Laparoscopic Management of an Intrauterine Fallopian Tube Incarceration After Curettage for a Non-progressing Pregnancy

Study ObjectiveTo report and demonstrate a case of a laparoscopic repair of an intrauterine fallopian tube incarceration as complication of curettage.DesignA step-by-step explanation of the surgery using video (instructive video) (Canadian Task Force classification III).SettingUniversity Hospital Estaing, Clermont-Ferrand, France.PatientA 29-year-old woman experiencing a nonevolving pregnancy at 8 weeks underwent curettage. After 9 months, she complained of abnormal vaginal discharge. Ultrasound evaluation showed a right parauterine mass. She reported a maternal medical history of ovarian cancer in a context of Lynch syndrome. Magnetic resonance imaging revealed a right hydrosalpinx 12 mm in diameter, with a suspect fimbriae lesion of the tube and a 7-mm endometriosis nodule of the uterine torus.InterventionWe decided to explore the fallopian tube by laparoscopy and to perform hysteroscopy. A fallopian tube incarceration was suspected during hysteroscopy: a defect of the uterine wall was observed, through which there was protrusion of a tubal fimbriae. The laparoscopic view of the pelvis confirmed incarceration of the right fallopian tube through the uterine wall. It was carefully extracted out of the uterine defect, and the uterine wall defect was repaired with an X-point using Monocryl 1.Measurements and Main ResultsA tubal patency test was performed, which was positive on both sides. Because phimosis responsible for the hydrosalpinx had been treated, salpingectomy was not performed.ConclusionCurettage for miscarriage or undesired pregnancy is not exempt from complications, such as hemorrhage, simple perforation, and infection. Intrauterine fallopian tube incarceration is uncommon but can affect fertility. This diagnosis is important to avoid destruction of the fimbriae and necrosis of the tube and also to reduce the risk of ectopic pregnancy.     

Primary carcinoma of the fallopian tube: difficulties of diagnosis and treatment.

Twenty cases initially coded as primary carcinoma of the fallopian tube were analyzed and the histological sections reviewed microscopically. Twelve cases were confirmed pathologically. The patterns of dissemination of fallopian tube carcinoma resembled those of epithelial ovarian tumors. The most common and effective treatment was total abdominal hysterectomy, bilateral salpingo-oophorectomy, and postoperative external irradiation to the whole pelvis. At the completion of the study, 2 of the 12 patients had survived 10 years, and 4 had survived 5 years. The importance of early laparotomy in patients with adnexal masses and/or continuing symptoms after uterine curettage is stressed. The potential value of postoperative irradiation to the whole abdomen and the pelvis coupled with systemic chemotherapy is discussed.     

Treatment of viable cesarean scar ectopic pregnancy with suction curettage.

OBJECTIVE: Pregnancy in previous cesarean scar is the rarest form of ectopic pregnancy. All reported cases in the literature that were treated with uterine curettage either become unsuccessful or complicated. We aimed to present a case of cesarean scar ectopic pregnancy that was successfully treated with suction curettage without any additional therapy. CASE: A 32-year-old asymptomatic woman, gravida 2, para 1 was referred to our hospital with the possible diagnosis of cervical ectopic pregnancy. Transvaginal and transabdominal sonographic examination revealed the diagnosis of viable ectopic pregnancy in a previous cesarean scar. Suction curettage with carman canulles was performed under transabdominal ultrasonographic guidance. beta-hCG decreased progressively postoperatively. CONCLUSION: Suction curettage under ultrasonography guidance can be used in termination of selected cases (early diagnosed, without symptoms that necessitates emergency intervention) of cesarean scar pregnancy.     

