abdominal pain and low-grade fever.Computed tomography of the abdomen showed a solid cystic mass(29.4 cm×18.8 cm×37.7 cm)in the pelvis and abdomen.Moreover,routine blood test results indicated a baseline cancer antigen 125(CA-125)level of 187.7 U/mL and C-reactive protein of 109.58 mg/L.Subsequently,retrograde hysterectomy and bilateral adnexectomy were performed in this patient.On histopathologic examination of the surgical specimen,a rare cellular leiomyoma in the broad ligament was diagnosed.CONCLUSION Clinicians need to constantly improve diagnosis and treatment for the challenges posed during clinical assessment,differential diagnosis,and surgical management.展开更多
Broad ligament hematoma is typically seen during cesarean section due to rupture of branches of uterine and vaginal vessels and it’s rare to be seen post-normal vaginal delivery. Addressing puerperal hematomas postpa...Broad ligament hematoma is typically seen during cesarean section due to rupture of branches of uterine and vaginal vessels and it’s rare to be seen post-normal vaginal delivery. Addressing puerperal hematomas postpartum presents considerable challenges for obstetric care providers. While hematomas such as those affecting the vulva, vulvovaginal region, or paravaginal area are frequently encountered, retroperitoneal hematomas are rare and notably pose a greater risk to the life of the patient. The medical literature contains scant case reports on retroperitoneal hematomas, with no consensus on a definitive treatment approach. Pelvic arterial embolization has emerged as both a sensible and increasingly preferred method for treating these hematomas recently, but its application is contingent upon the patient maintaining hemodynamic stability and the availability of a specialized interventional embolization unit. In our case, we are presenting a very rare case of a 31-year-old primigravida female with a history of in vitro fertilization pregnancy. She delivered a normal vaginal delivery at 31 weeks gestation. Unfortunately, she experienced multiple complications intrapartum, including preeclampsia and placental abruption. These complications increased her risk of developing a broad ligament hematoma.展开更多
Internal hernia of the broad ligament is rare. Computerized tomography is the key tool of the diagnosis. The treatment is surgical and takes advantage of the use of laparoscopy. We report a case of internal hernia of ...Internal hernia of the broad ligament is rare. Computerized tomography is the key tool of the diagnosis. The treatment is surgical and takes advantage of the use of laparoscopy. We report a case of internal hernia of right broad ligament suspected on computerized tomography and treated by laparoscopy. The following was uneventful.展开更多
An 86-year-old Japanese woman underwent an examining laparoscopy for removing the huge pelvic tumor. At laparoscope examination, the cystic tumor was found within the left broad ligament, while the ovaries, fallopian ...An 86-year-old Japanese woman underwent an examining laparoscopy for removing the huge pelvic tumor. At laparoscope examination, the cystic tumor was found within the left broad ligament, while the ovaries, fallopian tubes and uterus showed almost normal appearance. The tumor was removed together by total laparoscopic hysterectomy and bilateral salpingo-oophorectomies after the suction of serous content in the broad ligament. Cytological findings of the ascites suggested serous carcinoma. The resected ovaries and fallopian tubes were grossly and histologically normal. Histological examination of the solid part of broad ligament tumor, closely next to the fallopian tube, revealed a serous adenocarcinoma. Immunohistochemically, the tumor cells were strongly positive for CK7, WT-1, estrogen receptor, AE1/AE3 and EMA, and negative for CK20, D2-40 and calretinin. Also, they were negative for progesterone receptor and p53. The authors diagnosed the primary tumor as being a serous cystadenocarcinoma of the broad ligament [pTIC3NxM0, as modified and adapted to post-surgical staging of ovarian cancer (FIGO 2014)]. The patient has been receiving 6 cycles of adjuvant chemotherapies with one course with paclitaxel (PTX) and carboplatin (CBDCA) and five with PTX, CBDCA and Bevacizumab, and has no signs of recurrence and metastasis six months after the operation.展开更多
Broad ligament pregnancy is a rare event and always delays in diagnosis. A pregnant woman in early twenties presented for our center. Routine ultra-sonography revealed a first trimester abdominal pregnancy. Broad liga...Broad ligament pregnancy is a rare event and always delays in diagnosis. A pregnant woman in early twenties presented for our center. Routine ultra-sonography revealed a first trimester abdominal pregnancy. Broad ligament pregnancy was diagnosed intraoperation and treated with laparoscopic resection successfully. The patient has a history of right tubal pregnancy 2 years ago and terminated with Laparoscopic Salpingostomy. According to the long term followed-up for the patient, we found that she had recurrent right tubal pregnancy 5 months after the broad ligment ectopic pregnancy. She received the salpingectomy laparoscopically. We presented the case to discuss the clinical management of broad ligament ectopic pregnancy and options of surgical treatments of tubal pregnancy to reduce the risk of recurrent.展开更多
