لاپاراتومی

Uterine myoma is the most common mass in gynecology and affects many women in different societies. Uterine myomas have different types and cause different symptoms that require treatment to prevent further complications.

This study reports multiple myomas in two 34-year-old and 31-year-old unmarried sisters. Both patients had severe digestive, urinary and bleeding problems. Due to the fact that the patients were young and childless and wanted to preserve their fertility, they underwent myomectomy by laparotomy. Despite the large number of myomas (56 and 47), in order to preserve fertility, attention was paid to preserving the normal anatomy of the uterus and fallopian tubes, and the uterus was repaired.

The presence of multiple myomas in two sisters indicates the great influence of genetics on the incidence of uterine myoma. There are different treatments for these fibroids, one of the most common of which is hysterectomy. However, myomectomy is supported in young and childless patients who wish to preserve fertility despite multiple myomas.

The injuries of hollow organs are less known than the injuries of solid organs and delay in their diagnosis can increase mortality and complications in patients. The diagnostic value of CT scan in hollow organ damage has been less investigated. Therefore, the present study was conducted with the aim of determining the diagnostic value of abdominal and pelvic CT scan with intravenous contrast in the diagnosis of hollow viscera damage in blunt trauma patients.

In this cross-sectional study, 90 blunt trauma patients were included in the study. Clinical data of patients with blunt abdominal trauma who underwent CT scan and laparotomy were collected. The diagnostic value of CT scan compared to the results of laparotomy as a gold standard was analyzed by calculating sensitivity, specificity, positive and negative predictive value and accuracy.

69 patients (76.7%) were male and 21 patients (23.3%) were female. The mean age of the patients was 29.82 ± 17.51 years. Based on laparotomy, there was no injury in 60% of patients (54 patients) and in 36 patients (40%) damage to hollow organs was diagnosed. In general, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT scan were 22.2%, 100%, 100%, 65.8% and 68.9%, respectively. The sensitivity of CT scan was 12% for bowel damage and 62.5% for bladder damage. The sensitivity of CT scan for intra-abdominal/pelvic fluid (31.25%) was the highest and the specificity and positive predictive value for other CT scan findings were similar (100%).

While the sensitivity of CT scan in detecting hollow viscera injuries is low, its specificity, positive predictive value, negative predictive value, and accuracy are high and acceptable. Therefore, CT scan can be used as a complementary tool along with other diagnostic methods to diagnose hollow organ injuries in blunt trauma patients.

Excessive bleeding during and after childbirth is a serious complication that can endanger the life of the mother. The present study reported a case of active arterial bleeding after normal delivery.

The patient is a 22-year-old woman, G2L1 (second pregnancy), who underwent natural childbirth due to labor pains, decreased fetal movements, and exceeding the due date. The baby girl was born naturally without any complications, with an Apgar score of 9 and a weight of 3050 grams, without dystocia or any specific abnormalities. Approximately three hours after delivery, the mother experienced dizziness and fainting while trying to get out of bed. At that time, the patient's pulse was 120 bpm, and she appeared pale. The patient's blood pressure was reported as 60/90, and there was no vaginal bleeding. The uterus was palpated in its normal position above the suprapubic area. The vagina and cervix were checked again and found to be without any abnormalities or bleeding. Due to the persistence of the patient's symptoms, an emergency abdominal and pelvic ultrasound was requested, which was performed after several hours of delay. Consultation with a urologist was requested, and it was suggested to perform a cystogram and abdominal ultrasound on the patient. The abdominal ultrasound reported a large hematoma measuring 3.14 x 7.5 x 17 cm in front of the uterus and behind the bladder. The patient was transferred to the operating room and underwent general anesthesia. The abdomen was opened through a wide incision. A large hematoma measuring 17 x 18 cm was found in the area behind the bladder and in front of the uterus, extending up to the fundus of the uterus and broad ligaments. The hematoma was drained and found to be located in the lower uterine segment, without any connection to the cervix or inside the uterus.

Active primary and secondary intra-abdominal hemorrhage is one of the surgical emergencies after delivery. The patient should undergo surgery immediately and the bleeding should be controlled.

Among diseases causing acute lower abdominal pain in women, isolated fallopian tube torsion is a rare cause that occurs mainly in women of reproductive ages and if left untreated can lead to fertility problems. Immediate diagnosis and timely surgery are urgent and necessary to preserve the fertility of females. Successful pregnancy with simultaneous involvement of isolated fallopian tube torsion is one of the rare operations in the world.