甲氨蝶呤联合子宫动脉栓塞术后定点吸胚术治疗剖宫产术后子宫瘢痕妊娠51例临床分析

目的:探讨甲氨蝶呤(MTX)预处理联合子宫动脉栓塞术(UAE)后超声引导下定点吸胚术治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床疗效和最佳给药方法。方法:回顾性分析首都医科大学附属朝阳医院2011年1月—2014年12月收治的采用MTX预处理联合UAE后超声引导下定点吸胚术治疗的51例CSP患者资料,按MTX不同给药方式分为3组。A组(23例):MTX全身用药后行UAE,然后行定点吸胚术;B组(11例):MTX子宫动脉灌注化疗栓塞(UACE)后行定点吸胚术;C组(17例):MTX全身用药联合UACE,再行定点吸胚术。比较各组患者的基本信息、治疗前情况和术中情况,并评估治疗效果指标。结果:3组患者均一次性手术成功,无需腹腔镜手术等二次处理,无膀胱损伤、子宫穿孔和子宫切除等并发症发生。3组患者出血量、手术时间、血清人绒毛膜促性腺激素β亚单位(β-hCG)转阴时间、包块吸收时间、手术成功率和并发症发生率比较,差异无统计学意义(均P>0.05)。B组的住院时间和住院费用较另2组减少,差异有统计学意义(均P<0.05)。孕囊或包块最大直径在Logistic回归模型中有统计学意义(OR=1.094,95%CI:1.012～1.183,P=0.024)。结论:MTX预处理联合UAE后定点吸胚术疗效确切、手术难度小、创伤小且花费少,可广泛用于治疗内生型和外生型CSP,推荐UACE作为术前预处理的首选方式,该方法对于病灶最大直径<4.3 cm的患者更安全。     

Primary Transitional Cell Carcinoma of the Fallopian Tube: A Case Report and Review of the Literature

Primary carcinoma of the fallopian tube is extremely rare and the preoperative diagnosis is often misdiagnosed as an ovarian carcinoma. We report a patient with primary carcinoma of the fallopian tube, strongly suspected preoperatively on the basis of characteristic clinical symptoms, elevated CA125 levels, and transvaginal sonography, computed tomography, and magnetic resonance imaging findings. The histology of fallopian tube carcinoma was demonstrated as transitional cell carcinoma. Extensive review of the literature showed that our case seemed to be the 14th case of primary transitional cell carcinoma of the fallopian tube.     

Fallopian Tube Presenting as a Uterine Polyp

A case is reported of a patient who presented with the clinical diagnosis of a uterine polyp extruded through the cervix. Subsequently, the "polyp" was found to be a Fallopian tube which had been pulled into the uterus through a fundal perforation of curettage performed 10 months previously.     

Unrecognized cervical pregnancy treated by suction curettage and cervicovaginal tamponade

The authors presented a case of a 30-year tertigravidar women with unrecognized cervical pregnancy, treated by suction curettage and cervicovaginal tamponade.In our case of unrecognized cervical pregnancy, during hysterometry and cervical dilatation occured uterine bleeding and clinical pictures of obstetrics hemorrhagic shock, so we continued with suction curettage and cervicovaginal tamponade as a urgent procedure which turned out as a final. Medicamentous chemotherapy of the cervical pregnancy (methotrexat) was not used, because after described procedure beta-HCG lytic decreased and without colour-Doppler visualization of local cervical trophoblastic vascularisation.     

Retención intraabdominal de feto posterior a legrado uterino. Comunicación de un caso

Uterine perforation during the first trimester after uterine curettage is a rare complication that occurs in 0.02% to 0.4% of all procedures. The presence of fetus or any of its parts is even less common. We report the case of a 19-year-old patient, gravida I, abortion I, who presented with abdominal pain 1 week after a curettage. Exploratory laparotomy was performed, revealing a perforation in the posterior portion of the right uterine horn with the presence of a fetus in the pouch of Douglas.     

