Search Results (873)

Objective: Our objective was to compare clinical safety and postoperative efficacy between transvesicoscopic Politano–Leadbetter (TPL) and laparoscopic Lich–Gregoir (LLG) ureteral reimplantation in infants and toddlers under 36 months diagnosed with primary obstructive megaureter (POM). Methods: This was a single-center retrospective cohort study of pediatric patients with POM who underwent ureteral reimplantation between January 2018 and April 2025. Patients were stratified into TPL and LLG groups by surgical approach. Baseline characteristics, perioperative outcomes, perioperative complications, imaging findings, renal functional outcomes, and long-term complications were collected and analyzed. Primary group comparisons were unadjusted, with additional multivariable linear regression performed for operative duration. Results: We enrolled 65 children: 30 in the TPL group and 35 in the LLG group. Baseline characteristics showed no statistically significant differences across the two study cohorts. There were no open conversions in either group. Total operative duration did not differ significantly between the TPL and LLG groups (145.8 ± 30.6 min vs. 136.9 ± 25.2 min; mean difference, 8.9 min; 95% CI, −4.9 to 22.7; p = 0.210). In multivariable linear regression, TPL showed a non-significant trend toward longer operative time after adjustment for age, preoperative ureteral diameter, and surgery year (B = 10.4 min; 95% CI, −3.7 to 24.4; p = 0.141). Time to postoperative oral intake was slightly shorter in the TPL group (6.1 ± 2.3 h vs. 8.2 ± 2.9 h; mean difference, −2.1 h; 95% CI, −3.4 to −0.8; p = 0.002). No statistically significant differences were detected in estimated blood loss, ureteral tapering rate, double-J stent placement rate, postoperative pain score, acetaminophen use, urinary catheterization duration, or length of hospital stay. Perioperative complications occurred in 3 patients in the TPL group and 5 patients in the LLG group (10.0% vs. 14.3%; risk difference, −4.3%; 95% CI, −20.1% to 11.5%; p = 0.716). No Clavien–Dindo grade III or higher complications occurred in either group. During follow-up, both groups showed reductions in anteroposterior pelvic diameter (APD) and ureteral diameter (UD), with preserved differential renal function (DRF). Low-grade postoperative vesicoureteral reflux (VUR) was detected in two LLG patients, including one grade I case at 4 months and one grade II case at 6 months after surgery; both were managed conservatively. Neither group experienced recurrent ureterovesical junction obstruction (UVJO) nor required reoperation during follow-up. Conclusions: In this single-center retrospective cohort of infants and toddlers with POM, no statistically significant differences were detected in the main perioperative and follow-up outcomes between TPL and LLG. TPL enables intravesical reconstruction and better preserves the natural anatomical course of the ureter and may serve as an alternative minimally invasive option for this patient population. Full article

Background: This systematic review aimed to evaluate the safety and outcomes of extraperitoneal cesarean section (EPCS), including the French Ambulatory Cesarean Section (FAUCS), by comparing them to those of transperitoneal cesarean section (TCS). Data Sources: The search was conducted using the following electronic bibliographic databases: PubMed, Web of Science, and Scopus. Studies were included if they were observational or interventional and investigated EPCS, including FAUCS, as the primary intervention. Exclusion criteria were animal studies, reviews, editorials, and conference abstracts. Methods: Two reviewers independently assessed the risk of bias using RoB 2 for RCTs and ROBINS-I for retrospective studies. Studies were grouped into comparable categories, and data were synthesized in summary tables and by comparative descriptive analysis. Results: In comparative studies, EPCS was associated with significantly lower rates of postoperative complications, such as fever (4% vs. 16% for TCS) and elevated C-reactive protein or leukocytosis (0% vs. 16–20%). EPCS reduced postoperative pain, with lower VAS scores at 24 h (e.g., 2.5 vs. 4.0 in TCS, p < 0.001) and shorter analgesic use. Time to return of bowel function was faster in EPCS and modified EPCS (6–8 h vs. 18–24 h in TCS, p < 0.01). Hospital stays were shorter after EPCS (4.15 ± 0.89 days vs. 4.82 ± 1.34 days, p = 0.027). FAUCS enabled early discharge within 24–48 h in 86–93% of cases and reduced morphine use (0.8% vs. 38% in TCS). Neonatal outcomes, including Apgar scores and cord pH, were similar across all groups. Conclusions: EPCS offers several potential advantages over TCS, including less postoperative pain, faster recovery, and shorter hospital stays. EPCS and its FAUCS variant are also associated with quicker return of bowel function and lower analgesic needs. TCS, while enabling faster fetal delivery, is linked to greater postoperative discomfort and slower recovery. However, current evidence is limited, and further high-quality trials are needed to confirm these benefits and assess long-term outcomes. Full article