Internal hernia is a rare cause of intestinal obstruction. We present a case of 43-year-old woman without any prior surgical history who was referred as a case of obstructed para-umbilical hernia from a satellite clin...Internal hernia is a rare cause of intestinal obstruction. We present a case of 43-year-old woman without any prior surgical history who was referred as a case of obstructed para-umbilical hernia from a satellite clinic. The objective is to highlight the occurrence of such a rare clinical problem and to provide an insight into decision making especially when there is discordance between an obvious pathology and clinical features.展开更多
The broad ligament is the commonest extra uterine site for the occurrence of leiomyoma but with a very low incidence rate. Because of its overall low incidence rate, it poses both clinical and radiological difficulty ...The broad ligament is the commonest extra uterine site for the occurrence of leiomyoma but with a very low incidence rate. Because of its overall low incidence rate, it poses both clinical and radiological difficulty in differentiating with an ovarian tumour. We report a case of a 31-year-old unmarried nullipara (para 0 + 0) who presented with 12-month history of progressive abdominal swelling, three-month history of pelvic pain and one-month history of prolonged heavy menstrual flow. Examination of the abdomen showed a 36-week-size mass which was multi-lobulated, firm, non tender and slightly mobile extending to the xyphisternum. On abdominal ultrasonography scan, the uterus was deviated to the contra lateral side with a huge, irregular mass measuring 24 × 18 cm posterior to the uterus. She had laparotomy and four fibroid seedlings were removed. The largest was a broad ligament myoma which measured 24 × 17 × 12 cm and weighed 3883 g.展开更多
Background: Giant fibroids usually arise from the uterus, and very rarely can also arise from the broad ligament. Large fibroids can undergo hyaline, cystic degeneration and very rarely red degeneration. Case Report: ...Background: Giant fibroids usually arise from the uterus, and very rarely can also arise from the broad ligament. Large fibroids can undergo hyaline, cystic degeneration and very rarely red degeneration. Case Report: In our case, ovarian neoplasm of the ovaries was suspected, as an adnexal mass with cystic degeneration and intervening septations were seen which were not separate from the lesion. The MRI findings were also characteristic of ovarian neoplasm. Giant fibroid with cystic degeneration was a rare differential diagnosis. Broad ligament fibroid excision, total abdominal hysterectomy, and bilateral salpingo-oophorectomy were performed on the patient. The diagnosis was confirmed on histopathological examination. Conclusion: Broad ligament leiomyoma should be kept as an important differential diagnosis for solid adnexal or ovarian masses.展开更多
Objective:To assess using the pelvic pressure pack as temporizing treatment for combined vaginal and broad ligament hematoma before selective arterial embolization could be undertaken.Methods:A 29-year-old woman was t...Objective:To assess using the pelvic pressure pack as temporizing treatment for combined vaginal and broad ligament hematoma before selective arterial embolization could be undertaken.Methods:A 29-year-old woman was transferred because of a 10cm right upper vaginal hematoma found shortly after the spontaneous delivery of a 3400g infant at term.Following evacuation of the clots,the patient’s condition deteriorated with the appearance of a painful right pelvic mass,displacing the uterus.At laparotomy,the hematoma extended between the folds of the broad ligament into the pelvic sidewall.After evacuation of the clots,hemostasis failed despite subtotal hysterectomy.Eventually a pressure pack created from joined gauze rolls was used to fill up the pelvic cavity and achieved hemostasis before abdominal closure.When the vaginal pack was removed 30 hours later,vaginal bleeding recurred,and bilateral hypogastric embolization was performed with Gianturco coils.Results:The patient was successfully treated by this way and discharged uneventfully.Conclusion:In combined vaginal and broad ligament hematoma,pelvic pressure pack can be used to ensure maternal survival until definitive treatment with angiographic embolization.展开更多
