Small bowel herniation after operative laparoscopy is an uncommon but serious complication that can result in bowel resection. Therefore, it is important to prevent and diagnose early. We experienced a case of small bowel herniation through trocar site and present with a brief review of literatures.
Laparoscopy ; Surgical Instruments

Fibroepithelial polyps are benign soft tissue tumors that occur in a wide variety of sites, including the lower female genital tract. They exhibit a wide range of morphologic appearances and can be misinterpreted as malignant. A 16-year-old woman presented with a 28x27 cm polypoid lesion localized on the right labium. The labial lesion was resected and recurred 6 years following the initial treatment. The histologic findings of the initial and recurrent lesions were consistent with fibroepithelial polyps. We present a case of a fibroepithelial polyp that is larger than any previously described lesion and recurred lesion with a brief review of the literature.
Adolescent ; Female ; Humans ; Polyps ; Vulva

In patients with gynecologic malignancies, bone metastases are unusual and generally occur in a more advanced stage of the disease with extended local invasion of the primary site and/or parenchymal metastasis. In ovarian cancer, the main route of spread is intraperitoneal implantation and loco-regional invasion, whereas extraperitoneal spread usually implies advanced disease. Bone metastasis from ovarian cancer is rare and occurs in approximately 1% of primary or recurrent disease. The prognosis of cases with bone metastasis is poor. We report a patient with metastases to the sternum and a rib after prolonged treatment and a patient with recurrent ovarian cancer metastatic to the sacrum 8 months after primary treatment.
Humans ; Neoplasm Metastasis ; Ovarian Neoplasms ; Prognosis ; Ribs ; Sacrum ; Sternum

Benign metastasizing leiomyoma (BML) is a rare entity, defined as a muscle tumor in association with one or more smooth muscle tumor of the uterus and without evidence of any extra uterine primary site. The lung is the most common site of involvement,(2) and the etiology of BML remains unknown. We experienced a case of BML arising in pelvic and para-aortic lymph nodes and report with a brief review of literature.
Leiomyoma ; Lung ; Lymph Nodes ; Muscles ; Smooth Muscle Tumor ; Uterus

Estimated incidence of round ligament varicosities in pregnancy is not known and often times it is confused with inguinal hernia due to their clinical similarities. When a patient is presented with inguinal mass especially in association with varicosity in the genital region or lower extremity, round ligament varicosity must be considered as a plausible diagnosis. Depiction of "bag of worms" on color Doppler ultrasonography is diagnostic of the round ligament varicosity and it is known to resolve spontaneously following delivery. We report a case of round ligament varicosities that was diagnosed at 29 weeks of gestation with a brief review of the literatures.
Hernia, Inguinal ; Humans ; Incidence ; Lower Extremity ; Pregnancy ; Round Ligament of Uterus ; Ultrasonography, Doppler, Color

OBJECTIVE: To analysis the 10 cases of relaparotomy for intractable hemorrhage after emergency postpartum hysterectomy with massive transfusion. METHODS: Between January 1995 and December 2008, relaparotomies for intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy with massive transfusion were performed on 10 patients. Medical records were reviewed and detailed to collect clinical data including patients' clinical status, causes of bleeding, duration from hysterectomy to relaparotomy, bleeding sites, procedures for bleeding control, amount of transfusions, complications and prognosis. RESULTS: In relaparotomies, the points of bleeding were identified in all cases and multiple bleeding foci than one bleeding focus were found, and procedures for bleeding control were performed. In 8 cases, the bleeding were controlled successfully and these patients recovered without long term sequales. But in the other 2 cases, although the bleeding controls were successful during relaparotomy and bleeding amount decreased after relaparotomy, but bleeding amount increased the next day and angiographic embolizations were performed. These patients died due to multi-organ failure and continued bleeding. In one of these cases, the endotracheal intubation had been done on arrival at our hospital with postpartum hemorrhage after vaginal delivery at private clinic. In another case, the cardiopulmonary resuscitation was performed on arriving at our hospital with intractable bleeding after postpartum subtotal hysterectomy in other hospital. CONCLUSION: In most cases, bleeding controls for intractable bleeding after postpartum hysterectomy were successful during and after relaparotomy in spite of development of dilutional coagulopthy due to massive transfusion, and resulted in rapid recovery and good prognosis. Even though dilutional coagulopthy was developed because of massive transfusion, relaparotomy was safe and effective procedure for management of intractable hemorrhage after emergency postpartum hysterectomy with clotting factor replacement. If personnel and adequate clotting factor replacement are available, relaparotomy should not be delayed for management of intractable hemorrhage and unstable vital sign after emergency postpartum hysterectomy.
Cardiopulmonary Resuscitation ; Emergencies ; Hemorrhage ; Humans ; Hysterectomy ; Intubation, Intratracheal ; Medical Records ; Postpartum Hemorrhage ; Postpartum Period ; Prognosis ; Vital Signs

