Browsing by Author "Ali, Yasmin"

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    Adnexal Torsion Secondary to Primary Cystadenoma of the Fallopian tube
    (American Medical Women's Associaiton, 2024-03-22) Ganapaneni , Sruthi; Ali, Yasmin; Phiri, Maggie; Sarda, Bhavi
    Background: Ovarian torsion is twisting of the ovary, typically due to an ovarian mass. However, rare primary fallopian tube tumors can be in the differential. Symptoms can occur intermittently as the adnexal mass torses and de-torses. Prompt diagnosis is crucial for the preservation of ovarian functionality and fertility. Case Description: Pt. is an 18 yo. who presented to the ED four times over the course of 6 months with repeated episodes of severe LLQ abdominal pain. During each evaluation, CTAP showed bilateral cysts, however, concurrent ovarian dopplers were negative for ovarian torsion. Gynecologists were consulted and based upon clinical exam; outpatient follow up was recommended. A follow up outpatient MRI had new concerning changes for a compromised ovary in comparison to prior imaging, so the patient was immediately contacted for counseling and recommended surgical management. Intraoperative findings revealed a twisted enlarged necrotic mass primary within the fallopian tube with normal ovaries bilaterally. Left ovarian detorsion and salpingectomy were performed with bilateral ovarian preservation. Pathology was consistent with serous cystadenoma within the left fallopian tube. Clinical Significance: This case highlights difficulties in diagnosing gynecological pathology in a patient with intermittent symptoms and varying presentation on imaging. Torsion was not due to an ovarian mass, but rather a rarer primary cystadenoma of the fallopian tube. Surgical intervention was successful in detorsion, salpingectomy of the affected tube, and preserving the ovary in order to decrease cardiovascular and osteoporotic risks and increase fertility options. Conclusion: Ovarian torsion represents a surgical emergency that requires prompt diagnosis. This case was complicated by rarer torsion due to a fallopian tube mass and inconsistent imaging findings. MRI findings lead to necessary laparoscopy for ovary detorsion and preservation.
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    Emergent Intervention of a Non-Communicating Rudimentary Uterine Horn Pregnancy
    (2023-03-24) Friel, Rylee; Evelyn, Crowley; Ali, Yasmin; Bell, Libby; Tian, Wendy; Scott, Nicole
    Background: Non-communicating rudimentary uterine horns (NRCH) arise from Mullerian duct malformations during embryonic development. Pregnancies of the rudimentary horn account for 0.0013% to 0.00067% of all pregnancies. Such pregnancies are non-viable and pose major risks to the mother. Without early detection and management, maternal mortality rates can be as high as 88% due to rupture. Case Description: A 22-year-old G1P0 female at 7 weeks gestation presented to the emergency department with abdominal pain for 3 weeks. A transvaginal ultrasound (TVUS) was performed and a fetal pole with cardiac activity was seen in the right adnexa, suspicious for ectopic pregnancy. She had an unremarkable TVUS 1 year ago. A diagnostic laparoscopy was performed for presumed treatment of ectopic pregnancy. During the procedure, patient was found to have a right non-communicating rudimentary uterine horn with pregnancy noted inside. The left horn was connected to the cervix and otherwise normal. Intraoperatively, the right ureter was not identified. Due to high risk of rupture, the rudimentary right horn with pregnancy and the right fallopian tube were resected. A postoperative CT urogram revealed a solitary renal kidney and single left ureter. Clinical Significance: The high mortality rate of ruptured NCRH pregnancies highlights the importance of early detection and proper management of such pregnancies. Mullerian duct anomalies are usually detected with ultrasound or magnetic resonance imaging prior to conception. In this case, the NRCH was formerly unknown and treated as an ectopic pregnancy with fetal cardiac activity. The complete resection of the rudimentary horn with pregnancy and fallopian tube proved to be an appropriate management for this emergent situation. Conclusion: In emergent situations of an undetected NRCH until pregnancy, resection of rudimentary horn with ipsilateral fallopian tube is not only therapeutic, but also preventative for potential future ectopic pregnancies.