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Unusual Presentation of a Vulvar Abscess
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Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S151–S178
congestion syndrome. If other caused of pelvic pain are abscent, it may be considered a valuable alternative treatment for women with pelvic congestion syndrome, especially ovarian varice. 532 Presentation of an Unusual Retroperitoneal Tumor Mama ST, Schaeffer K, Alimonos L. OB/GYN, Cooper University Hospital, Camden, New Jersey Study Objective: Leiomyomas are common benign smooth muscle tumors of uterine origin affecting 25% of all women. The symptomatic
manifestations are pelvic pain, dysmenorrhea, menorrhagia, frequency, and tenesmus. Leiomyomas usually reside within the body of the uterus. However, they can occur in ectopic locations and exhibit aberrant growth patterns. Treatment varys from expectant & medical management to surgery. Surgical therapy includes hysteroscopy, ablation, myomectomy, and hysterectomy. We present a case of an extremely large retroperitoneal tumor and the management approach. Design: Case: The patient presented with a sudden increase in longstanding pelvic pain. Physical exam revealed a large mass confirmed by ultrasound. MRI suggested a left ovarian tumor or a broad ligament fibroid. Setting: The patient was consented for a minimally invasive robotic approach. Patients: On initial laparoscopy, the mass was 20cm size, retroperitoneal occupying the entire pelvis and separate from the uterus and ovaries. Radiology confirmed the mass did not arise from the sacral spine. Intervention: An exploratory laparotomy was done. It was not of rectosigmoid or mesenteric origin. The mass was dissected free sparing the hypogastric plexus. The blood supply originated from a 2cm portion of the rectosigmoid and a 1.5cm portion of the left posterior broad ligament. Leiomyoma was reported on frozen section and confirmed on final pathology. Measurements and Main Results: The patient had a normal postoperative course and is symptom free. Conclusion: This case illustrates the importance of anatomical variations and flexibility in the surgical approach. There are three rare variants from the normal leiomyoma in the literature. Leiomyomas of ectopic origin have unusual growth patterns and include benign metastasizing leiomyomas,intravenous leiomyomatosis,and leiomyomatosis peritonealis disseminata. In this patient, the final pathology was leiomyoma and not one of the above variants. The unusually large size of the tumor with the blood supply from only 2 locations makes this case unique. 533 Unusual Presentation of a Vulvar Abscess Reyes DC,1 Mama ST.2 1Temple University Hospital, Philadelphia, Pennyslvania; 2Obstetrics and Gynecology, Cooper University Hospital, Camden, New Jersey Study Objective: The vulva and perineal area are susceptible to infection due to risk factors such as shaving and waxing (2). In obese and disabled patients, the risk is increased due to difficulty in cleaning and possibly due to altered skin, lymphatic and vascular function (6). This area is also a frequent location for infected hair follicles, epidermal inclusion cysts and Bartholin gland cysts. We present an unusual case of a patient with an extensive tracking vulvar abscess with no known risk factors. Design: Case: A 63-year old female presented with recurrent right vulvar pain. She was initially diagnosed with pubic symphysitis and treated supportively. She subsequently presented with an erythematous and fluctuant right vulva. Initial incision and drainage was performed and she was started on intravenous antibiotics. There was tracking of the abscess superiorly into the right mons pubis and inferiorly to the labia majora. There was cortical bony erosion of the pubic symphysis as well. The patient underwent multiple debridements and a prolonged course of staged repairs before proper wound healing ensued. Conclusion: Common causes of vulvar abscesses include infected inclusion cysts and Bartholin gland cysts. Risk factors are external manipulation with shaving and waxing and inefficient genital hygiene. In the absence of these known causes and risk factors, it is important to explore other possibilities such as an immune system deficiency or seeding from another source.
