Ruptured ectopic pregnancy in rudimentary horn of the uterus

Rudimentary horn is one of the rarest congenital uterine anomalies and consists of a relatively normal appearing uterus on one side with a rudimentary horn on the other side. It is difficult to diagnose before surgery and hazardous to maternal life as rupture of pregnant horn result in severe hemoperitoneum. Case of rudimentary horn pregnancy is reported in a lady with history of habitual abortion and signs and symptoms of acute adnexal pathology. Exploratory laparotomy revealed ruptured rudimentary horn pregnancy. Excision of accessory horn was done.     

Laparoscopic excision of a rudimentary uterine horn in a child

Unicornuate uterus with a rudimentary horn is the rarest congenital anomaly of the female genital system. It can result in a variety of gynecologic and obstetric complications. This case report is an acute presentation of a cavitated, noncommunicating, rudimentary horn in a premenarchal girl. Successful laparoscopic excision was performed. The full extent of the anomaly was diagnosed by a combination of operative findings and postoperative magnetic resonance imaging.     

Laparoscopic management of rudimentary uterine horn pregnancy: case report and literature review.

BACKGROUND: Pregnancy in the rudimentary uterine horn is an extremely rare clinical condition. Treatment includes surgical removal of the rudimentary horn. METHODS: A rudimentary horn pregnancy was reported that occurred after intrauterine insemination. Similar cases treated with laparoscopic surgery reported in the peer-reviewed journals were reviewed as well. RESULTS: Pregnancy in the right rudimentary horn of 6-weeks gestational age was successfully treated with laparoscopic surgery. CONCLUSION: Laparoscopy is a feasible and safe method for treating rudimentary horn pregnancy.     

Rupture of non-communicating rudimentary uterine horn pregnancy

Unicornuate uterus with rudimentary horn is a rare type of uterine malformation associated with obstetrical complications. Rupture of pregnant rudimentary horn is the usual presentation resulting in severe haemoperitoneum with increased maternal morbidity, and at times, mortality. A case of ruptured rudimentary horn pregnancy in a 24-year-old, second gravida, is reported. Exploratory laparotomy revealed a ruptured rudimentary horn pregnancy of 14 weeks gestation with haemoperitoneum. Excision of the rudimentary horn was done and an uneventful recovery followed.     

Pregnant noncommunicating rudimentary uterine horn with placenta percreta.

BACKGROUND: To report a placenta percreta in a 7-week gestational rudimentary noncommunicating uterine horn pregnancy. METHODS: A 28-year-old woman with no complaints presented with a rudimentary uterine horn pregnancy at 7-weeks gestation. The diagnosis was suspected by ultrasonography and diagnosed by laparoscopy. Laparoscopic excision of the rudimentary uterine horn and ipsilateral salpingectomy were performed, as well as biopsy of several peritoneal endometriosis lesions. RESULTS: A 7-week gestation pregnancy with placenta percreta was identified in the rudimentary uterine horn. No communication was found with the right unicornuate uterus. Endometriosis was confirmed. Clinical outcome was favorable. CONCLUSION: Placenta percreta may occur in rudimentary uterine horn pregnancies, but accidents may be avoided by an early diagnosis and surgical management. However, in young women who desire pregnancy, planned laparoscopic resection of a rudimentary uterine horn revealed accidentally should be discussed.     

Combined medical and surgical management of rudimentary uterine horn pregnancy.

BACKGROUND: Pregnancy within a noncommunicating rudimentary horn is a known complication of unicornuate uterus. The risk of rupture approximates 50%, most of which occur in the second trimester. Case: A rudimentary horn pregnancy was discovered at 8 weeks gestation. Medical termination was then performed with fetal intracardiac potassium chloride and intraplacental methotrexate. Magnetic resonance imaging (MRI) of the pelvis was obtained. Laparoscopic uterine horn resection 6 weeks after medical termination was performed. DISCUSSION: While surgical resection of a rudimentary horn pregnancy is necessary, early diagnosis affords the opportunity to take steps that minimize surgical risks. MRI assists surgical planning by demonstrating the form of attachment of the uterine horn to the unicornuate uterus. Preoperative medical termination may decrease vascularity of the gestation, thereby decreasing operative blood loss.     

HERNIA UTERUS INGUINALE ASSOCIATED WITH UNILATERAL RENAL AGENESIS

We report a patient with a rudimentary uterine horn, fallopian tube and ovary in an inguinal hernia. Associated with this abnormality the patient had ipsilateral renal agenesis and a unicornuate uterus.     

Laparoscopic removal of a rudimentary uterine horn in a previously hysterectomized patient.