Broad ligament pregnancy is defined as gestation that grows in the space formed by anterior and posterior peritoneal folds of the broad ligament.We report a case of 30 years old lady admitted to our hospital with the ...Broad ligament pregnancy is defined as gestation that grows in the space formed by anterior and posterior peritoneal folds of the broad ligament.We report a case of 30 years old lady admitted to our hospital with the diagnosis of gravida 2,para 1,live birth 1,with 24 weeks of gestation with low lying placenta with anhydramnios.She was taken up for lower segment cesarian section at 28 weeks gestation in view of low lying placenta with chorioamnionitis.The broad ligament pregnancy was diagnosed peroperatively after identifying the anatomical relationship of the pregnancy.Sac was excised and margins secured after extraction of the baby and placenta.Patient had an uneventful postoperative period.Broad ligament pregnancy may be missed in antenatal period but in cases of displaced cervix,early onset unexplained anhydramnios,and failed induction of labor,it may raise high suspicion.Laparotomy/laparoscopic management is the mainstay of management of broad ligament pregnancy.展开更多
文摘BACKGROUND Leiomyomas or fibroids commonly originate from the uterus;extrauterine leiomyomas are rare and most often arise from the broad ligament.Diagnosing broad ligament leiomyomas becomes particularly challenging when they undergo degenerative changes because their clinical and radiological features often mimic those of ovarian tumors.We report a rare case of a giant broad ligament fibroid with cystic degeneration,which was initially mistaken for an ovarian mass.CASE SUMMARY A 49-year-old woman presented with mild abdominal distension and pain as the only symptoms.Upon abdominal examination,a large mass measuring approximately 30 cm and extending from the pelvic cavity to just below the xiphoid process was identified.Both transvaginal ultrasound and contrast-enhanced computed tomography suggested an ovarian origin of the mass.However,laparotomy confirmed that the mass originated from the right broad ligament.The mass was separated from the uterus and bilateral ovaries,with no involvement of the uterus or ovaries.The mass was completely resected with respecting the patient’s desire to retain her uterus and adnexa.Postoperative histopathological examination confirmed leiomyoma with cystic degeneration.CONCLUSION Broad ligament myomas mimic ovarian tumors;accurate diagnosis and careful operation are critical to avoid complications and ensure safety.
文摘We report a case of 28-year-old woman presenting with small bowel obstruction. She had neither prior surgery nor delivery. An upright abdominal radiograph revealed several air-fluid levels in the small bowel in the midabdomen and the pelvic cavity. Computed tomography demonstrated a dilated small bowel loop in the Douglas＇s fossa, but no definite diagnosis could be made. Supportive therapy with draining the intestinal fluid by a long intestinal tube did not result in improvement, which suggested the possibility of a strangulated hernia. Exploratory laparotomy revealed mobile cecum and a 20-cm length of the ileum herniated into a defect of the right broad ligament. As a gangrenous change was recognized in the incarcerated bowel, its resection was carried out, followed by endto-end anastomosis and closure of the defects of the broad ligament. The postoperative course was uneventful. Intestinal obstruction is a very common cause for presentation to an emergency department, while internal hernia is a rare cause of obstruction. Among internal hernias, those through defects of the broad ligament are extremely rare. Defects of the broad ligament can be either congenital or secondary to surgery, pelvic inflammatory disease, and delivery trauma. In conclusion, we emphasize that hernia of the broad ligament should be added to the list of differential diagnosis for female patients presenting with an intestinal obstruction. Early diagnosis and surgical repair reduce morbidity and mortality from strangulation.
基金Supported by the Science and Technology Department of Jilin Province,No.20210204080YY.
文摘BACKGROUND Retroperitoneal leiomyoma is a rare benign tumor.Retroperitoneal leiomyomas located in the latissimus uterine ligament are even rarer.Retroperitoneal leiomyomas have similar characteristics to uterine leiomyomas in terms of tissue,which results in confusion during diagnosis.CASE SUMMARY A 47-year-old female with 3 years of pain in the right lower quadrant and discovery of a pelvic mass 13 d ago underwent open abdominal exploration.In the right broad ligament,a solid mass with well circumscribed boundaries,approximately 15 cm×10 cm×10 cm in size was bluntly peeled off.The pathological result was a spindle cell tumor,morphologically considered to originate from smooth muscle.Immunohistochemical results supported a deep soft tissue leiomyoma.CONCLUSION Retroperitoneal leiomyoma is a rare benign tumor,and surgical treatment can have a good therapeutic effect.
