Isolated torsion of a hydrosalpinx is an exceptionally rare gynaecological emergency that often presents with vague and non-specific symptoms, leading to delays in diagnosis. Hydrosalpinx is a known predisposing factor for tubal torsion, yet isolated involvement without ovarian pathology is uncommon. We report the case of a 22-year-old woman presenting with acute right lower abdominal pain and vomiting, in whom ultrasonography demonstrated a cystic adnexal lesion distinct from the ovary. Laparoscopic evaluation confirmed isolated torsion of the right hydrosalpinx with necrosis, necessitating salpingectomy. Early laparoscopic intervention enabled prompt recovery and preservation of ovarian function. This case highlights the importance of maintaining a high index of suspicion for isolated tubal torsion in reproductive-aged women presenting with acute pelvic pain.

We report the case of a 21-year-old male semi-professional football player presenting with a one-month history of progressive inguino-pubic pain without a history of acute trauma. Clinical examination revealed point tenderness over the pubic symphysis and pain on resisted adductor contraction. Standard pelvic radiographs were unremarkable. Magnetic resonance imaging (MRI) demonstrated a stress fracture of the left inferior pubic ramus with associated stress reaction of the pubic body, osteitis pubis, and oedema at the left adductor insertion. Conservative management comprising immediate cessation of sporting activity, progressive protected weight bearing, analgesia, and structured physiotherapy resulted in complete resolution of symptoms and a gradual return to competitive football without complications. Stress fractures of the pubic symphysis should be considered in the differential diagnosis of groin pain in athletes. MRI is the imaging modality of choice for early diagnosis and characterisation of associated soft-tissue lesions. Conservative treatment with structured rehabilitation yields favourable outcomes.

Adnexal masses in postmenopausal women represent a significant clinical challenge. This case report describes the clinical presentation, diagnostic evaluation, and surgical management of a large adnexal mass complicated by ovarian torsion in a postmenopausal woman. A 65-year-old postmenopausal woman with long-standing abdominal distention presented with acute pelvic pain, early satiety, and constipation. Computed tomography revealed a 20.6 × 16.5 cm torsed adnexal mass with a twisted vascular pedicle, intratumoral hemorrhage, intratumoral gas and peritumoral fluid. Mass shows no enhancement in post contrast images. Serum CA 125 and CA 19-9 were markedly elevated. Exploratory laparotomy revealed a twisted left ovarian mass with ischemic changes. Total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO) were performed. Following surgery, she had uneventful recovery and reported symptom resolution by day three. Gross pathology showed no features of malignancy. This case highlights that large adnexal masses in postmenopausal women require urgent evaluation. Although elevated tumor markers may mimic malignancy, torsion and benign pathology can present similarly. Final diagnosis was torsion of a benign ovarian mass with ischemic infarction. Early surgical intervention is essential to avoid such complications.

Appendiceal endometriosis is a rare form of extragenital endometriosis that can mimic acute appendicitis. This reports presents the case of a 19-year-old woman with no significant medical history who presented with right-sided abdominal pain, nausea, and lightheadedness. Physical examination revealed right lower quadrant tenderness and a positive Rovsing sign. Laboratory studies showed no leukocytosis, and her modified Alvarado score was 4. Computed tomography of the abdomen and pelvis demonstrated mild fluid and inflammatory changes near the base of the cecum extending toward the right adnexa, raising concern for acute appendicitis versus a ruptured ovarian cyst. Pelvic ultrasound identified a complex cystic structure in the right ovary with adjacent free fluid, while appendicitis could not be excluded. Due to persistent symptoms and diagnostic uncertainty, laparoscopic appendectomy was performed. Intraoperative findings included hemoperitoneum, endometriotic lesions, and possible rupture of a right ovarian follicle. Histopathological examination revealed appendiceal serosal endometriosis. This case underscores the diagnostic challenge of appendiceal endometriosis and the importance of considering gynecologic etiologies in young women presenting with right lower quadrant pain.