BACKGROUND: The unicornuate uterine anomaly is often difficult to diagnose and usually low on the list of differential diagnoses for pelvic pain and dysmenorrhea. The authors present a case of a rudimentary uterine horn as a cause for continued pelvic pain and dysmenorrhea in a previously hysterectomized woman. CASE REPORT: A 43-year-old woman, gravida 1, para 1, presented for evaluation of right lower quadrant pain of several years' duration. Her past surgical history was significant for multiple prior laparoscopies and a vaginal hysterectomy. Radiographic studies revealed a mass in the right lower quadrant. Laparoscopy revealed a solid mass in the right pelvis that was diagnosed as a rudimentary uterine horn. CONCLUSION: Uterine anomalies, although uncommon, should be thought of as part of the differential diagnosis for pelvic pain and dysmenorrhea. A thorough inspection of the pelvis should be performed at the time of any operative procedure for abdominal pain.     

Laparoscopic removal of a symptomatic rudimentary uterine horn in a perimenarchal adolescent

An adolescent patient with a symptomatic, noncommunicating, rudimentary uterine horn is described. Diagnosis was suggested by ultrasonography and treatment was by laparoscopic resection. A review of other pediatric cases as well as the adult literature gives evidence that laparoscopic resection is worth considering in such cases.     

Robot-assisted laparoscopic surgery for a rudimentary uterine horn with two non-communicating cavities

Due to severe dysmenorrhoea a 29-year-old woman, gravida 2 para 2, was diagnosed with a unicornuate uterus and a rare variety of a rudimentary uterine horn associated with two separate non-communicating cavities. Increasingly intense dysmenorrhoea, refractory to medical treatment, motivated fertility-sparing surgical treatment. A da Vinci S-HD robot was side-docked to facilitate simultaneous vaginal access during surgery. After sacrificing the left uterine artery for hemostatic reasons, the rudimentary horn with one cavity was resected. Guided by vaginal ultrasonography we then completely resected the second cavity located deep in the myometrium without entering the cavity of the functioning hemiuterus. Finally the uterine defect was sutured in two layers. Surgery and postoperative course were uneventful. At 4-month follow-up, dysmenorrhoea was alleviated, and 3 months later the patient had an early intrauterine pregnancy. We believe the precise dissection capabilities of the robot facilitated in particular resection of the second, deeply located cavity and its multilayer reapproximation by sutures. A video of the procedure is provided.     

Diagnosis and Management of Acute Gastric Distention following Laparoscopic Adjustable Gastric Banding

Laparoscopic adjustable gastric banding (LAGB) is commonly performed for weight reduction in the morbidly obese population. Morbidly obese patients often suffer from many co-morbid conditions including diabetes. Diabetic patients may suffer from symptomatic or asymptomatic gastric dysmotility resulting in intermittent gastric distention. Following gastric banding, in the early postoperative period, patients may be unable to decompress trapped air in the stomach and may develop severe acute distention with associated risk for catastrophic results. We present the case of a diabetic patient who underwent an uneventful LAGB but returned to the hospital with severe abdominal and back pain. Following the diagnosis of acute gastric distention using an abdominal roentgenogram, the stomach was decompressed using a naso-gastric tube. Following initiation of promotility agents, the patient was successfully discharged home without symptoms. A high index of suspicion, prompt diagnosis and appropriate management can prevent complications of acute gastric distention in this patient population.     

Laparoscopic resection of a non-communicating uterine rudimentary horn using intra-operative indigocarmine injection: A case report

Introduction and importanceAn unicornuate uterus with a non-communicating rudimentary horn (UUNCRH) is a very rare uterine malformation which is difficult to diagnose and to decide the surgical plan. We aim to describe the case of pediatric UUNCRH patient and our operative technique of laparoscopic intra-uterus indigo carmine injection (LIUICI) to confirm that the rudimentary horn (RH) is non-communicating before the resection and review the relevant literature to ascertain the most appropriate treatment option in these patients.Case presentationA 11-year-old girl who developed progressive severe abdominal pain and dysmenorrhea was referred to our hospital. Uterine malformation and right hematosalpinx was confirmed with magnetic resonance imaging (MRI). Pre-operative treatment with a gonadotropin-releasing hormone agonist enabled improvement in the symptoms. Laparoscopic exploration was scheduled. The right fallopian tube was resected laparoscopically and a 3Fr tube was inserted into its cut end. Indigo carmine injected in the RH through the tube. No leakage of indigo carmine was found from the vagina, indicating the diagnosis of the uterine malformation is an UUNCRH and we performed the resection of the RH safely.Clinical discussionIn pediatric patients transvaginal detailed examination is not easy to perform. Therefore, diagnostic and operative laparoscopy is critically important for the safe treatment. In addition, laparoscopic removal of a RH can be used to decrease the incidence of adhesions.ConclusionWe found LIUICI technique before the resection of the RH is safe, technically feasible and minimally invasive approach for pediatric UUNCRH patients.     

