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Giant endometrioma
The American Journal of Surgery 181 (2001) 272–273
Images in clinical surgery
Giant endometrioma Olaf Andersen, M.D.*, Peter Giustra, M.D., Richard Leidinger, M.D. Department of Surgery, Penobscot Bay Medical Center, 731 Commercial Street, Rockport, ME 04856, USA Manuscript received September 12, 2000; revised manuscript November 20, 2000
A 50-year-old woman came to the emergency room with a 3-week history of progressive malaise, nausea, anorexia, chills, and obstipation. Her abdomen had gradually increased in girth but over the preceding 24 hours had markedly enlarged with worsening diffuse abdominal tenderness. She had no urinary tract symptoms. She had entered the menopause but was having some vaginal bleeding. On examination she looked pale. Her temperature was 37.1°C, pulse rate 144 beats per minute, and blood pressure 120/80 mm Hg. The abdomen was massively distended and diffusely tender but without guarding or rebound. Bowel sounds were normally active. Femoral pulses were strong.
* Corresponding author. Tel.: ⫹1-207-354-0899; fax: ⫹1-207-5942123.
Rectal examination was negative, but pelvic examination suggested an enlarged uterus. Plain x-ray films of the abdomen showed a huge air fluid collection in the mid abdomen with surrounding bowel pattern appearing unremarkable (Fig. 1A and B). Computed tomography scan demonstrated a greater than 20 cm diameter, thin-walled mid-abdominal mass containing a mixture of fluid and air (Fig. 1C). A pelvic view demonstrated a large lobular uterus (Fig. 1D). White count was 19,000/ mm3, hematocrit 30.6%, urinalysis 6 to 10 white cells, and rare red cells. Blood cultures showed no growth. The patient underwent emergency laparotomy with resection of a giant left ovarian endometrioma, multiple right ovarian endometrial cysts, and bilateral hydrosalpinges. She had an unremarkable recovery. Because cultures were negative and no bacteria were seen in specimen smears, the source of air in the endometrioma is uncertain.
0002-9610/01/$ – see front matter © 2001 Excerpta Medica, Inc. All rights reserved. PII: S 0 0 0 2 - 9 6 1 0 ( 0 1 ) 0 0 5 5 7 - 8
O. Andersen et al. / The American Journal of Surgery 181 (2001) 272–273
273
Fig. 1. Plain x-ray films of the abdomen showing a huge air fluid collection in the mid abdomen with surrounding bowel pattern appearing unremarkable (A, B). (C) CT scan showing ⬎20 cm thin-walled mass. (D) Pelvic view showing large lobular uterus.
Images in clinical surgery
Giant endometrioma Olaf Andersen, M.D.*, Peter Giustra, M.D., Richard Leidinger, M.D. Department of Surgery, Penobscot Bay Medical Center, 731 Commercial Street, Rockport, ME 04856, USA Manuscript received September 12, 2000; revised manuscript November 20, 2000
A 50-year-old woman came to the emergency room with a 3-week history of progressive malaise, nausea, anorexia, chills, and obstipation. Her abdomen had gradually increased in girth but over the preceding 24 hours had markedly enlarged with worsening diffuse abdominal tenderness. She had no urinary tract symptoms. She had entered the menopause but was having some vaginal bleeding. On examination she looked pale. Her temperature was 37.1°C, pulse rate 144 beats per minute, and blood pressure 120/80 mm Hg. The abdomen was massively distended and diffusely tender but without guarding or rebound. Bowel sounds were normally active. Femoral pulses were strong.
* Corresponding author. Tel.: ⫹1-207-354-0899; fax: ⫹1-207-5942123.
Rectal examination was negative, but pelvic examination suggested an enlarged uterus. Plain x-ray films of the abdomen showed a huge air fluid collection in the mid abdomen with surrounding bowel pattern appearing unremarkable (Fig. 1A and B). Computed tomography scan demonstrated a greater than 20 cm diameter, thin-walled mid-abdominal mass containing a mixture of fluid and air (Fig. 1C). A pelvic view demonstrated a large lobular uterus (Fig. 1D). White count was 19,000/ mm3, hematocrit 30.6%, urinalysis 6 to 10 white cells, and rare red cells. Blood cultures showed no growth. The patient underwent emergency laparotomy with resection of a giant left ovarian endometrioma, multiple right ovarian endometrial cysts, and bilateral hydrosalpinges. She had an unremarkable recovery. Because cultures were negative and no bacteria were seen in specimen smears, the source of air in the endometrioma is uncertain.
0002-9610/01/$ – see front matter © 2001 Excerpta Medica, Inc. All rights reserved. PII: S 0 0 0 2 - 9 6 1 0 ( 0 1 ) 0 0 5 5 7 - 8
O. Andersen et al. / The American Journal of Surgery 181 (2001) 272–273
273
Fig. 1. Plain x-ray films of the abdomen showing a huge air fluid collection in the mid abdomen with surrounding bowel pattern appearing unremarkable (A, B). (C) CT scan showing ⬎20 cm thin-walled mass. (D) Pelvic view showing large lobular uterus.