Transcervical Suction of Interstitial Pregnancy under Laparoscopic and Hysteroscopic Guidance

Interstitial pregnancy is a rare but life-threatening condition. It is usually treated using cornual resection at operative laparoscopy or laparotomy; however, this may adversely affect future fertility and pregnancy. Transcervical suction using an 8F pediatric catheter placed through the cornua under laparoscopic and hysteroscopic guidance may be possible in some patients if the pregnancy is accessible vaginally. We describe a case of interstitial pregnancy treated with transcervical suction using an 8F pediatric catheter placed through the cornua under laparoscopic and hysteroscopic guidance with preservation of the uterine cornua and fallopian tube. The procedure was quick, bleeding was minimal, and there were no complications. Removal was complete, and serum β–human chorionic gonadotropin quickly became undetectable. Three months after the operation, salpingography yielded normal findings, and the patient was pregnant again 8 months after the surgery.     

Primary fallopian tube adenocarcinoma: preoperative diagnosis, treatment and follow-up

Preoperative diagnosis of fallopian tube carcinoma is difficult due to the rarity and silent course of this neoplasm. We present herein the case of a 58-year-old woman with primary fallopian tube carcinoma that was diagnosed preoperatively on the basis of a positive for adenocarcinoma Papanicolaou vaginal smear, repeated episodes of vaginal bleeding, negative endocervical and endometrial curettage, characteristic features on ultrasonography and elevated CA-125 levels. The patient was treated by total abdominal hysterectomy, bilateral salpigno-oophorectomy and omentectomy. Pathologic confirmation of primary serous papillary adenocarcinoma of the left fallopian tube was made. Peritoneal washings were positive for malignancy. FIGO stage was considered as IIIb and the patient received six courses of combined carboplatin-taxol chemotherapy. At two years from onset of therapy the patient underwent a modified radical mastectomy and lymphadenectomy because of primary carcinoma of the right breast. The patient was started on tamoxifen therapy, which she is still taking. At 60 months after initial surgery, the patient is alive and well. In conclusion, our study suggests an association between fallopian tube carcinoma and breast cancer and a good response of the patient to platinum-based chemotherapy.     

Placenta increta/percreta associated with uterine perforation during therapy for fetal death. A case report.

BACKGROUND: Placenta accreta involves abnormal adherence of the placenta to the myometrium. Placenta increta and percreta are defined by the degree of trophoblastic penetration of the myometrium. These conditions are rarely observed in the first trimester; placenta increta and percreta are exceptionally infrequent. CASE: A woman had a uterine perforation after suction curettage for fetal death at 11 weeks' gestation, requiring hysterectomy for control of a profuse hemorrhage. Histopathologic examination of the uterus revealed placenta increta involving the lower uterine segment and placenta percreta at the site of uterine perforation. CONCLUSION: This is the first report of placenta percreta associated with uterine perforation during therapy for first-trimester fetal death.     

Laparoscopy as a diagnostic and therapeutic technique in uterine perforations during first-trimester abortions

During the period 10/71 to 1/73, laparoscopy was performed in 11 cases of instrumental uterine perforation during 1st trimester abortion at the New York Hospital-Cornell Medical Center. 7 of the 11 patients did not require laparotomy; the remaining 4 had laparotomy after preliminary laparoscopy (3 had uncontrollable bleeding or extensive uterine injury while 1 had bowel injury due to the laparoscope trocar). The reported incidence of uterine perforations during 1st trimester abortion ranges from 0.4/1000 abortions to 15/1000 abortions. The incidence is lowest when the abortion is performed using suction technique and local anesthesia. In this hospital, laparoscopy is performed as soon as the perforation occurs, using the same anesthesia if general anesthesia was used. Immediate laparotomy is performed in cases of extensive instrumentation after perforation or bowel injury. Abortion is completed either by suction or sharp curette; intra-abdominal bleeding can be controlled by cauterization under laparoscopic observation. This procedure eliminates the need for patient exploratory laparotomy and hence shortens hospital stay and minimizes medicolegal problems. The management of uterine perforation during 1st trimester abortion is also discussed.     

