Journal of Clinical Case Reports

Two Unusual Causes of Acute and Chronic Left Iliac Fossa Pain in the Gynaecology Clinic

Abstract

Abdel-Gadir A

Three patients attended our gynaecology clinic with left iliac fossa pain for second opinion. One patient had sharp pain which started two weeks previously. It improved slightly over one week before getting worse and unbearable. Clinical examination and routine investigations including ultrasound and CT scanning were normal. Laparoscopic examination showed two abnormal looking appendices epiploicae which were excised. One was darker and firm and the other was large with few hyperaemic areas and bruised pedicle indicating recent torsion. Appearance and consistency of the two appendages most likely reflected the cause of the two pain episodes respectively. Histological assessment showed necrotic fat tissue with no evidence of inflammatory cells. The patient felt well thereafter and was discharged from the clinic. The other two patients presented with intermittent left iliac fossa pain for 3 and 6 years respectively. Both patients noticed increased pain frequency and intensity with progressive weight gain. Diagnostic laparoscopy showed a large irregular gap in the left broad ligament in one patient and a small fenestration in the same ligament in the other one. Left salpingectomy to disrupt the medial margin of the large gap and laparoscopic suturing of the small fenestration were done in the two patients respectively. The surgical objective was to prevent bowel herniation through these gaps which was the most likely cause of pain. Both patients recovered well and had no further symptoms. Accordingly, patients with acute or chronic pelvic or lower abdominal pain of unidentifiable aetiology should be subjected to diagnostic laparoscopy and further surgical intervention as necessary.