Endometrioid ovarian adenocarcinoma is a common subtype of epithelial ovarian cancer that can arise on a background of endometriosis. Maximal cytoreductive effort with an aim to remove all macroscopic disease (achieve R0) is the single independent prognostic factor for survival. Complex multidisciplinary surgeries may be required in order to achieve this.

(1) Introduction: The laparoscopic approach to low pelvic tumors is challenging and hindered by suboptimal tumor visualization and dissection, with possible oncological failure. Stereotactic navigation provides real-time image guidance that may optimize safety, accuracy, and precision when dissecting challenging low pelvic tumors. (2) Methods: Preoperative CT images were acquired with eight skin-fixed fiducials and loaded into a navigation system. A patient tracker was mounted on the bed side. Patient-to-image paired point registration was performed, and an instrument tracker was mounted on a laparoscopic instrument and calibrated for instrument tracking. Surgical operations were performed with real-time stereotactic navigation assistance. (3) Results: Three patients underwent stereotactic navigation surgery. Fiducial registration errors were good to optimal (±1.9, ±3.4, and ±3.4 mm). Lesions were easily identified and targeted with real-time navigation. Surgeries were uneventful. Histopathology examinations identified one retro-rectal schwannoma, one lateral pelvic recurrence from rectal adenocarcinoma, and one advanced anal canal carcinoma. No navigation-related complications, readmissions, or postoperative mortalities were observed. (4) Conclusions: The application of laparoscopic stereotactic navigation surgery to complex low pelvic tumors is feasible and could impact oncological surgical quality by enabling tumor targeting and ensuring resection margins. Further wider series are needed to confirm stereotactic navigation\'s impact on challenging low pelvic tumors.

A 67-year-old woman was referred to our hospital for further evaluation of a positive fecal occult blood test. Colonoscopy revealed an elevated rectal lesion (10 mm in size) with a central depression. A rod-like object was noted in the center of the lesion. Magnifying endoscopy with narrow-band imaging showed obscure surface structures and dilated vessels. Magnifying endoscopy with crystal violet staining showed that the pit pattern had disappeared. These endoscopic findings suggested that the lesion was comprised of granulation tissue. A detailed medical history revealed that she had undergone a total hysterectomy with mesh placement for bladder prolapse. We reasoned that the mesh used during pelvic surgery might have penetrated the rectum. She underwent subsequent surgery to remove the mesh. Although most foreign bodies in the rectum are swallowed or self-inserted, pelvic surgery is another source of foreign bodies in the rectum.

Ovarian fibrothecoma are a mostly benign and profoundly rare type of gonadal stromal cell tumor. It makes up 3-4% of all kinds of ovarian neoplasia. They are predominantly unilateral in origin and mostly present in women during the postmenopausal phase. Our case is especially important because the tumors occurred bilaterally and were associated with ascites. This seldom happens in patients with ovarian fibrothecoma. Early identification and treatment are key components to avoid the subsequent complications of this tumor.
UNASSIGNED: We present the case of a 54-year-old female who presented complaining only of a slow progressive increase in the abdominal contour associated with vague abdominal pain. Our preoperative radiological imaging revealed multiple ovarian and uterine masses.
UNASSIGNED: Surgical intervention in the form of a hysterectomy with bilateral salpingo-oophorectomy was achieved. Histopathological analysis revealed bilateral benign ovarian fibrothecoma with benign uterine leiomyomas. The patient underwent an uneventful postoperative recovery.
UNASSIGNED: Ovarian Fibrothecoma is a rare gynecological pathology. The uniqueness of our case stems from the rarity of its bilateral occurrence and in rare occasions, their occurrence is accompanied by ascites. This kind of co-occurrence should be differentiated from other rare presentations, such as Meigs Syndrome. Therefore, documentation is necessary to circumvent misdiagnoses and to abate the resulting patient morbidity. To further highlight the value of our case, it is to the best of our knowledge, the first documented case of this pathology from our country.