The increasing detection of small, non-palpable testicular lesions has challenged the traditional paradigm that every solid intratesticular mass should be managed by radical orchiectomy. Many incidental lesions, particularly in infertile men and in patients with negative tumour markers, are benign or non-neoplastic, making overtreatment a clinically relevant concern. In this setting, ultrasound has become central to a more conservative and individualised diagnostic strategy. By combining high-resolution grey-scale imaging with Doppler, microvascular imaging, CEUS and elastography, multiparametric ultrasound provides complementary information on lesion morphology, vascularity, stiffness and interval change. When integrated with clinical presentation, tumour markers, fertility status, syndromic background and patient history, these features can help characterise lesions and estimate the likelihood of malignancy in the appropriate clinical context. Although imaging cannot replace histology, it can refine pre-test probability, support active surveillance in selected low-risk lesions, guide testis-sparing surgery, and improve assessment of the operated testis. This review examines the role of multiparametric ultrasound in characterisation of focal testicular lesions across different clinical settings, including incidentalomas, acute scrotal pain, trauma, bilateral disease, heterogeneous parenchyma, genetic and endocrine syndromes, and the postoperative testis. A structured, context-sensitive imaging approach may help reduce unnecessary orchiectomy while preserving timely detection of malignant, persistent, recurrent or metachronous disease. Full article

Introduction: Major retroperitoneal arterial bleeding may remain clinically difficult to recognize when vital signs are initially stable. Case presentation: We report the case of a 67-year-old man who developed progressive abdominal and right groin pain radiating to the ipsilateral flank, accompanied by two episodes of vomiting and an early hemoglobin (Hb) and hematocrit decline on the first postoperative day after right-sided direct anterior total hip arthroplasty (THA). Despite the absence of hemodynamic instability, computed tomography angiography (CTA) demonstrated active contrast extravasation from the right external iliac artery (EIA) with a large retroperitoneal hematoma. CTA localized the bleeding source and enabled immediate endovascular treatment planning. Subsequent angiography confirmed active extravasation from the right EIA, and a covered stent–graft was deployed through ultrasound-guided superficial femoral artery access, achieving complete exclusion of the bleeding source with preserved arterial patency. The subsequent Hb nadir and transfusion were interpreted as reflecting preceding retroperitoneal blood loss rather than persistent bleeding, because follow-up CTA showed a stable hematoma without active extravasation. The patient was discharged in stable condition, and 1-month duplex ultrasound and following 3-month CTA confirmed stent–graft patency. Discussion: This case highlights the diagnostic mismatch that may occur between substantial retroperitoneal blood loss and initially reassuring hemodynamic findings. When progressive abdominal or groin symptoms are accompanied by a serial, otherwise unexplained Hb decline, CTA may be more informative than DUS for suspected deep pelvic bleeding because it can identify active extravasation, define hematoma extent, assess alternative abdominopelvic causes, and support treatment planning. In anatomically suitable lesions, covered stent–graft repair can rapidly control hemorrhage while preserving EIA patency. Conclusions: Stable vital signs do not exclude major retroperitoneal arterial bleeding after direct anterior THA. Progressive abdominal or groin pain with early postoperative Hb decline should raise suspicion for occult vascular injury, for which CTA can provide rapid diagnosis and guide immediate endovascular management. Full article