Anatomic effect of distention therapy in unstable bladder: New approach

The recent clinical success of distention therapy in the treatment of the unstable bladder is reviewed. Bladder stability and increased capacity as measured by cystometry following distention therapy as well as relief of symptoms have prompted this anatomic study. The neuromuscular pathways of conduction in rat and rabbit bladder wall were examined following short-term (two-hour) and prolonged (six-hour) distention. Treated and control animals were studied at fixed intervals for four months. Prolonged distention did not alter either smooth muscle cell architecture or intercellular junctions. It did produce a transient phase of degeneration among the unmyelinated nerve fibers in the bladder wall consisting of axonal swelling and lysis of organelles. A quantitative estimate of nerve injury was compiled using pooled histograms. These results suggest that bladder stability following distention therapy may be related to nerve degeneration in the bladder wall.     

宫腔镜联合B超诊断24例子宫畸形

目的探讨子宫畸形,尤其少女子宫畸形的宫腔镜诊断可行性. 方法选择24例子宫畸形采用宫腔镜联合B超检查确定子宫畸形的类型. 结果确诊双角子宫8例,单宫颈纵隔子宫10例,双宫颈单宫体纵隔子宫2例,青春期残角子宫4例. 结论宫腔镜联合B超诊断子宫畸形明确,且适用于少女.     

Colonoscopic decompression for pseudo-obstruction of the colon

The purpose of this report was to review the authors' experience with colonoscopy as a method of treating patients with acute colonic distention. For the period 1981-1987, 19 patients at two teaching hospitals met the selection criteria for this study. In terms of measurable decompression of a colon distention, colonoscopy was successful in 89 per cent of patients, although 41 per cent required repeat endoscopic decompression during their hospital stay. The procedure failed in two patients (11%) and operative decompression was necessary. The authors have found that colonoscopy is a useful procedure for determining the cause of progressive colon distention and for providing safe and effective treatment.     

Intestinal obstruction caused by an ectopic fallopian tube in a child: case report and literature review

The authors present the case of a prepubertal 14-year-old girl who was admitted for an acute abdominal pain, fever, and vomiting. She was in a poor general state, having recently suffered a weight loss of 5 kg. A plain abdominal x-ray disclosed signs of mechanical ileus. An abdominal ultrasound scan showed a normal uterus, a normal right-sided ovary, but no left ovary. An emergency laparoscopy found a normal uterus with complete absence of the left ovary and salpinx, the upper left dome of the uterus being smooth with no visible horn. The right ovary and salpinx were normal. Intestinal obstruction was caused by a strangulating cordlike structure of unclear origin. After converting to a laparotomy, we found an abnormal fallopian tube inserted in the left parieto-colic groove. The tube extended next on the lateral sigmo?d mesentery and wrapped itself around the ileum, provoking a local strangulation and an ischemic covered bowel perforation. The bowel perforation was treated by a segmental bowel resection. Careful dissection of the cordlike structure disclosed a true rudimentary fallopian tube with hypotrophic fimbriae and a small distal round structure containing ovarian tissue. These structures were removed entirely. A review of the literature on this rare situation is presented and discussed.     

Effects of postpneumonectomy distention on pulmonary compliance and vascular resistance

Postpneumonectomy pulmonary distention has been considered harmful by many clinicians. We measured changes in pulmonary compliance and vascular resistance with distention in five dogs. There was no significant change in compliance and vascular resistance in the range of pulmonary distention seen following pneumonectomy.     

Clinical study on responses of the upper esophageal sphincter after subtotal esophagectomy for esophageal cancer]

Responses of the upper esophageal sphincter (UES) to distention of the esophageal wall by use of a balloon catheter were measured in 30 patients after subtotal esophagectomy for esophageal cancer and 33 volunteers with unrelated disorders (control group). Patients were divided into extended dissection group and non-extended dissection group according to the width of lymph node dissection, or palsy group and non-palsy group according to recurrent-laryngeal nerve palsy. The resting upper esophageal sphincter pressure (UESP) and the upper esophageal sphincter contraction (UESC) following UES induced by swallowing were measured after esophageal distention. Neither of UESP nor UESC without distention was significantly different among each group. But those of the extended dissection group and palsy group after esophageal distention were significantly lower values than those of control group. These findings suggest that responses of the UES to distention of esophageal wall are decreased, thus protection against aspiration is probably decreased.     

脊髓压迫伤脊髓前角中微管相关蛋白1B的表达

目的 探讨在脊髓压迫伤时微时相关蛋白（ＭＡＰ）１Ｂ的表达及其意义。方法 用免疫组织化学方法对持续压迫和压迫后减压的大鼠脊髓中ＭＡＰ１Ｂ和乙酰胆碱转移酶（ＣｈＡＴ）的表达进行观察。结果 受压迫减压后的脊髓前角ＭＡＰ１Ｂ有一高表达过程,而持续压迫的脊髓无明显高表达;减压后的脊髓前角有ＣｈＡＴ的表达有所恢复,而持续压迫的脊髓前角ＣｈＡＴ的表达则明显受抑制;从时相上看,减压脊髓ＭＡＰ１Ｂ高表达出现略晚于Ｃ