The reported case is a 37-year-old pregnant woman (Gravid 2, with 33-week gestational age) with nausea, vomiting and abdominal pain in August 2020 who presented to the Maryam Hospital in Karaj in August 2020. The patient was examined in the operating room under anesthesia, and pain in the right and lower abdomen was observed. There was no anorexia, and on examination, there was severe tenderness in the right lower quadrant (RLQ) area. There was no pain in other parts of the abdomen. Ultrasonography in the patient's tenderness showed an image of a tubular and cystic structure measuring 30×10 mm. In CBC test, leukocytosis with high PMN (Polymorphonuclear), (WBC: 11700 mm3 and Neutrophil: 78%) was observed. During laparotomy, isolated torsion of the right fallopian tube observed, half of which was cyanotic. Due to the confirmation of fimbriae necrosis during surgery, preservation of uterine tube integrity, fallopian tube detorsion, excision of cyanotic fimbriae and hemorrhagic cyst of fimbriae, intra-abdominal fluid suction and fimbriae repair performed. The patient discharged in good condition after two days and gave birth to a healthy baby at 38 weeks of gestation by cesarean section.

Isolated fallopian tube torsion should be considered as a potential differential diagnosis in patients that have acute lower abdominal pain in women of reproductive ages and even adolescents. Early diagnosis and early surgical intervention are critical to maintaining the fallopian tube and fertility in the future. Laparoscopy is one of the main diagnostic tools for assessing, management and maintenance isolated torsion of the fallopian tube.

Incisional hernia is one of the most common complications after abdominal surgery. This hernia occurs due to failure to repair the fascia of the abdominal wall muscles and the separation of the deep fascia from each other at the site of previous surgery. Therefore, the aim of this study was to investigate the prevalence and risk factors of incisional hernia following laparotomy after one year.

Inclusion criteria included all patients undergoing laparotomy, one year after their laparotomy, and willingness to participate in the study. Reluctance to participate in the study was considered as an exclusion criteria. Three hundred and sixty patients with inclusion criteria who undergoing laparotomy from April/16/2020, to September/20/2020, were included in the study by convenience sampling method. Data were collected using a demographic questionnaire and physical examination.

The results of current study showed that the incidence of incisional hernia was 7.2%. The incidence of incisional hernia following laparotomy was not significantly different based on age, sex, hypertension, dyslipidemia, ischemic heart disease, type of surgery, suture type, incision type, smoking, addiction and length of hospital stay. However, it was found that the frequency of incisional hernia after laparotomy in overweight and obese patients was significantly higher than patients with normal BMI (12.2% vs. 2.2%), in patients with diabetes was significantly higher than patients without diabetes
(25% vs. 4.5%), and in patients with infection at the surgical site was significantly higher than patients without infection site of surgery (37.5% vs. 4.3%) (P < 0.001).

Considering the positive relationship between obesity and postoperative complications in incidence of Incisional hernia, it is recommended to reduce their BMI before surgery for all patients with risk factors and in need of elective surgery, and for all patients in need of surgery (emergency and Elective) prevents infection at the surgical site to reduce the incidence of Incisional hernia.

Patients with penetrating abdominal trauma can be treated with invasive procedures such as laparotomy and less invasive procedures such as laparoscopy. Since the management of patients with penetrating abdominal trauma based on non-invasive methods is more important, the present study was performed to compare laparoscopic and laparotomy methods to evaluate the surgical outcomes, complications and costs of patients with penetrating abdominal trauma.

In this retrospective study, the records of all patients with penetrating abdominal trauma and stable hemodynamics referred to Kowsar Hospital in Sanandaj during one year were reviewed. Patientschr('39') information including demographic characteristics, rate of laparotomy or laparoscopy surgery, time of operation, surgical wound infection, incidence of ileus, patientschr('39') pain intensity, length of hospital stay and hospital costs were collected and reviewed based on patientschr('39') records.

In this study, the medical records of 40 patients were reviewed. The average pain intensity in the laparoscopy group was 2.03±0.69 and in the laparotomy group was 6.77±1.95. Postoperative ileus was seen in 3 patients (16.66%) who underwent laparoscopy and 17 patients (77.2%) who underwent laparotomy. The average number of hospitalization days in the laparoscopy group was 1.38±0.61 days and in the laparotomy group was 5.73±1.78 days. The average cost of surgery in laparoscopic surgery was equal to 532240 Rials and in laparotomy was 1365600 Rials (p=0.0001).