Perioperative management of antirheumatic medications in adults with rheumatoid arthritis (RA) undergoing orthopedic surgery requires balancing postoperative infection and impaired wound healing against disease flare, pain, and delayed rehabilitation. This systematic review aimed to evaluate how perioperative continuation, withholding, interruption timing, restart timing, dose modification, or exposure to antirheumatic medications relates to postoperative outcomes in adults with RA undergoing arthroplasty and non-arthroplasty orthopedic procedures. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched from database inception to 18 April 2026 for English-language full-text clinical studies. The primary outcomes were surgical site infection/periprosthetic joint infection, delayed wound healing, and postoperative RA flare. Secondary outcomes included reoperation, revision, readmission, mortality, venous thromboembolism, dislocation, and other procedure-specific complications. Original studies were classified as direct perioperative strategy evidence, medication-exposure evidence, or supportive clinical-context evidence. Forty-three original clinical studies were included, together with six non-original contextual sources. The evidence was predominantly observational, clinically heterogeneous, and of very low certainty. Methotrexate continuation was not associated with an evident increase in early postoperative complications, whereas direct evidence for other conventional synthetic agents was limited. Longer interruption of biologic or targeted synthetic therapy did not consistently reduce infection or wound-healing complications, while several studies associated treatment interruption with postoperative flare. Chronic baseline glucocorticoid exposure was associated with adverse outcomes but was clinically distinct from short-term perioperative administration; stress-dose supplementation was not directly evaluated. Medication decisions should therefore be individualized according to drug class, disease control, glucocorticoid burden, surgical procedure, and patient risk profile. Full article

Angioleiomyoma is a benign soft tissue tumor originating from the smooth muscle of vascular structures. Though relatively uncommon, it frequently occurs in the lower extremities and is often misdiagnosed due to its nonspecific clinical presentation. We report the case of a 54-year-old female with chronic posterolateral heel pain initially attributed to insertional Achilles tendinopathy and Haglund’s deformity. After failure of conservative management, MRI revealed a well-circumscribed subcutaneous lesion with signal characteristics concerning for a soft tissue neoplasm. Surgical excision was performed, and histopathologic analysis confirmed a venous-type angioleiomyoma, characterized by thick-walled vascular channels and smooth muscle proliferation without atypia. Immunohistochemistry was positive for SMA, weakly positive for desmin, and ERG-positive in the vascular endothelium. The patient experienced complete symptom resolution postoperatively. Although not exceedingly rare, angioleiomyomas remain underrecognized in clinical practice, particularly in the foot and ankle, resulting in diagnostic delays averaging over five years. MRI demonstrated characteristic features described in recent literature, validating its utility in preoperative assessment. This case reinforces the importance of maintaining a broad differential when evaluating chronic, focal heel pain and supports the use of advanced imaging and histopathologic confirmation in atypical cases. Greater awareness of angioleiomyomas can help reduce diagnostic delays and improve outcomes in patients with chronic, unexplained soft tissue pain in the foot and ankle. Full article

