Abstract
13 haftalık gebeliği bulunan olgunun rutin kontrollerinde tesbit
edilen 11 cm ‘lik adneksial kitlesine yaklaşım değerlendirilmiştir. Çekilen
abdominal MR’da; pelvik bölgede uterusu ve sigmoid kolonu
belirgin derecede sağa deplase eden 112x87x104 mm boyutlarında
keskin sınırlı, belirgin derecede vaskülaritesi mevcut olan solid özellikte
lezyon ve sol böbrekte pelvikalisiyel yapılar ve sol üreter belirgin
derecede genişlemiş görünümde izlendi. Hasta 13 haftalık gebeliği
mevcut iken üroloji kliniği ile birlikte operasyona alınıp, retroperitoneal
alandan kaynaklanan 12x12 cm lik kitle ekstirpasyonu yapıldı.
Perioperatif gelişen mesane injurisi primer onarılarak, sol hipogastrik
arter ligasyonu, sol a.uterina ligasyonu yapıldı. Gebelik sırasında adneksiyal
kitlelere yaklaşım hastanın semptomlarına, gebelik haftasına
ve kitlenin büyüklük ve özelliklerine göre belirlenir. Olgumuzda kitlenin
12 cm den büyük olması, MR’da solid görünümlü olması, ve malign
bir kitleyi düsündürmesi, bası semptomlarının olması nedeniyle
laparotomi gerçekleştirilmiştir
References
- 1. Mukherji SK, Rojiani AM, Younathan CM, Ros P. CT findings of retroperitoneal malignant mesenchymoma. Abdom Imaging 1994; 19:82-83.
- 2. Pai MR, Raghuveer CV. Primary retroperitoneal tumours a 25 year study. Indian J Med Sci 1995; 49:139-41.
- 3. Wolpert A, Beer-Gabel M, Lifschitz O, Zbar A.P. The management of presacral masses in the adult. Tech coloproctol. 2002; 6: 43-59.
- 4. Dozois RR. Rectorectal tumors: spectrum of disease, diagnosis and surgical management. Perspect Colon Rectal Surg. 1990;3:241-5
- 5. Benissa N, Soualy K, Alouta N, Kafih M, Zerouali NO. Primary retroperitoneal tumors in adults: report of 11 cases. Ann Urol. 2003 Oct; 37(5): 252-7.
- 6. Whitecar P, Turner S, Higby K. Adnexal masses in pregnancy: A review of 130 cases undergoing surgical management. Am J Obstet Gynecol 1999;181:19-24.
- 7. Spillane AJ, Thomas JM. Gyneacological presentation of retroperitoneal tumors. BJOG 2000; 107(2): 170-3.
- 8. Isaacs JH, Dolan JR. Nongynecologic Conditions Encountered by the Gynecologic Surgeon. In: Rock JA, Thompson JD,eds. Te Linde’s Operative Gynecology,ed 50. Lippincott-Raven, 1997:1305-28.
- 9. Beck HH. Retroperitoneal tumors: diagnosis and treatment. In: Isaacs JH, Byrne MP, eds. Pelvic surgery: a multidisciplinary approach. Mt Kisco, NY, Futura Publishing, 1987:91. 10. Bromley B, Benacerraf B. Adnexal masses during pregnancy: Accuracy of sonographic diagnosis and outcome. J Ultrasound Med 1997;16:447-52
- 11. Hess LW, Peaceman A, O’Brien WF, Winkel CA, Cruikshank DP, Morrison JC. Adnexal mass occurring with intrauterine pregnancy: report of fifty-four patients requiring laparotomy for definitive management. Am J Obstet Gynecol 1988; 158: 1029- 34..
- 12. Platek DN, Handerson CE, Goldberg GL. The management of a persistent adnexal mass in pregnancy. Am J Obstet Gynecol 1995;173:1236-40.
- 13. Sherard GB 3rd, Hodson CA, Williams HJ, Semer DA, Hadi HA, Tait DL. Adnexal masses and pregnancy: a
- 12-year experience. Am J Obstet Gynecol 2003; 189: 358- 62.
- 14. Condous G, Okaro E, Bourne T. The conservative management of early pregnancy complications: a review of the literature. Ultrasound Obstet Gynecol 2003;22:420-30.
