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Torsion of the hydatid of morgagni simulating early ruptured ectopic pregnancy
162
AMERICAN
JOURNAL
OF
OBSTETRICS
ANLl
GYNECOLOGY
In one patient, three years prior and acroparesthesia
in whom an artificial menopause ha1 been induced with radium and in whom the rasomotor flushes to the onset of this tr&ment, were severe, no relief war oljtained t~ven after using ZOO rat Relit+ toight have In33 obtaine~l with nlucll units twice a week for four weeks. larger doses, hut these coultl not 1~1 obtainctl t>ecansc of tliti rest. Arlothrr patient, in whom a surgical menopause h:ul been intluc~~~l four ye:~rs previously, antI in whom and allergic. ( hay fever, n&I asthnut ) symptoms vasomotor Hushes, aeroparcstheaia, slight rcllief from 390 oc,curred simultaneously in May of ~ac:h ycb;(r simcs, rc&voll rat unit doses aclministrrell twice weekly.
A small series of cases (twenty) is presented in whicl? acroparesthesia was pro”‘inent as a symptom and evidently associated with the menopause. Treatment with theominal in two cases, and estrogenic hormone in sixteen cases produced almost complete relief. In one case, following artificial tained. In another case, following tained.
menopause surgical
intlucetl castration,
by
radium, no relief only slight relief
was was
obob-
REFEREKCES
(1) Bora!?, J. : Endokrinologie 5: 9, 1929. (2) @‘echskr, lsrael S. : A Textbook of Clinical Neurology, ed. 2, Philadelphia, 1931, W. B. Saunders Co., pp. 650, 651.
TORSION
OF THE EARLY
HYDATlD
RUPTURED
OF MORGAGNI ECTOPlC
1. TRAWENBERG, M.D., (From
T
the
Gyneoological
HE case herein described an early ruptured ectopic
is reported pregnancy.
PREGNANCY N. Y.
~~ROOKLYN,
Clinic because
SIIYIIJLATING
of Unity Hospital) it is extremely
rare
and
Mrs. H. B., a well-developed female, twenty-nine years of age, was ambulance, to the hospital, with complaints of acute abdominal pain left quadrant. She appeared very ill upon admission.
simulated
admitted, by in the lower
Her menses began at the age of thirteen, lasting four days, recurring about every three months, accompanied by severe pain. She married at the age of twenty and was married eight years when the symptoms of acute condition of the abdomen came on. After her marriage, her periods became regular, of the twenty-eight-day Two years later she was delivered of a normal child. Her pregnancy and type. parturition were normal in every respect. She felt well up to three years ago when her periods began to become irregular and again were accompanied by dysmenorrhea. About two months before her admission to the hospital the pain increased in severity and was accompanied by nausea and vomiting. It was aggravated by walking and greatly relieved by rest. On the rlay she was admitted to the hospital she experienced a sharp agonizing cramplike pain in the lower abdomen with nausea and vomiting. Her
temperature
Physical to the left
examination quadrant.
when
admitted
was
101.2”
revealed a distended There was also rebound
I!‘., pulse
120,
abdomen, which tenderness.
and
respiration was
tender,
38. more
so
Vaginal examination revealed a small mass in the left fornix. It was frt*t~l: moval~le aml very tender to the touch. There was a brown. sh hlo~ly diacahargr frorr: the vagina. The blood count showed white cells 13,.?00. with %(I per cent l)olpmorJ~llonuclr:trs. refl crlls 3,800,000, 65 per cent hemoglobin. A tentative clinical diagnosis of rctopie pregnanq of thi! left side was ma& because there was a history of two months’ amenorrhea, a palpable mass on the left side, pain was felt upon pushing against the rarrvis, and there was a hloo~l~discharge from the vagina. !I Six hours later a laparotonrp was performed t,hrough a midline incision. blooll-tinge11 seroux fluid was found in the ah~lominal ~a&::. The left ‘tube was ret1 am1 congrstetl, the fimbria em1 was fount1 to 1~ edematous, and hanging from the timhria I)y ;I petlicle :% cm. long, with two conlplrte t,wists. There was a dark rr~l Ilvstic mass, t,he size of a small tangerine (1 cn). 1)~ 1: cm.j. It was it liyclatill cysi of Xorgagni. No other pathology was found in the ltelvird cavity. The ~ys:t *vas removed am1 the patient ma11e an uneventful rccovcr~. Uisfologic I’,indin.qqs: The cyst was lineal witlt The vessels in the wall were necrosetl and thrre tent, of the Cyst was a bloody 3erous fluill. From a survey of the literature on the sul-),jert to this one, namely that of Dr. Waters.1 Besides this there are three others of torsion ported,2 but these occurred on the right side and
. it GnqlrI layer of low was some hyalinization. I could of the simulated
find
only
hydatirl acute
cul)oirlal cells. Th,, (‘on-
one case similar of Morgagui appendicitis.