Background and Objectives: Non-traumatic spontaneous adrenal mass rupture (SAMR) is a rare and life-threatening surgical emergency. It has around a 32% mortality rate based on the underlying pathology. We aimed to explore the presentations, management, and outcomes of SAMR with various pathologies. Materials andMethods: We reviewed electronic and operative records over the last eight years to identify SAMR at our institute. Patients’ demographics, comorbidities, presentations, pathology, interventions, and outcomes were analyzed. Results: There were 14 unilateral SAMR patients who arrived at the emergency department (ED)presenting with abdominal pain. The median age at presentation was 34 years (range 27–56). In total, 12 patients were male (83.3%), and 2 were female, including a 32-week-pregnant woman. Ten were South Asians and four were Arabs. All the patients with SAMR did not have a history of prior adrenal disorders. Nine patients had hypotension at presentation. After the initial clinical examination, the patients underwent a computed tomography (CT) scan in the ED, which revealed unilateral SAMR. There was no medical history of adrenal mass or trauma prior to index admission. The CT scan size of the masses ranged from 5.5 to 23.6 cm (eight were right-sided and six left-sided). Time to intervention ranged from 1 to 11 days. Histopathology showed four pheochromocytomas, four myelolipomas, three normal adrenal tissues with hemorrhagic cysts, one adrenal gland hemorrhage, one pseudocyst, and one angiosarcoma. Six adrenal masses were non-functioning. All patients were managed with open adrenalectomy (two had pre-operative interventional radiological embolization). Blood transfusion was required in most cases. Ten patients required post-operative surgical intensive care with an average stay of 2.42 days. There were no perioperative deaths during the hospital course. Conclusions: Ruptured adrenal masses most commonly present with acute abdominal pain requiring urgent surgical intervention, particularly in patients with hemodynamic instability, insufficient initial conservative management or malignancy. Despite the dramatic presentation, outcomes are favorable in experienced centers when early diagnosis and hemodynamic optimization precede interventions and are accompanied by multidisciplinary team involvement. Full article

Patients with heart failure require special considerations in the perioperative setting given the challenges caused by heart failure pathophysiology. This pathophysiology is complex and involves several mechanisms that contribute to both disease progression and the clinical syndrome, including cardiac remodeling, neurohormonal activation, and resultant hemodynamic derangements. Anesthetic management of these patients requires diligence at all stages of care. Preoperative assessment includes risk stratification, management of comorbid conditions, and heart failure medication management. Anesthetic agents have differing effects on hemodynamics and selection of these agents must be aimed at preventing hemodynamic collapse in patients with heart failure. In addition, the increased risk of intraoperative complications among these patients often necessitates means of invasive hemodynamic monitoring and use of vasopressor or inotropic support. Finally, the postoperative care of heart failure patients requires attention to the volume status of these patients, as well as considerations for pain management and modulation of the surgical stress response. In this review article, we aim to review how the pathophysiologic mechanisms and changes that occur with heart failure impact anesthetic management and patient-centered perioperative care. Full article

Background/Objectives: Optimizing surgical visualization via controlled hypotension and managing postoperative pain remain challenging in arthroscopic Bankart repair. While interscalene brachial plexus block (ISBPB) is effective, pharmacological adjuncts may further improve hemodynamics and prolong analgesia. The aim of this study was to assess the impact of intraoperative intravenous dexmedetomidine on visual clarity, hemodynamics, and postoperative pain during arthroscopic Bankart repair. Methods: This retrospective, single-center cohort study evaluated 63 patients undergoing isolated anterior Bankart repair under ISBPB. The dexmedetomidine group (Group D, n = 33) received an intravenous dexmedetomidine loading dose (1 mcg/kg) and maintenance infusion (0.5 mcg/kg/h) alongside ISBPB. A historical control group (Group C, n = 30) received ISBPB alone. Secondary outcomes included serial intraoperative hemodynamics, blinded surgeon-rated surgical visualization, and pain scores, while the primary outcome was postoperative analgesia duration. Results: Baseline characteristics were comparable between groups. Group D yielded significantly higher surgeon satisfaction for visual clarity (p < 0.001). Intraoperatively, Group D showed a significantly lower diastolic blood pressure at the 50 min mark after correction for multiple comparisons. Postoperatively, Group D exhibited significantly lower 24 h visual analog scale (VAS) pain scores (p < 0.001) and a significantly prolonged duration of analgesia (7.45 vs. 4.16 h; p = 0.001). Overall patient satisfaction and Pain Catastrophizing Scale scores did not differ significantly between cohorts. Conclusions: In this retrospective cohort, adjunctive intravenous dexmedetomidine added to ISBPB was associated with improved surgeon-rated visualization, lower postoperative pain scores, and prolonged analgesia, without an increase in adverse events. Due to the retrospective design and historical control group, these findings should be interpreted as associations; prospective randomized trials are required to confirm them. Full article