- 15. Schmeler KM, Mayo-Smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol 2005;105:1098-103.
Abstract
The approach towards an 11cm adnexal mass found during routine
checks of a patient in her 13th week of gestation has been evaluated.
The abdominal MRI scan shows a sharp edged solid lesion with
significant vascularity and dimensions of 112x87x104mm. The lesion
visibly displaces the uterus and the sigmoid colon to the right in the
pelvic region. The MRI scan also shows pelvicalyceal structures in the
left kidney and that the left ureter is significantly enlarged. The 13
weeks pregnant patient was operated together with the urology clinic
and an excision was performed on a 12x12cm mass in the retroperitoneal
space. Primary repair of bladder injury performed perioperatively.
Left hypogastric artery ligation, and left a.uterina ligation were
also performed. The approach to adnexal masses during pregnancy
depends on the patient's symptoms, the pregnancy week, the size and
the characteristics of the mass. Since the mass was larger than 12cm,
looked solid in the MRI scan, was indicative of a malignant mass, and
had certain symptoms, laparotomy was performed on the patient.
References
- 1. Mukherji SK, Rojiani AM, Younathan CM, Ros P. CT findings of retroperitoneal malignant mesenchymoma. Abdom Imaging 1994; 19:82-83.
- 2. Pai MR, Raghuveer CV. Primary retroperitoneal tumours a 25 year study. Indian J Med Sci 1995; 49:139-41.
- 3. Wolpert A, Beer-Gabel M, Lifschitz O, Zbar A.P. The management of presacral masses in the adult. Tech coloproctol. 2002; 6: 43-59.
- 4. Dozois RR. Rectorectal tumors: spectrum of disease, diagnosis and surgical management. Perspect Colon Rectal Surg. 1990;3:241-5
- 5. Benissa N, Soualy K, Alouta N, Kafih M, Zerouali NO. Primary retroperitoneal tumors in adults: report of 11 cases. Ann Urol. 2003 Oct; 37(5): 252-7.
- 6. Whitecar P, Turner S, Higby K. Adnexal masses in pregnancy: A review of 130 cases undergoing surgical management. Am J Obstet Gynecol 1999;181:19-24.
- 7. Spillane AJ, Thomas JM. Gyneacological presentation of retroperitoneal tumors. BJOG 2000; 107(2): 170-3.
- 8. Isaacs JH, Dolan JR. Nongynecologic Conditions Encountered by the Gynecologic Surgeon. In: Rock JA, Thompson JD,eds. Te Linde’s Operative Gynecology,ed 50. Lippincott-Raven, 1997:1305-28.
- 9. Beck HH. Retroperitoneal tumors: diagnosis and treatment. In: Isaacs JH, Byrne MP, eds. Pelvic surgery: a multidisciplinary approach. Mt Kisco, NY, Futura Publishing, 1987:91. 10. Bromley B, Benacerraf B. Adnexal masses during pregnancy: Accuracy of sonographic diagnosis and outcome. J Ultrasound Med 1997;16:447-52
- 11. Hess LW, Peaceman A, O’Brien WF, Winkel CA, Cruikshank DP, Morrison JC. Adnexal mass occurring with intrauterine pregnancy: report of fifty-four patients requiring laparotomy for definitive management. Am J Obstet Gynecol 1988; 158: 1029- 34..
- 12. Platek DN, Handerson CE, Goldberg GL. The management of a persistent adnexal mass in pregnancy. Am J Obstet Gynecol 1995;173:1236-40.
- 13. Sherard GB 3rd, Hodson CA, Williams HJ, Semer DA, Hadi HA, Tait DL. Adnexal masses and pregnancy: a
- 12-year experience. Am J Obstet Gynecol 2003; 189: 358- 62.
- 14. Condous G, Okaro E, Bourne T. The conservative management of early pregnancy complications: a review of the literature. Ultrasound Obstet Gynecol 2003;22:420-30.
- 15. Schmeler KM, Mayo-Smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol 2005;105:1098-103.
Details
| Other ID | JA85DM86VP |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | July 1, 2013 |
| Submission Date | July 1, 2013 |
| Published in Issue | Year 2013 Volume: 16 Issue: 3 |