Desmoid-type fibromatosis is a rare, locally aggressive mesenchymal neoplasm that accounts for fewer than 0.03% of all tumors. Its retroperitoneal variant in young women closely mimics uterine leiomyoma on pelvic ultrasonography. When the diagnosis of desmoid-type fibromatosis is delayed, the tumor can silently invade adjacent viscera with fatal consequences. A 21-year-old woman presented with lower abdominal pain and a large pelvic mass on ultrasonography. The mass was labelled a uterine fibroid, and she was discharged. Two days later, she returned with an acute abdomen; CT revealed a 29 cm retroperitoneal mass with pneumoperitoneum. Emergency laparotomy confirmed colonic invasion and perforation with gross fecal peritonitis. Debulking colectomy with colostomy was performed; complete resection was not achievable. Histopathology was morphologically consistent with desmoid-type fibromatosis; confirmatory immunohistochemistry was not performed. Postoperatively, the patient developed refractory septic shock driven by an MDR Escherichia coli wound infection. Serum lactate never normalized across thirteen serial measurements over nine days from admission to death. She died nine days after presentation with a terminal lactate of 4.8 mmol/L and combined metabolic and respiratory failure. This case shows how retroperitoneal desmoid-type fibromatosis (DTF) can precisely replicate a uterine fibroid on ultrasound when it compresses but does not invade the uterus. Sporadic desmoid disease can reach catastrophic size silently and cause hollow-viscus perforation. Any large pelvic mass with bilateral ureteric obstruction in a young woman should prompt cross-sectional imaing before discharge.

Septic arthritis of the pubic symphysis is an uncommon and frequently overlooked condition, typically occurring as a postoperative complication. Spontaneous cases without identifiable risk factors are exceptionally rare and may present with misleading clinical features, often mimicking acute abdominal, gynecological, urological, or hip-related conditions. We report the case of a 59-year-old woman with no prior medical or surgical history who presented with acute febrile hypogastric and suprapubic pain. Initial clinical and laboratory findings suggested a lower abdominal or pelvic inflammatory process, leading to diagnostic uncertainty. Computed tomography revealed inflammatory changes centered on the pubic symphysis, with symphyseal erosions and a retropubic/prevesical fluid collection. Magnetic resonance imaging further characterized the lesion, demonstrating bone marrow edema, soft tissue inflammatory involvement, and an ill-defined fluid collection with surrounding enhancement and caudal extension toward the proximal adductor and perineal soft tissues. Ultrasound-guided aspiration confirmed the diagnosis, yielding approximately 13 mL of purulent material positive for Staphylococcus aureus. Targeted antibiotic therapy resulted in rapid clinical improvement, with follow-up MRI showing marked regression of the collection and residual fluid-sensitive inflammatory changes. This case underscores the diagnostic challenge of spontaneous septic arthritis of the pubic symphysis and illustrates the value of cross-sectional imaging, especially MRI, for early characterization of disease extent, minimally invasive diagnostic confirmation, and post-treatment assessment.

Diagnosis of acute and chronic pelvic inflammatory disease continues to be a challenge despite advances in investigative procedures. Complications of PID include infertility, chronic pelvic pain and ectopic pregnancy. Currently, transvaginal ultrasonography is primarily used to detect tubo-ovarian abscesses (TOA) or pyosalpinx. We present a case where dynamic transvaginal ultrasound can detect filmy adhesions in the posterior the cul-de-sac corresponding to surgically confirmed PID.

Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a rare multisystem paraneoplastic disorder. The syndrome presents unique perioperative challenges, including sclerotic bone changes that may preclude conventional neuraxial techniques. The ultrasound-guided sacral erector spinae plane (SESP) block represents a novel interfacial plane block that offers an alternative approach for sacral region analgesia. We describe a 58-year-old man with POEMS syndrome who presented with an acute perianal abscess requiring surgical drainage. The patient exhibited multiple high-risk features: sacrococcygeal sclerosis preventing identification of the sacral hiatus, severe hyperkalemia (6.54 mmol/L), stage 3 chronic kidney disease, pericardial effusion, and previous ischemic stroke. These comorbidities rendered traditional caudal epidural block contraindicated and general anesthesia high risk. Under ultrasound guidance, a single-shot SESP block was performed at the S3-S4 level using 25 mL of 0.2% ropivacaine with 25 µg dexmedetomidine. The block provided complete intraoperative analgesia (visual analog scale [VAS] score of 0) and effective postoperative pain control (VAS score <2 for 24 hours), facilitating successful surgery and discharge on postoperative day 1. This case demonstrates that the SESP block is a feasible and effective alternative for patients with complex conditions such as POEMS syndrome, where neuraxial techniques are anatomically precluded or clinically contraindicated. Based on this experience and supporting literature, the SESP block warrants consideration as a valuable component of multimodal analgesic strategies for anorectal and pelvic floor surgery, particularly in high-risk patients with challenging anatomy or significant comorbidities.