Objectives: Retrospective comparative cohort study. This study aimed to compare the clinical and radiological outcomes of rigid, dynamic, and hybrid stabilization systems in the surgical management of degenerative lumbar spine disease, with a focus on adjacent segment disease (ASD), fusion-related complications, and postoperative recovery. Rigid fusion techniques provide immediate stability but may increase mechanical stress at adjacent segments, leading to ASD. Dynamic and hybrid constructs aim to preserve more physiological motion, potentially reducing fusion-related complications. Methods: A retrospective analysis was conducted on 86 patients who underwent posterior lumbar stabilization between January 2017 and December 2021. Patients were categorized into four groups based on the surgical technique: Rigid (titanium rod), Dynamic (PEEK rod), Rigid + TLIF (Transforaminal Lumbar Interbody Fusion), and Hybrid (Dynamic + TLIF). Clinical evaluation included the Visual Analog Scale (VAS) for back and leg pain. Radiological assessments comprised segmental and total range of motion (ROM), disc and foraminal height, fusion success, pseudoarthrosis, and the presence of ASD. Results: All surgical approaches resulted in significant postoperative improvement in back and leg pain (p < 0.001). The incidence of ASD was highest in the Rigid + TLIF group (45.5%, p < 0.001) and lowest in the Dynamic (4.8%) and Hybrid (4.2%) groups. Pseudoarthrosis was most frequently observed in the Rigid group (26.3%). The Hybrid group demonstrated favorable outcomes, with a high anterior fusion rate (91.7%) and low rates of ASD and pseudoarthrosis. Conclusions: All stabilization techniques were associated with significant postoperative clinical improvement. In this retrospective cohort, dynamic and hybrid constructs showed lower observed rates of early symptomatic ASD than the Rigid + TLIF construct, while TLIF-treated groups showed higher anterior fusion rates. Because treatment allocation was nonrandomized and adjustment for all potential confounders was not possible, these findings demonstrate associations rather than causal treatment effects. Larger prospective studies with longer follow-up are required to determine whether the stabilization strategy independently influences ASD, fusion, or pseudoarthrosis. Full article

Introduction: Desmoid fibromatosis (DF) is a rare, locally invasive, and typically non-metastatic neoplasm. Its pathophysiology is poorly understood, and the subtle clinical presentation makes diagnosis challenging. A multidisciplinary approach is necessary to achieve a definitive diagnosis and identify the most effective therapeutic strategy. Because of its heterogeneous presentation and unpredictable behavior, DF cannot be managed through a standardized protocol, and diagnostic and therapeutic decisions must instead be tailored to the individual patient, consistent with a personalized-medicine approach. We present an unusual case in which we aim to evaluate the diagnostic procedures and treatments used and determine whether they align with the recent literature. Materials and Methods: A case report. A 27-year-old man presented with fever and worsening abdominal pain, without clinical signs of intestinal obstruction. He had undergone a sleeve gastrectomy five years earlier. A computed tomography (CT) scan revealed an intra-abdominal mass in the mesohypogastric region, likely originating from the mesentery of the small intestine. The patient underwent a right hemicolectomy extended to the terminal ileum. Histopathological examination and immunohistochemistry confirmed the diagnosis of DF. The patient was discharged on the 5th postoperative day (POD) in good general clinical condition. To date, there are no signs of recurrence. Conclusions: The multidisciplinary approach is essential for managing DF and R0 surgical resection remains the gold standard. The diagnostic and therapeutic pathway followed in our patient appears consistent with the recent literature. This case illustrates how individualized clinical reasoning can be applied even to a rare, heterogeneous neoplasm for which no standardized protocol exists. Furthermore, an established post-surgical management protocol for DF has not yet been developed. Additionally, we observed a possible, hypothesis-generating association between bariatric surgery and the subsequent onset of an intra-abdominal desmoid tumor; given the rarity of desmoid fibromatosis relative to the high volume of bariatric procedures performed worldwide, this observation should not be interpreted as a confirmed correlation, and we conducted a literature review to explore it as a hypothesis. Numerous studies are needed on this matter, but we hope that this case can provide a small starting point for subsequent studies. Full article