According to the results of this study, it seems that the use of diagnostic laparoscopic method for the management and treatment of patients with penetrating abdominal trauma and stable hemodynamics, significantly reduces complications and minimizes costs and length of hospital stay.

Sodium bicarbonate may be effective in reducing the pain since it creates an alkaloid environment and prevents acidosis. Therefore, this study aimed to investigate the effect of intraperitoneal irrigation using sodium bicarbonate on postoperative pain severity.

This non-randomized, double-blind clinical trial was performed on 50 candidates for elective surgery with midline laparotomy at Besat Hospital in Hamadan, Iran, during 2017-18. The patients were assigned into an intervention (underwent intraperitoneal irrigation using sodium bicarbonate solution) and a control group (underwent intraperitoneal irrigation using the normal saline solution). The severity of the pain 12 and 24 h after the surgery in patients was measured using a Visual Analog Scale (VAS).

The mean ages of the patients were 48.87±11.68 and 49.56±15.44 years in the intervention and control groups, respectively. Regarding gender distribution, 52% of the participants were male. Moreover, the mean pain scores 12 h after the surgery were 6±1.71 and 7.56±1.47 in the intervention and control groups, respectively. Additionally, the mean pain scores obtained from VAS 24h after the surgery were 20.20±1.15 and 3.68±1.62 in the intervention and control groups, respectively. According to the results, the mean score of pain was significantly lower in the intervention group, compared to the control group (P<0.05). However, there was no significant difference between the two groups regarding the frequency of complications and the amount of opioid consumption.

The combination of sodium bicarbonate and normal saline solution for intraperitoneal irrigation is a simple method with no complication. This can help reduce postoperative pain up to 24 h after surgery.

Interstitial pregnancy is a dangerous and challenging ectopic pregnancy. Despite different diagnostic methods, the early detection of interstitial pregnancy is very difficult and misleading. Interstitial ectopic pregnancy tends to severe bleeding, so that incorrect diagnosis leads to life threatening of patient. The aim of this study was to introduce a case of interstitial ectopic pregnancy (Corneal) with placenta Increta in the second half of pregnancy. A 23-year-old woman G2 with history of previous cesarean section, at 23 weeks of pregnancy with complaints of abdominal pain, nausea and vomiting after sexual intercourse referred to Izadi educational Hospital. Regarding drop in vital signs, oliguria, generalized tenderness and ultrasound reports of abdominal blood, the patient was transferred to the operating room. On the left, interstitial ectopic pregnancy was torn with placenta Increta. The embryo was removed, but the placenta was placed in the cornea to the cervix and to the broad ligament. Hysterectomy was performed due to the placenta Increta. Ultimately, the diagnosis and immediate treatment saved the patient's life. The pathological study showed placenta Increta. Intrauterine ectopic pregnancy is one of the rare diseases. Since interstitial pregnancy is located in a place full of vessels, any rupture can lead to catastrophic and life threatening bleeding. Interstitial pregnancy requires accurate diagnosis and immediate treatment. Proper and timely intervention therapy can prevent serious complications and reduce maternal mortality and mortality.

Ovarian pregnancy is a rare form of ectopic pregnancy, and usually is diagnosed after complication. The most common risk factor for ovarian pregnancy is the use of the intrauterine devices (IUD). Case Report: Our patient was a 20-year-old woman with a history of salpingectomy, gravid 2, with one previous ectopic pregnancy presented with abdominal pain for one week, nausea, vomiting, and orthostatic hypotension. Beta-human chorionic gonadotropin (βhCG) was positive with a titer of 105000 mIU/ml. Sonography showed a uterus of normal size with no gestational sac, but an echogenic mass with size of 44 × 32 mm at the right adnexa, and with free fluid in abdomen was detected, ectopic pregnancy was suggested, and laparotomy was performed. In women that present with history of menstrual retard, abdominal pain, and spotting, ectopic pregnancy is the first differential diagnosis. Patient should be evaluated by checking βhCG and sonography, and be treated based on clinical examination and paraclinical evidence.