Ureteroarterial fistula is an uncommon yet potentially fatal source of hematuria, typically arising in patients with a history of pelvic surgery, radiation exposure, or malignancy. An 80-year-old woman with a history of metastatic colon cancer status post chemoradiation and partial colectomy with Hartmann pouch formation, with bladder involvement, presented with abdominal pain and hematuria. During hospitalization, she developed hypotension with an acute drop in hemoglobin to 7 g/dL. Triphasic CT angiography (CTA) revealed active arterial contrast extravasation from the left external iliac artery into the distal ureter, consistent with a ureteroarterial fistula. Digital subtraction angiography (DSA) confirmed a left external iliac artery pseudoaneurysm, and the patient underwent successful endovascular management with a covered stent placement and exclusion of the left hypogastric artery. Hematuria resolved following intervention, with stabilization of hemodynamics and hemoglobin levels. The patient was maintained on continuous bladder irrigation. Although her long-term prognosis remained poor due to advanced malignancy, she was ultimately stabilized and discharged home. This case emphasizes the need for early recognition of ureteroarterial fistula in high-risk patients and underscores the value of multiphasic imaging and endovascular management.

Acute abdomen in elderly postmenopausal women requires prompt evaluation to exclude life-threatening conditions such as bowel perforation, intra-abdominal sepsis, and malignancy. Advanced gynecological malignancies may involve the gastrointestinal tract, commonly through peritoneal dissemination or direct invasion. However, presentation as bowel perforation is rare and associated with significant morbidity. A 61-year-old postmenopausal woman presented with diffuse abdominal pain and altered bowel habits. She was hemodynamically unstable with clinical features of sepsis. Imaging revealed a pelvic mass with suspected bowel involvement, pneumoperitoneum, and a hepatic lesion suggestive of metastasis. Emergency exploratory laparotomy demonstrated purulent peritoneal contamination and a sloughed ileal segment near the ileocecal junction, forming a mass with adjacent pelvic structures and a hepatic lesion suggestive of metastasis. Ileal resection with end ileostomy was performed. Histopathological examination of the bowel segment and liver lesion biopsy revealed metastatic carcinomatous deposits. Immunohistochemistry showed CK7+, PAX8+, WT1+, CK20-, and SATB2-, favoring a Müllerian origin. Further imaging demonstrated advanced disease with hepatic and vertebral metastases. The patient received combination chemotherapy with gemcitabine, carboplatin, and bevacizumab, achieving a near-complete metabolic response. Bowel perforation as an initial presentation of pelvic malignancy is rare. This case highlights the importance of clinical judgment in managing an acute abdomen, especially when imaging findings are inconclusive. Immunohistochemistry plays a crucial role in identifying the primary tumor origin. Management requires a staged approach with emergency surgical intervention followed by multidisciplinary oncological treatment for optimal outcomes.

Acute abdominopelvic pain requires rapid imaging triage, traditionally dominated by computed tomography (CT) and ultrasound (US). However, advances in magnetic resonance imaging (MRI), including accelerated acquisition, motion-robust sequences, and non-contrast protocols, have expanded its role beyond a problem-solving tool toward selective first-line imaging in specific clinical scenarios. This review provides a decision-based framework for MRI utilization in nontraumatic abdominopelvic emergencies, integrating current evidence on diagnostic performance, workflow considerations, and clinical impact. MRI offers clear advantages in radiation-sensitive populations (pregnant and pediatric patients), in biliary obstruction, and for characterizing pancreatic complications, while remaining complementary in most other emergency settings. We highlight high-yield indications where MRI may replace or precede CT, supported by comparative data, and provide practical, rapid MRI protocols (< 15 min) adaptable to emergency workflows. Importantly, we present a balanced discussion of real-world constraints, including availability, cost, scan time, and patient tolerance, that currently limit universal adoption. MRI should therefore be viewed not as a universal replacement for CT, but as a targeted, high-value imaging strategy in selected emergency scenarios where it improves diagnostic confidence, avoids ionizing radiation, and influences management.