OBJECTIVE: We undertook this study to determine the clinical characteristics and the prognostic factors of neonatal survival in patients with fetal anemia who were treated by intraumbilical venous transfusion (IUT). METHODS: From July 2000 to March 2009, 16 cases of fetal anemia were diagnosed at Asan Medical Center in Seoul, Korea. These patients underwent intraumbilical venous transfusions and were thus included in our study. Doppler measurement of the middle cerebral artery peak systolic velocity was performed before and after cordocentesis in all fetuses. RESULTS: The gestational age at the time of the diagnosis of anemia ranged from 21.3 to 33.6 weeks. There was a linear correlation between pre- and post-procedure fetal hemoglobin (Hb,MoM, (x)) and the MCA-PSV (MoM, (y)), i.e., y=0.810-0.229x, r2=0.542, CI 0.316-0.141, p<0.005; and y=1.374-0.391x, r2=0.499, CI 0.584-0.197, p<0.005. The survival was better in patients with severe anemia than those with mild to moderate anemia (p<0.05), and survival was better in patients with anemia of a known cause than those with anemia of an unknown cause (p<0.001). CONCLUSION: In fetuses with anemia, the severity of the anemia before IUT and the change of hemoglobin concentration after IUT, can be estimated noninvasively using Doppler ultrasonography, on the basis of an increase in the peak velocity of systolic blood flow in the middle cerebral artery. Both severity and etiology were meaningful factors for the survival of neonates with fetal anemia who were treated by intraumbilical venous transfusion. Although fetuses have severe anemia, they expected improved survival through IUT. These data are valuable information for use when counseling the parents of an affected fetus.
Anemia ; Blood Transfusion, Intrauterine ; Cordocentesis ; Counseling ; Fetal Hemoglobin ; Fetus ; Gestational Age ; Hemoglobins ; Humans ; Hydrops Fetalis ; Infant, Newborn ; Korea ; Middle Cerebral Artery ; Parents ; Ultrasonography, Doppler

Cervical cancer of gynecologic cancer is considered a preventable disease because it has a long preventive state, cervical cytology screening programs are currently available, and treatment of precancerous lesions is effective. Proper management of precancerous disease is important because improper management of precancerous disease can increase risk of invasive cancer on the one hand and can result in complications from overtreatment on the other. The decision as to which therapeutic option to use in an individual patient depends on considerations such as patient age, parity, desire for future childbearing, preferences, prior cytology and treatment history, and history of default from follow-up, operator experience, and nonvisualization of the transformation zone.
Cervical Intraepithelial Neoplasia ; Female ; Follow-Up Studies ; Hand ; Humans ; Mass Screening ; Parity ; Uterine Cervical Neoplasms

The intestinal obstruction during pregnancy is rare but early diagnosis and treatment is essential. This disease can be diagnosed very late because the presenting symptoms such as nausea, vomiting and abdominal pain are often seen in normal pregnancies and most pregnant women avoid radiologic examinations. Moreover, this disease can be accompanied by high aspartate transaminase/alanine transaminase (AST/ALT) which can be also found in acute fatty liver of pregnancy or preeclampsia, and it makes diagnosis to be much delayed. If the diagnosis were delayed much, maternal and perinatal mortality would be increased highly. Therefore, the previous record of abdominal surgery or above mentioned symptom should be considered as the intestinal obstruction, and simple abdominal x-ray for early diagnosis and prompt operation step are critical. We present a case of small bowel obstruction accompanied with high AST/ALT during pregnancy which had the history of previous cesarean section with a brief review of the literature.
Abdominal Pain ; Aspartic Acid ; Cesarean Section ; Early Diagnosis ; Fatty Liver ; Female ; Humans ; Intestinal Obstruction ; Nausea ; Perinatal Mortality ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Trimester, Third ; Pregnant Women ; Vomiting

Angular pregnancy is rare, in which the embryo in the lateral angle of uterine cavity and located medial to the utero-tubal junction. Angular pregnancy is differentiated from interstitial pregnancy. There is no report about term angular pregnancy in Republic of Korea, a few reports in other countries. Angular pregnancy has different clinical characteristics according to the trimester. We diagnosed angular pregnancy by ultrasonography and computed tomography (CT). The CT is a useful diagnostic method. We report a case of term angular pregnancy with placenta accreta and review the diagnostic process and complications.
Embryonic Structures ; Placenta ; Placenta Accreta ; Pregnancy ; Republic of Korea