rta-
1Mp vase, however, differs from that of Dr. \Vatrrs in that it occurred in a married woman. It differs from the others in that it occurred on t,hr left side, anti, principally, because it simulated an early rultt.ured eg,topic: pregnancy as the Ivatient was married and gave a history of irregular menstruation.
REF'ERENCFS A (1) Waters: 22: 220, 1912; 21: 120, 1931. 514
OCEAN
J. A. M. A. 72: 1072, 1919. Brit. M. J. 1: 144, 1929; Ilri~ic*h.
Abmhmrc
Obst. $ Gynec. : Av. J. Ossr.
Brit. Emp. & QYNRC,.
PARKWAY
AN TJXUSIJAL
CASE
IRVING K. KRELLENSTEIN,
T
(2) Idem:
OF POSTPARTTJJI
TNFE(.‘TION
N.D.. F.A.C’.S., NE,W YORK,
S. 1’.
HIS patient, admitted to Lebanon Hospital. died six hours after a normal 11+ livery with a temperature of 704” F.. which con111 not he acrounte(1 -for at thfa time. The llatient was a para ii, twenty-eiqht years ohi, had typhus fever many years ago, had a normal spontaneous delivery al)oat thrrc years ago. Her menses tqan when she was thirteen years old, were always regular, twenty-eight-day type. a~1 IIer last period WRS Jan. ‘6, 19.74. She first would last about three to five days. appeared at the prenatal clinic of I,ehanon Hospital on Jul,v 11, 1934. She had experienced no trouhle Iluring this pregnnncy, except for mild morning sickness of short duration, constipation, and slight Ieucorrhea. Prior to her pregnancy she developed an abscessed tooth which was not treated. Physical examination disclosed an obese moman ahout five and one-half months pregnant; otherwise nega.
AMERICAN
JOURNAL
OF
OBSTETRICS
ANLl
GYNECOLOGY
In one patient, three years prior and acroparesthesia
in whom an artificial menopause ha1 been induced with radium and in whom the rasomotor flushes to the onset of this tr&ment, were severe, no relief war oljtained t~ven after using ZOO rat Relit+ toight have In33 obtaine~l with nlucll units twice a week for four weeks. larger doses, hut these coultl not 1~1 obtainctl t>ecansc of tliti rest. Arlothrr patient, in whom a surgical menopause h:ul been intluc~~~l four ye:~rs previously, antI in whom and allergic. ( hay fever, n&I asthnut ) symptoms vasomotor Hushes, aeroparcstheaia, slight rcllief from 390 oc,curred simultaneously in May of ~ac:h ycb;(r simcs, rc&voll rat unit doses aclministrrell twice weekly.
A small series of cases (twenty) is presented in whicl? acroparesthesia was pro”‘inent as a symptom and evidently associated with the menopause. Treatment with theominal in two cases, and estrogenic hormone in sixteen cases produced almost complete relief. In one case, following artificial tained. In another case, following tained.
menopause surgical
intlucetl castration,
by
radium, no relief only slight relief
was was
obob-
REFEREKCES
(1) Bora!?, J. : Endokrinologie 5: 9, 1929. (2) @‘echskr, lsrael S. : A Textbook of Clinical Neurology, ed. 2, Philadelphia, 1931, W. B. Saunders Co., pp. 650, 651.
TORSION
OF THE EARLY
HYDATlD
RUPTURED
OF MORGAGNI ECTOPlC
1. TRAWENBERG, M.D., (From
T
the
Gyneoological
HE case herein described an early ruptured ectopic
is reported pregnancy.
PREGNANCY N. Y.
