Girls’ big belly, not "early pregnancy" dog blood plot
On the afternoon of December 27, 2019, the 16 -year -old girl Mao Mao came to my department for a doctor. I saw her limbs slender, but "big belly" and frowned. I thought that this would not be pregnant.
When Mao Mao sat down, I found out that she had abdominal distension that had no obvious causes two years ago, and accompanied by the symptoms of oil hate, her stomach was a bit drum, but there was no other disgust and vomiting.But in the past year, Mao Mao’s belly has become more and more powerful, so he came to the hospital.
The outpatient clinic is intended to hold the digestive department.Mao Mao’s body has always been healthy, so young, there are no other problems.
It’s just that hairy weight exceeds the standard, with 75kg, and body check: The auspicious area of the heart of the heart and the pathological murmur, the two lung breathing sounds, the obvious dry and wetness, the abdomen is swollen, such as the full moon pregnancy.Intestinal shape and peristaltic waves, tough abdominal walls, no tenderness and reflux pain, no touches of mass, murphy is negative, no pain in the liver and kidney area, full abdominal percussion, weak bowel sound, 3 times/min, no lower limbs, no lower limbs, no lower limbs.Edema.
After the blood is checked, the blood is routine and the liver function is obviously abnormal, and the urine HCG is negative.And hepatobiliary pancreatic spleen color Doppler ultrasound examination prompts a large amount of effusion.
Preliminary diagnosis: abdominal effusion?
why?
Once Mao Mao’s menstrual history is normal, and urine HCG is negative, so it can exclude abdominal distension caused by pregnancy; second, she has no history of hepatitis and does not support liver cirrhosis and ascites;
If it is an abdominal effusion, the hair requires the abdominal pest, and then discharge the ascites.
In addition, Mao Mao is generally good, can eat and drink, and does not decrease significantly. For the time being, no matter malignant tumors are considered.
After admission, the results of the abdominal CT examination were: the abdominal pelvic cystic position.
Combined with clinical and pathological considerations as gynecological tumors.Thinking of a sigh of relief here, fortunately there was no abdominal puncture, otherwise the consequences would be unimaginable.
Then he asked the gynecologist to consult, and Mao Mao was transferred to the gynecological examination and treatment on the 28th.At the same time, improve preparation preparation.After the pelvic cavity CT, it was found that: 1. The abdominal pelvic cavity is huge cystic. Considering that the benign may be large, please combine the pathological settings;
Take 20,000 ml of cyst liquid, the girl drops 40 pounds suddenly
On the 31st, Mao Mao was going to perform surgery.
After the anesthesia took effect, Mao Mao was lying on the bed, and from the left side of her lower abdomen, cut a incision of about 7cm, cut the subcutaneous fat and fascia layer layer by layer, and separated the rectus muscles.After opening the peritoneum, I saw a huge mass of the abdomen, full of pelvic abdominal cavity, milky white, thick skin, a lot of lotus on the surface of the cyst, a small incision in the purse, and the attractor was gradually sucking about 20000ml of brown sac in the incision.
What is 20000ml?A bottle of 2 yuan conventional mineral water is about 550ml, about 36 bottles of mineral water …
The process of suction liquid is very slow, and the cyst is gradually delivered. The diameter of the cyst skin is about 40cm.Continue to explore and find that: in the front of the uterus, the size is normal, the cyst is the left ovary cyst, and the right attachment is normal.
Pathological sliced diagnosis after examination: (left attachment) ovarian mucus cystic adenoma, and some areas are plasmal cystic glandular tumor.
What is ovarian cyst?
First of all, what is ovarian cyst?
It is not a disease, it is a morphological description of a large type of disease.All lumps that appear on the ovary, shaped like pockets, are called ovarian cysts.Including: mucus cysts, slurry cyst tumors, teratoma, endometriosis, endometriosis cyst, mucus cystic gland cancer, slurry cyst gland cancer, endochem tumor …
Most of the common clinical ovarian cysts are ovarian tumors, and there are some. It may only be wrapped in effusion, not tumors, or physiological cysts.
Most ovarian tumors have no symptoms.It is usually found in the medical examination, or it was discovered accidentally because of some symptoms that are not related to ovarian tumors.
Some people say that my ovarian cyst has symptoms.For example, bleeding, amenorrhea, dysmenorrhea, abdominal pain and other issues.
Alas, symptoms such as bleeding and amenorrhea are more common in luteum cysts. They are benign, or they can be physiological, and they may disappear.Lutein cysts may also have mild-moderate pain.
For severe abdominal pain, for the age of childbearing age, internal bleeding caused by ectopic pregnancy and luteal rupture must be excluded.
Secondly, ovarian cysts are reversed, of which teratoma is the most common cause of reversing.Normally, about 5cm of teratoma is the easiest to reverse.Too small cysts can’t be stuck, even if you twist, you can quickly twist back; too large cysts occupy the entire pelvic cavity, and there is no room for movement, and it cannot be reversed.
In addition, chocolate cysts can also cause persistent and severe abdominal pain, which usually occurs in menstrual period.Increasing dysmenorrhea is a typical feature of chocolate cysts.
How to diagnose ovarian cystoma?
Ovarian cyanoma is a tumor source for raw epithelium. It is the most common group of tumors in the ovaries. It is common in slurry and mucus. It is more common in women of childbearing age and can also occur after menopause.Average age of onset:
The slurry cyst adenoma is 36.4 years old;
Smooth cyst adenoma is 41.8 years old;
Global or malignant age is 5-10 years old.
Early tumors were smaller, and most patients had no special symptoms and developed slowly. They were discovered during gynecological examinations. When the tumor was huge, abdominal distension or abdominal pupae and mass were clear.Clinical examinations are common abdominal swelling, block mobility is poor, and percussion has no mobility voicing.The lumps are touched on the side of the uterus or bilateral sides, and they are mostly cystic. The surface is smooth, and the activity is not adhesive to the uterus. If the tumor grows up and is full of pelvic cavity, compression symptoms appear in the abdominal cavity, such as frequent urination, constipation, anxiety, palpitations, etc.
Mao Mao came to see the symptoms of abdominal distension because of the large tumor.
Identification of cystic adenoma
The first place of the ovarian tumor of the peeling source of the slurry cyst adenoma. The tumor is more common in single rooms, smooth appearance, thin walls, and full of colorful or light yellow liquid in the cyst cavity.Crispy nipples, this benign nipple is difficult to find on CT.
Smooth cystic adenoma is more common in many rooms, and rooms can be large or small. Often, there is one or few small sub -rooms in a house. The sub -room is unique.EssenceThe borders of the gonadotomas, the active hyperplasia of epithelial cells, protrudes in the cavity to form nipples, but no tumor cells are infiltrated into intermediary quality. This is one of the main pathological differences between junior and malignant.
In summary, CT is manifested as a single room, thin or thick wall cysts, or the thickness of the sac wall is uneven, while the density is prompted to indicate the slurry cyst tumor.Multi -room and size are different, the density is uneven, the sub -sac or sac wall is evenly thickened and thickened, which is often greater than or equal to 1/3 of the periodic diameter of the tumor.When the cyst wall or the separation of the separation is thickened and the realm is blurred, or the cystic changes are changed, or the wall nodules appear and are accompanied by a large amount of ascites, it is strongly prompted to be borders or cyst tumor cancer.
Written in the end: I was fortunate to warn myself through this case that when the disease diagnosed was unclear, there was no creative inspection.