Aims and background: A major surgery such as a laparotomy can induce severe pain in a patient. However administration of pain control medications can have dramatic effects on the hemodynamic status of the patient. Therefore, the aim of this study was to investigate intravenous infusion of magnesium sulfate for pain control and its’ effect on the hemodynamic status of the patient after laparotomy surgery. In this clinical trial , 80 patients undergoing laparotomy surgery were randomly classified into intervention and control groups based on exclusion and inclusion criteria. The intervention group received a bolus of magnesium sulfate 50 mg /kg half an hour before surgery, and then an infusion of 500 mg /hr. for 24 hours after surgery. P <0.05 was considered significant. Findings: No significant difference was seen before and after surgery between the intervention and control groups regarding hemodynamic status or pain severity up to 6 hours after surgery. However by 6 hours after surgery, the severity of pain in the intervention group was lower than in the control group. This difference was statistically significant (P = 0.01). Magnesium sulfate has little effect on the hemodynamics of the patients undergoing surgery, but also was not effective for the control of pain in the first hours after surgery However six hours after surgery a pain control effect was noted

Trauma is one of the most common causes of death in the age range 1 to 44 and the third cause of death regardless of age. Abdominal trauma is one of the most common types of trauma. This study aimed to investigate the frequency of causes of laparotomy in penetrating and blunt abdominal traumas in 2016.
This descriptive study was conducted on 120 medical records of patients hospitalized for penetrating and blunt abdominal traumas in Fatemi Hospital, Ardabil, 2016. The inclusion criterion consisted of all patients undergoing laparotomy due to abdominal trauma. In this study, age, gender, education level, type of trauma (blunt or penetrating), results of laparotomy surgery, physical examination and paraclinical findings of patients before operation were collected by a researcher- made checklist.
The results showed that 80% of the patients were male and 35% were in the age range 20-29years. Of patients, 38.3% had penetrating trauma and 61.7% blunt trauma. The most common mechanism of blunt abdominal trauma was car accident (83.8%). Penetrating object was the cause of all penetrating abdominal traumas. Peritoneal stimulation symptoms were observed in 56.5% of penetrating abdominal traumas and 62.2% of blunt abdominal traumas. Hypotension was observed in 21.7% of patients with penetrating abdominal trauma compared with 62.2% in patients with blunt abdominal trauma. The most prevalent damaged organ in patients with blunt trauma was spleen (51.4%). The most prevalent damaged intraabdominal organ was small bowel (17.4%). Negative laparotomy was significantly higher in patients with penetrating trauma than those with blunt trauma (p The results of this study showed that: 1. Road traffic accident and penetrating object were the most common causes of laparotomy in patients with blunt and penetrating trauma respectively; 2. Spleen and small bowel were the most prevalent damaged organs in blunt and penetrating abdominal trauma respectively and; 3. Young males were at highest risk of abdominal traumas.

Heterotopic pregnancy is defined as a spontaneous intrauterine and ectopic pregnancy. The incidence of this type of pregnancy is estimated at 1 in 30,000 in the general population. This Pregnancy is commonly seen in the use of vitro fertilization and ovarian induction. It is a life-threatening disease. It may be ignored in diagnostic procedures; therefore, this can change into a diagnostic and therapeutic problem for physicians. In this study, we report a case of heterotopic pregnancy in a 37-year-old woman who was undergone laparotomy and curettage.
Description: A 37-year-old woman presented with a history of two times cesarean section surgery and an ectopic pregnancy that has been self-absorbed in the last 6 months. The patient has been referred to physician because of the delay in menstruation since 3 last weeks. Considering the ultrasonography that has been done for the patient, a picture of gestational sac with a normal shape and position, normal and uniformly decidual reaction containing yolk sac without embryo in the uterine cavity with free fluid in the pelvic cavity indicated the heterotopic pregnancy. The gestational age was estimated based on MSD of 5w. The patient has been undergone laparotomy surgery. The ovary and right fallopian have been removed and curettage has been done.
Heterotopic pregnancy can occur in normal cycles and in the absence of any predisposing risk factors. Therefore, pregnant women should consider the possibility of heterotopic pregnancy as the diagnosis of intrauterine pregnancy cannot rule out the possibility of concomitant ectopic pregnancy.