Total-knee arthroplasty (TKA) is associated with substantial acute postoperative pain. While the adductor canal block (ACB) is widely used to provide motor-sparing anterior knee analgesia, effective management of posterior knee pain remains an important clinical challenge. The infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) block was developed to address posterior capsular pain but may be associated with technical and ergonomic limitations. More recently, the popliteal plexus block (PPB) has emerged as a novel motor-sparing alternative. This narrative review summarizes the anatomical basis, current clinical evidence, and practical considerations of combining the ACB with the PPB, with particular emphasis on its potential role as an alternative to the IPACK block within Enhanced Recovery After Surgery (ERAS) pathways. Current anatomical and early clinical evidence suggests that the PPB selectively targets the terminal articular branches around the adductor hiatus while preserving the major motor nerve trunks. Available randomized clinical trials indicate that the PPB provides analgesia comparable to IPACK while maintaining motor function, with additional practical advantages including shorter procedural time and, in individual studies, reduced postoperative opioid consumption and postoperative nausea. Overall, the combined ACB and PPB approach appears to be a promising motor-sparing strategy for perioperative analgesia after TKA. However, the current evidence is derived predominantly from cadaveric studies, early-phase randomized trials, and single-center clinical investigations. Therefore, larger multicenter studies with longer follow-ups are needed to establish its long-term efficacy, safety, and role relative to the established IPACK technique. Full article

Background: High tibial osteotomy (HTO) is commonly performed to manage medial compartment knee osteoarthritis by correcting mechanical alignment; however, the role of adjunctive regenerative therapies remains uncertain. Methods: This retrospective study compared leukocyte-rich platelet-rich plasma (LR-PRP) with leukocyte-poor PRP (LP-PRP) in patients undergoing HTO. Forty patients were allocated into three groups: HTO alone (n = 10), HTO with LR-PRP (n = 20), and HTO with LP-PRP (n = 10). Clinical outcomes were assessed preoperatively and at 12 months using the Visual Analog Scale, Oxford Knee Score, and Western Ontario and McMaster Universities Osteoarthritis Index. Cartilage repair appearance was evaluated through second-look arthroscopy using the ICRS grading and Koshino staging systems. Multivariable analysis of covariance (ANCOVA), adjusting for baseline imbalances, was employed to evaluate postoperative outcomes. Results: All groups demonstrated significant improvements in pain and function (p < 0.05), with no significant differences among groups. However, Group B exhibited a greater shift toward lower ICRS grades than Group A (p < 0.05), whereas no significant difference was found between Groups C and A. Arthroscopic findings revealed more complete defect coverage and improved structural integrity in the LR-PRP group. Conclusions: These findings demonstrate a clear discrepancy exists between clinical and structural outcomes; while HTO drives substantial and comparable short-term functional improvements across all cohorts, adjunctive LR-PRP is positively associated with a significantly enhanced arthroscopic cartilage repair appearance compared to LP-PRP or HTO alone. Further prospective studies are needed to validate these findings and elucidate the underlying biological mechanisms. Full article