VIRTUAL POSTER: REPRODUCTIVE ISSUES 534 Persistent Trophoblastic Implant on the Right Ovary after Laparoscopic Salpingectomy for Ectopic Pregnancy. A Case Report Bolinjkar R,1 Belotte J,1 Hussein Y,3 Dean M,2 Hendrix S.2 1OB/GYN, Wayne State University/Detroit Medical Center, Detroit, Michigan; 2OB/ GYN, Detroit Medical Center, Detroit, Michigan; 3Pathology, Wayne State University/Detroit Medical Center, Detroit, Michigan
Abstracts / Journal of Minimally Invasive Gynecology 19 (2012) S151–S178
congestion syndrome. If other caused of pelvic pain are abscent, it may be considered a valuable alternative treatment for women with pelvic congestion syndrome, especially ovarian varice. 532 Presentation of an Unusual Retroperitoneal Tumor Mama ST, Schaeffer K, Alimonos L. OB/GYN, Cooper University Hospital, Camden, New Jersey Study Objective: Leiomyomas are common benign smooth muscle tumors of uterine origin affecting 25% of all women. The symptomatic
manifestations are pelvic pain, dysmenorrhea, menorrhagia, frequency, and tenesmus. Leiomyomas usually reside within the body of the uterus. However, they can occur in ectopic locations and exhibit aberrant growth patterns. Treatment varys from expectant & medical management to surgery. Surgical therapy includes hysteroscopy, ablation, myomectomy, and hysterectomy. We present a case of an extremely large retroperitoneal tumor and the management approach. Design: Case: The patient presented with a sudden increase in longstanding pelvic pain. Physical exam revealed a large mass confirmed by ultrasound. MRI suggested a left ovarian tumor or a broad ligament fibroid. Setting: The patient was consented for a minimally invasive robotic approach. Patients: On initial laparoscopy, the mass was 20cm size, retroperitoneal occupying the entire pelvis and separate from the uterus and ovaries. Radiology confirmed the mass did not arise from the sacral spine. Intervention: An exploratory laparotomy was done. It was not of rectosigmoid or mesenteric origin. The mass was dissected free sparing the hypogastric plexus. The blood supply originated from a 2cm portion of the rectosigmoid and a 1.5cm portion of the left posterior broad ligament. Leiomyoma was reported on frozen section and confirmed on final pathology. Measurements and Main Results: The patient had a normal postoperative course and is symptom free. Conclusion: This case illustrates the importance of anatomical variations and flexibility in the surgical approach. There are three rare variants from the normal leiomyoma in the literature. Leiomyomas of ectopic origin have unusual growth patterns and include benign metastasizing leiomyomas,intravenous leiomyomatosis,and leiomyomatosis peritonealis disseminata. In this patient, the final pathology was leiomyoma and not one of the above variants. The unusually large size of the tumor with the blood supply from only 2 locations makes this case unique. 533 Unusual Presentation of a Vulvar Abscess Reyes DC,1 Mama ST.2 1Temple University Hospital, Philadelphia, Pennyslvania; 2Obstetrics and Gynecology, Cooper University Hospital, Camden, New Jersey Study Objective: The vulva and perineal area are susceptible to infection due to risk factors such as shaving and waxing (2). In obese and disabled patients, the risk is increased due to difficulty in cleaning and possibly due to altered skin, lymphatic and vascular function (6). This area is also a frequent location for infected hair follicles, epidermal inclusion cysts and Bartholin gland cysts. We present an unusual case of a patient with an extensive tracking vulvar abscess with no known risk factors. Design: Case: A 63-year old female presented with recurrent right vulvar pain. She was initially diagnosed with pubic symphysitis and treated supportively. She subsequently presented with an erythematous and fluctuant right vulva. Initial incision and drainage was performed and she was started on intravenous antibiotics. There was tracking of the abscess superiorly into the right mons pubis and inferiorly to the labia majora. There was cortical bony erosion of the pubic symphysis as well. The patient underwent multiple debridements and a prolonged course of staged repairs before proper wound healing ensued. Conclusion: Common causes of vulvar abscesses include infected inclusion cysts and Bartholin gland cysts. Risk factors are external manipulation with shaving and waxing and inefficient genital hygiene. In the absence of these known causes and risk factors, it is important to explore other possibilities such as an immune system deficiency or seeding from another source.
VIRTUAL POSTER: REPRODUCTIVE ISSUES 534 Persistent Trophoblastic Implant on the Right Ovary after Laparoscopic Salpingectomy for Ectopic Pregnancy. A Case Report Bolinjkar R,1 Belotte J,1 Hussein Y,3 Dean M,2 Hendrix S.2 1OB/GYN, Wayne State University/Detroit Medical Center, Detroit, Michigan; 2OB/ GYN, Detroit Medical Center, Detroit, Michigan; 3Pathology, Wayne State University/Detroit Medical Center, Detroit, Michigan