Ovarian torsion and ectopic pregnancy occur in 2.7 and 2% of all pregnancies, respectively, and both are known as gynecologic emergencies. The simultaneous occurrence of these two cases is rare. This study reports a case with simultaneous ovarian torsion and ectopic pregnancy.
CASE REPORT: The patient is a 31-year-old woman with history of two abortions, who referred with a history of 6-week missed menstrual period and vaginal bleeding from one day before and abdominal colic pain accompanied by two occasions of nausea and vomiting. In ultrasonography, cyst was reported to be 54 × 60 mm in right ovary and moderate free fluid was found in cul de sac, while serum HCGβ levels were more than 1000. Due to the exacerbation of abdominal pain, emergency laparotomy was performed, which revealed ruptured ectopic pregnancy and ovarian torsion with active bleeding and a 7×6 cm cyst in the same side with two rounds of torsion. Open torsion, right salpingectomy and cystectomy were performed. The patient was discharged 48 hours after the operation with a good general condition and without serious complication, and there was no problem during the 6-week postoperative follow-up.
Simultaneous occurrence of ovarian torsion and ectopic pregnancy is rare, but it is likely to occur. Therefore, early diagnosis to maintain future pregnancies and preserve the ovary is important and suitable medical measures may prevent the unwanted side effects in these patients.

Foreign body ingestion can be deliberate or accidental and mostly defecated with no complication in gastrointestinal tract. Some of them can injury the gastrointestinal tract. Patient is a 30 years old man known case of psychologic disorder that was referred with abdominal pain without other symptoms in gastrointestinal tract 3 days after ingestion of a lot of nails and screw nails. After first evaluations surgery was done and all of foreign bodies removed.

Endometriosis is one of a benign disease of female genital system, prevalence is 5-10 percent in reproductive age and the pelvis is the most common site for it, extra pelvic Endometriosis is much rare. Vaginal endometriosis is an uncommon and rare finding Between Extra pelvic one that its Prevalence is not clear. In this report we present a rare case of vaginal endometriosis and it`s treatment.Case Report: This report describes a 35 year-old woman with preumbilical, supra pubic pain and dysmenorrhea up to 10 years and also 6-years history of infertility, who did not receive any treatment during these years.Finally, by detection of necrotic mass in the posterior fornix of the vagina and probability of cervical myoma, laparoscopy and then laparotomy was performed and the mass was removed. Endometriosis has been reported by the pathologist. Surgery is a choice of treatment in a person with history of infertility and Endometriosis. Awareness of this rare finding could provide preoperative detection and proper treatment. Thus taking a thorough history of the patient, performing an accurate examination and doing the essential Diagnostic procedures are mandatory.

Peritoneal adhesions can be defined as abnormal fibrous bands between peritoneal or pelvic cavity. Flavonoid agents with antioxidant properties are present in Rosa damascene and seem to be useful for prevention of intra-abdominal adhesion formation. Therefore, the present study aimed to examine the effect of R. damascena hydroalcoholic extract on prevention of adhesions. In this experimental study, 30 rats were divided randomly into 3 groups; group A received 1% extract, group B 5% extract and group C distilled water. During laparotomy, three longitudinal and transvers incisions each of 2 cm length were made in the serous surface by scalpel in the right and left sides of peritoneum, and a 2x2 cm patch was completely cut off. Group A and B received 1% and 5% hydroalcoholic extract of R. damascena (3 ml, intra-abdominal cavity) respectively and group C received distilled water during the surgery. Two weeks later in the second laparotomy, the adhesions were graded by means of Canbaz scale. Using SPSS v.16 software, data were analyzed by Mann-Whitney test. There were significant differences between the scores of groups A and C (P = 0.007). The mean adhesion scores were 1.4 ± 1.265 and 3 ± 0.816 in groups A and C respectively. Results of this study demonstrated that use of R. damascena 1% extracts may result in effective prevention of postoperative intra-abdominal adhesions. After more studies in the future, R. damascena or its derivatives may prove to be useful for prevention of adhesions.

Although the treatment of patients referred to medical centers due to foreign body ingestion is a common problem، but surgical intervention is required in less than 1% of cases. This can be attributed to the development of endoscopic techniques. The patient was a 32 years old man who come to the emergency ward with complaint about repeated vomiting and nausea. The patient is a smoker with psychological disorders، and a history of addiction in the past few years. The patient''s vomiting had started on the morning of referral، and his defecation and gas passage had been reduced from two days before the referral. He noted ingestion of two connected safety pins، four days before presentation. Abdominal radiography revealed two safety pins in the terminal ileum and distension of small intestinal loops. The patient was hospitalized for four days with the diagnosis of partial obstruction of small intestine، and finally underwent laparotomy due to the worsening of his general condition. After McBurney incision in abdominal wall، impacted foreign bodies were drawn from terminal ileum to jejunum، and then enterotomy was done. The aim of this report is to attract especial attention to the case of patients with psychological disorders who refer to a hospital due to gastrointestinal tract obstruction.