文摘BACKGROUND Closed loop ileus caused by entrapment of bowel in a defect of the broad ligament is a rarity.Only a few cases have been reported in the literature.CASE SUMMARY We present the case of a 44-year-old,healthy patient with no prior history of abdominal surgery who developed a closed loop ileus due to an internal hernia secondary to a defect in the right broad ligament.She first presented to the emergency department with diarrhea and vomiting.As she had had no previous abdominal surgery,she was diagnosed with probable gastroenteritis and discharged.The patient subsequently returned to the emergency department due to a lack of improvement in her symptoms.Blood tests showed an elevated white blood cell count and a closed loop ileus was diagnosed on an abdominal computer tomography scan.Diagnostic laparoscopy revealed an internal hernia entrapped in a 2 cm large defect in the right broad ligament.The hernia was reduced and the ligament defect was closed using a running,barbed suture.CONCLUSION Bowel incarceration through an internal hernia may present with misleading symptoms and laparoscopy may reveal unexpected findings.
文摘BACKGROUND The treatment of large pelvic masses in postmenopausal women is a challenge in clinical practice.Although ultrasound or magnetic resonance imaging can be used to determine the size and location of the mass,it is still difficult to achieve a preoperative diagnosis.The majority of cellular leiomyomas are diagnosed by histopathology after surgery.We report the differential diagnosis and surgical management of a rare case of cellular leiomyoma in the broad ligament of the uterus.CASE SUMMARY A 52-year-old Chinese woman without sexual history was admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine for the first time.The patient had a 1-year history of progressive abdominal enlargement as well as a 2-year history of menopause,and complained of frequent abdominal pain and low-grade fever.Computed tomography of the abdomen showed a solid cystic mass(29.4 cm×18.8 cm×37.7 cm)in the pelvis and abdomen.Moreover,routine blood test results indicated a baseline cancer antigen 125(CA-125)level of 187.7 U/mL and C-reactive protein of 109.58 mg/L.Subsequently,retrograde hysterectomy and bilateral adnexectomy were performed in this patient.On histopathologic examination of the surgical specimen,a rare cellular leiomyoma in the broad ligament was diagnosed.CONCLUSION Clinicians need to constantly improve diagnosis and treatment for the challenges posed during clinical assessment,differential diagnosis,and surgical management.
文摘Broad ligament hematoma is typically seen during cesarean section due to rupture of branches of uterine and vaginal vessels and it’s rare to be seen post-normal vaginal delivery. Addressing puerperal hematomas postpartum presents considerable challenges for obstetric care providers. While hematomas such as those affecting the vulva, vulvovaginal region, or paravaginal area are frequently encountered, retroperitoneal hematomas are rare and notably pose a greater risk to the life of the patient. The medical literature contains scant case reports on retroperitoneal hematomas, with no consensus on a definitive treatment approach. Pelvic arterial embolization has emerged as both a sensible and increasingly preferred method for treating these hematomas recently, but its application is contingent upon the patient maintaining hemodynamic stability and the availability of a specialized interventional embolization unit. In our case, we are presenting a very rare case of a 31-year-old primigravida female with a history of in vitro fertilization pregnancy. She delivered a normal vaginal delivery at 31 weeks gestation. Unfortunately, she experienced multiple complications intrapartum, including preeclampsia and placental abruption. These complications increased her risk of developing a broad ligament hematoma.
文摘Internal hernia of the broad ligament is rare. Computerized tomography is the key tool of the diagnosis. The treatment is surgical and takes advantage of the use of laparoscopy. We report a case of internal hernia of right broad ligament suspected on computerized tomography and treated by laparoscopy. The following was uneventful.
文摘An 86-year-old Japanese woman underwent an examining laparoscopy for removing the huge pelvic tumor. At laparoscope examination, the cystic tumor was found within the left broad ligament, while the ovaries, fallopian tubes and uterus showed almost normal appearance. The tumor was removed together by total laparoscopic hysterectomy and bilateral salpingo-oophorectomies after the suction of serous content in the broad ligament. Cytological findings of the ascites suggested serous carcinoma. The resected ovaries and fallopian tubes were grossly and histologically normal. Histological examination of the solid part of broad ligament tumor, closely next to the fallopian tube, revealed a serous adenocarcinoma. Immunohistochemically, the tumor cells were strongly positive for CK7, WT-1, estrogen receptor, AE1/AE3 and EMA, and negative for CK20, D2-40 and calretinin. Also, they were negative for progesterone receptor and p53. The authors diagnosed the primary tumor as being a serous cystadenocarcinoma of the broad ligament [pTIC3NxM0, as modified and adapted to post-surgical staging of ovarian cancer (FIGO 2014)]. The patient has been receiving 6 cycles of adjuvant chemotherapies with one course with paclitaxel (PTX) and carboplatin (CBDCA) and five with PTX, CBDCA and Bevacizumab, and has no signs of recurrence and metastasis six months after the operation.