Background: Cancer rates are increasing significantly worldwide, with surgical intervention being the most convenient intervention. Transversus abdominis plane (TAP) block has been proven to enhance postoperative opioid use and its associated complications. Additionally, dexmedetomidine has been reported to provide effective analgesia with relatively minimal respiratory complications. This systematic review and meta-analysis aims to explore the efficacy of combining dexmedetomidine with transversus abdominis plane (TAP) block compared to transversus abdominis plane (TAP) block alone in patients undergoing various cancer surgeries as outcomes may also be influenced by surgical and patient-related factors. Methods: We conducted a comprehensive literature search across PubMed/MEDLINE, Scopus, Web of Science, Cochrane CENTRAL, and Embase to identify randomized controlled trials evaluating the efficacy and safety of dexmedetomidine as an adjunct to transversus abdominis plane (TAP) block in patients undergoing cancer surgery. Data were extracted from the six eligible randomized controlled trials that met the predefined inclusion criteria, and a random-effects meta-analysis was performed using RevMan software Version 5.4. Results: The meta-analysis found that dexmedetomidine as an adjunct to transversus abdominis plane (TAP) block was more effective than transversus abdominis plane (TAP) block alone in reducing the mean arterial pressure and the mean heart rate 2 h postoperatively (MD −6.46, 95% CI [−8.63; −4.30], p < 0.0001) and (MD −5.44, 95% CI [−7.67; −3.20], p < 0.0001). The duration until the first rescue analgesia was significantly longer in the TAP–DEX group (MD 3.75, 95% CI [3.08; 4.43], p < 0.0001). The overall patient satisfaction with postoperative pain management demonstrated statistically significant improvement compared to the TAP group (RR 1.31, 95% CI [1.13; 1.53], p = 0.0005). visual analog scale (VAS) pain scores, which are used to assess pain intensity, were significantly lower at rest and during movement 2 h postoperatively in the TAP-DEX group, although some complex patients may have difficulty using visual analog scale (VAS) pain scores accurately. Therefore, the Numeric Rating Scale (NRS) may be considered as an alternative tool. Conclusions: Compared to transversus abdominis plane (TAP) block alone, the dexmedetomidine and transversus abdominis plane (TAP) block arm showed a statistically significant difference in time to first rescue analgesia, patient overall satisfaction, nausea, and vomiting. However, no statistical significance difference was found across the remaining outcomes. Full article

Introduction: Uterine leiomyosarcoma (uLMS) is a rare, highly aggressive malignancy arising from the smooth muscle tissue of the uterine wall. It typically presents with abnormal vaginal bleeding, pelvic pain, or a pelvic mass. In rare instances, symptoms may result from local invasion or metastasis. We report a case of uLMS initially diagnosed following colonic perforation due to direct tumor invasion, accompanied by a comprehensive narrative review of the literature on the incidental identification of uterine sarcomas during emergency general surgery to further emphasize the diagnostic challenges, treatment approaches, and need for individualized care in these complex cases. Case Presentation: A 45-year-old woman presented to the Emergency Department with acute abdominal pain of several hours’ duration, in the absence of other associated symptoms. An emergency exploratory laparotomy was performed, revealing feculent peritonitis secondary to sigmoid colon rupture, resulting from local invasion by a large uterine mass. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was undertaken, followed by en bloc resection of the sigmoid colon, appendectomy and construction of a terminal colostomy. Her postoperative course was uneventful, and she was discharged on postoperative day eight. Histopathological examination of the specimen revealed a high-grade uterine leiomyosarcoma. Following evaluation by a multidisciplinary oncology board, the patient received adjuvant chemotherapy. Methods and Results: A narrative review of the literature was performed to identify cases of uterine sarcomas incidentally diagnosed during emergency surgery performed by general surgeons. Including the present case, six cases were identified. Most patients presented with acute abdomen mimicking gastrointestinal pathology, with diagnosis established intraoperatively or postoperatively. Definitive surgical management was achieved during the initial emergency procedure in all cases. Conclusion: Although exceptionally rare, uterine sarcoma should be considered in the differential diagnosis of acute abdomen in female patients undergoing emergency surgery. Awareness of this atypical presentation, the appropriate diagnostic approach, real-time intraoperative adaptability, and individualized multidisciplinary management are essential for ensuring appropriate surgical management and optimizing patient care. Full article