~~ROOKLYN,
Clinic because
SIIYIIJLATING
of Unity Hospital) it is extremely
rare
and
Mrs. H. B., a well-developed female, twenty-nine years of age, was ambulance, to the hospital, with complaints of acute abdominal pain left quadrant. She appeared very ill upon admission.
simulated
admitted, by in the lower
Her menses began at the age of thirteen, lasting four days, recurring about every three months, accompanied by severe pain. She married at the age of twenty and was married eight years when the symptoms of acute condition of the abdomen came on. After her marriage, her periods became regular, of the twenty-eight-day Two years later she was delivered of a normal child. Her pregnancy and type. parturition were normal in every respect. She felt well up to three years ago when her periods began to become irregular and again were accompanied by dysmenorrhea. About two months before her admission to the hospital the pain increased in severity and was accompanied by nausea and vomiting. It was aggravated by walking and greatly relieved by rest. On the rlay she was admitted to the hospital she experienced a sharp agonizing cramplike pain in the lower abdomen with nausea and vomiting. Her
temperature
Physical to the left
examination quadrant.
when
admitted
was
101.2”
revealed a distended There was also rebound
I!‘., pulse
120,
abdomen, which tenderness.
and
respiration was
tender,
38. more
so
Vaginal examination revealed a small mass in the left fornix. It was frt*t~l: moval~le aml very tender to the touch. There was a brown. sh hlo~ly diacahargr frorr: the vagina. The blood count showed white cells 13,.?00. with %(I per cent l)olpmorJ~llonuclr:trs. refl crlls 3,800,000, 65 per cent hemoglobin. A tentative clinical diagnosis of rctopie pregnanq of thi! left side was ma& because there was a history of two months’ amenorrhea, a palpable mass on the left side, pain was felt upon pushing against the rarrvis, and there was a hloo~l~discharge from the vagina. !I Six hours later a laparotonrp was performed t,hrough a midline incision. blooll-tinge11 seroux fluid was found in the ah~lominal ~a&::. The left ‘tube was ret1 am1 congrstetl, the fimbria em1 was fount1 to 1~ edematous, and hanging from the timhria I)y ;I petlicle :% cm. long, with two conlplrte t,wists. There was a dark rr~l Ilvstic mass, t,he size of a small tangerine (1 cn). 1)~ 1: cm.j. It was it liyclatill cysi of Xorgagni. No other pathology was found in the ltelvird cavity. The ~ys:t *vas removed am1 the patient ma11e an uneventful rccovcr~. Uisfologic I’,indin.qqs: The cyst was lineal witlt The vessels in the wall were necrosetl and thrre tent, of the Cyst was a bloody 3erous fluill. From a survey of the literature on the sul-),jert to this one, namely that of Dr. Waters.1 Besides this there are three others of torsion ported,2 but these occurred on the right side and
. it GnqlrI layer of low was some hyalinization. I could of the simulated
find
only
hydatirl acute
cul)oirlal cells. Th,, (‘on-
one case similar of Morgagui appendicitis.
rta-
1Mp vase, however, differs from that of Dr. \Vatrrs in that it occurred in a married woman. It differs from the others in that it occurred on t,hr left side, anti, principally, because it simulated an early rultt.ured eg,topic: pregnancy as the Ivatient was married and gave a history of irregular menstruation.
REF'ERENCFS A (1) Waters: 22: 220, 1912; 21: 120, 1931. 514
OCEAN
J. A. M. A. 72: 1072, 1919. Brit. M. J. 1: 144, 1929; Ilri~ic*h.
Abmhmrc
Obst. $ Gynec. : Av. J. Ossr.
Brit. Emp. & QYNRC,.
PARKWAY
AN TJXUSIJAL
CASE
IRVING K. KRELLENSTEIN,
T
(2) Idem:
OF POSTPARTTJJI
TNFE(.‘TION
N.D.. F.A.C’.S., NE,W YORK,
S. 1’.
HIS patient, admitted to Lebanon Hospital. died six hours after a normal 11+ livery with a temperature of 704” F.. which con111 not he acrounte(1 -for at thfa time. The llatient was a para ii, twenty-eiqht years ohi, had typhus fever many years ago, had a normal spontaneous delivery al)oat thrrc years ago. Her menses tqan when she was thirteen years old, were always regular, twenty-eight-day type. a~1 IIer last period WRS Jan. ‘6, 19.74. She first would last about three to five days. appeared at the prenatal clinic of I,ehanon Hospital on Jul,v 11, 1934. She had experienced no trouhle Iluring this pregnnncy, except for mild morning sickness of short duration, constipation, and slight Ieucorrhea. Prior to her pregnancy she developed an abscessed tooth which was not treated. Physical examination disclosed an obese moman ahout five and one-half months pregnant; otherwise nega.