文摘Broad ligament pregnancy is a rare event and always delays in diagnosis. A pregnant woman in early twenties presented for our center. Routine ultra-sonography revealed a first trimester abdominal pregnancy. Broad ligament pregnancy was diagnosed intraoperation and treated with laparoscopic resection successfully. The patient has a history of right tubal pregnancy 2 years ago and terminated with Laparoscopic Salpingostomy. According to the long term followed-up for the patient, we found that she had recurrent right tubal pregnancy 5 months after the broad ligment ectopic pregnancy. She received the salpingectomy laparoscopically. We presented the case to discuss the clinical management of broad ligament ectopic pregnancy and options of surgical treatments of tubal pregnancy to reduce the risk of recurrent.
文摘Internal hernia is a rare cause of intestinal obstruction. We present a case of 43-year-old woman without any prior surgical history who was referred as a case of obstructed para-umbilical hernia from a satellite clinic. The objective is to highlight the occurrence of such a rare clinical problem and to provide an insight into decision making especially when there is discordance between an obvious pathology and clinical features.
文摘The broad ligament is the commonest extra uterine site for the occurrence of leiomyoma but with a very low incidence rate. Because of its overall low incidence rate, it poses both clinical and radiological difficulty in differentiating with an ovarian tumour. We report a case of a 31-year-old unmarried nullipara (para 0 + 0) who presented with 12-month history of progressive abdominal swelling, three-month history of pelvic pain and one-month history of prolonged heavy menstrual flow. Examination of the abdomen showed a 36-week-size mass which was multi-lobulated, firm, non tender and slightly mobile extending to the xyphisternum. On abdominal ultrasonography scan, the uterus was deviated to the contra lateral side with a huge, irregular mass measuring 24 × 18 cm posterior to the uterus. She had laparotomy and four fibroid seedlings were removed. The largest was a broad ligament myoma which measured 24 × 17 × 12 cm and weighed 3883 g.
文摘Background: Giant fibroids usually arise from the uterus, and very rarely can also arise from the broad ligament. Large fibroids can undergo hyaline, cystic degeneration and very rarely red degeneration. Case Report: In our case, ovarian neoplasm of the ovaries was suspected, as an adnexal mass with cystic degeneration and intervening septations were seen which were not separate from the lesion. The MRI findings were also characteristic of ovarian neoplasm. Giant fibroid with cystic degeneration was a rare differential diagnosis. Broad ligament fibroid excision, total abdominal hysterectomy, and bilateral salpingo-oophorectomy were performed on the patient. The diagnosis was confirmed on histopathological examination. Conclusion: Broad ligament leiomyoma should be kept as an important differential diagnosis for solid adnexal or ovarian masses.
文摘Objective:To assess using the pelvic pressure pack as temporizing treatment for combined vaginal and broad ligament hematoma before selective arterial embolization could be undertaken.Methods:A 29-year-old woman was transferred because of a 10cm right upper vaginal hematoma found shortly after the spontaneous delivery of a 3400g infant at term.Following evacuation of the clots,the patient’s condition deteriorated with the appearance of a painful right pelvic mass,displacing the uterus.At laparotomy,the hematoma extended between the folds of the broad ligament into the pelvic sidewall.After evacuation of the clots,hemostasis failed despite subtotal hysterectomy.Eventually a pressure pack created from joined gauze rolls was used to fill up the pelvic cavity and achieved hemostasis before abdominal closure.When the vaginal pack was removed 30 hours later,vaginal bleeding recurred,and bilateral hypogastric embolization was performed with Gianturco coils.Results:The patient was successfully treated by this way and discharged uneventfully.Conclusion:In combined vaginal and broad ligament hematoma,pelvic pressure pack can be used to ensure maternal survival until definitive treatment with angiographic embolization.
文摘Broad ligament pregnancy is defined as gestation that grows in the space formed by anterior and posterior peritoneal folds of the broad ligament.We report a case of 30 years old lady admitted to our hospital with the diagnosis of gravida 2,para 1,live birth 1,with 24 weeks of gestation with low lying placenta with anhydramnios.She was taken up for lower segment cesarian section at 28 weeks gestation in view of low lying placenta with chorioamnionitis.The broad ligament pregnancy was diagnosed peroperatively after identifying the anatomical relationship of the pregnancy.Sac was excised and margins secured after extraction of the baby and placenta.Patient had an uneventful postoperative period.Broad ligament pregnancy may be missed in antenatal period but in cases of displaced cervix,early onset unexplained anhydramnios,and failed induction of labor,it may raise high suspicion.Laparotomy/laparoscopic management is the mainstay of management of broad ligament pregnancy.