Background Gender-affirming pelvic surgery (GAPS) can be associated with significant postoperative pelvic pain. Given the lack of available peripheral nerve blocks to the perineum, intrathecal morphine (ITM) injection could offer a potent analgesic modality for this patient population. No prior studies to date have been performed examining the analgesic effects of intrathecal morphine for these patients. Methods This retrospective case-control study aims to understand the postoperative analgesic effects of intrathecal morphine for these patients with a historical comparison group of patients who did not receive intrathecal morphine. Results Fourteen patients presented for gender-affirming pelvic surgery over an eight-month period at a single institution and were offered intrathecal morphine for postoperative analgesia. Their analgesic results were compared to a similar historical group of 13 patients who were not offered or declined intrathecal morphine. Conclusions Intrathecal morphine injection is a potent analgesic modality for patients presenting for gender-affirming pelvic surgery.

Pyoderma gangrenosum is a sterile inflammatory disease of unknown etiology characterized by recurrent cutaneous ulcers. It can occur in extracutaneous locations, especially at operative sites, and has been reported following gynecologic surgery. This report is the first case of pyoderma gangrenosum as a remote complication of pelvic surgery with associated ureteral stricture. It demonstrates the diagnostic challenge of this rare disease and the importance of broadening the differential diagnosis when apparent infections do not respond to treatment to minimize the morbidity of ineffective antibiotic and surgical interventions.

We report a case of a Chinese man who developed retroperitoneal haemorrhage almost 1 year after surgery for pelvic fracture (1). To the best of our knowledge, this type of delayed haemorrhaging is rarely observed in clinical practice. We also review the literature to identify the common causes of retroperitoneal haemorrhage in patients undergoing surgery for pelvic fracture and to examine the aetiology of this case.

BACKGROUND: Most patients with foreign bodies in their rectums present to medical institutions within a few days. In this report, we describe a foreign body in the rectum in situ for 5 months that resulted in a huge rectovesical fistula 4cm in diameter, requiring emergency laparotomy.
METHODS: A 59-year-old man, who had undergone rectal foreign body extraction via the anal canal without any complications 7 years previously, presented with abdominal pain and diarrhea. Computed tomography revealed a cup-shaped rectal foreign body and huge rectovesical fistula. We performed an emergency laparotomy. There was no contaminated ascites. The adhesion around the fistula was too stiff to be dissected. We incised the rectal wall, excised the ceramic cup-shaped foreign body, and detected a fistula approximately 4cm in diameter. We performed sigmoid colostomy, and the incised rectal wall and the bladder wall were sutured, and the residual rectum was supposed to function as a part of the bladder. After the surgery, no severe complications occurred. The patient told us that he inserted the foreign body himself 5 months earlier, and urine had appeared in the stool in the previous month.
CONCLUSIONS: A long-term retained rectal foreign body is very rare and could create an abnormal huge fistula between the pelvic organs because of prolonged pressure on the walls of the pelvic organs.
CONCLUSIONS: In patients with a long-term retained rectal foreign body, we should prepare for surgical treatment of not only the rectum but also the other pelvic organs.

BACKGROUND: To highlight the laparoscopic management as a feasible treatment option for vaginal cuff dehiscence with intestinal evisceration after hysterectomy.
METHODS: We report a rare case of a 49-year-old postmenopausal woman who was admitted to the emergency department with vaginal herniation of approximately 40cm of small bowel 3 months after total laparoscopic hysterectomy, treated laparoscopically exclusively.
CONCLUSIONS: The patient underwent a laparoscopic reduction of the protruded mass, inspection of the entire small bowel and closure of the vaginal dehiscence. She was discharged home in a good health and the postoperative course remains uneventful 6 months later. Our systematic review of the literature found 116 cases of vaginal evisceration, which were described as early as 1864. There is no consensus on the ideal method of surgical repair. To our knowledge, only 2% (3 cases) were treated totally laparoscopically and 10% by a combined approach (laparoscopic and vaginal). Although the current evidence does not suggest that one approach is preferred to the others, the laparoscopic approach seems to be the new trend for the management of this surgical emergency.
CONCLUSIONS: Totally laparoscopic repair in experience hands seems to be a safe approach to cure vaginal evisceration after pelvic surgery.