Isolated torsion of the fallopian tube: a case report and review of the literature

INTRODUCTION: Isolated torsion of the fallopian tube is a very rare condition. It occurs without ipsilateral ovarian involvement associated with pregnancy, haemosalpinx, hydrosalpinx, ovarian or paraovarian cysts and other adnexal alterations or even with an otherwise normal fallopian tube. We document a case of isolated torsion of the right fallopian tube associated with hydrosalpinx. CASE: The patient was a 39-year-old female, para 2, gravida 4, who was presented with acute pelvic pain, nausea and vomiting. Her medical history included an appendectomy and right hydrosalpinx diagnosed five months before admission by hysterosalpingography because of investigation for secondary infertility. The urinary pregnancy test was negative. Pelvic ultrasonography showed a dilated folded right tubular structure measuring 7.8 x 2.7 cm with thickened echogenic walls and mucosal folds protruding into the lumen; the ovaries and uterus were unremarkable. No free fluid in the cul-de-sac was noted. Preoperatively, a diagnosis of twisted right fallopian tube was suspected and an exploratory laparotomy confirmed the diagnosis of isolated torsion of the oviduct. The ipsilateral ovary appeared normal, but the fallopian tube was gangrenous and right salpingectomy was performed. The patient became pregnant three months after surgery. CONCLUSION: Isolated torsion of the fallopian tube should be considered in the differential diagnosis of patients with acute abdomen and previous medical history of hydrosalpinx.     

Isolated torsion of the fallopian tube during pregnancy: a case report

BACKGROUND: Isolated fallopian tube torsion during pregnancy is a rare condition, and only 16 cases have been reported. In all but 1 case the right tube was affected. We report the second case of isolated left fallopian tube torsion during pregnancy. CASE: A 23-year-old primigravida presented at 22 weeks of gestation with left lower abdominal pain. Sonography depicted a simple cystic mass adjacent to the left uterine border. Laparotomy revealed torsion of the left hydrosalpinx together with a paraovarian cyst. The patient delivered a healthy infant at term after an otherwise-uneventful pregnancy. CONCLUSION: As the gravid uterus increases the risk for fallopian tube torsion, this condition should be included in the differential diagnosis of lower abdominal pain during pregnancy.     

Laparoscopic approach to an uncommon adnexal neoplasm associated with infertility: serous cystadenofibroma of the fallopian tube

A rare case of serous cystadenofibroma of the fallopian tube was discovered during evaluation for in vitro fertilization-embryo transfer. Bilateral tubal occlusion was noted on hysterosalpingogram, and a right adnexal cyst, initially thought to be of ovarian origin, was identified by office transvaginal sonography. Laparoscopy revealed a 5.5-cm, fluid-filled mass involving the distal aspect of the right fallopian tube. Both ovaries and uterine exterior appeared grossly normal. The cyst was decompressed and removed intact without incident through a 5-mm laparoscopic cannula. The mass showed histologic features consistent with benign serous cystadenofibroma. The patient had an uncomplicated postoperative convalescence and continued to do well 3 months after surgery.     

Silent uterine rupture, an unusual cause of anhydramnios

Anhydramnios is a rather common ultrasound finding, usually caused by ruptured membranes, placental dysfunction, or impaired fetal renal function. We present a case of anhydramnios, resulting from the perforation of a fetal leg through the uterine wall. Neonatal death occurred caused by severe lung hypoplasia. The absence of clinical symptoms strongly suggests a preexisting weak spot in the uterine wall, presumably resulting from an unrecognized perforation at a previous curettage procedure.     

Unusual synechia at hysterosalpingography: intrauterine fallopian tube after surgical abortion

We report a patient who had uterine perforation with incarceration of the fallopian tube after surgical abortion. The diagnosis was made during hysteroscopy, realized after hysterosalpingography, and treated by laparoscopy.     

Lymphangioleiomyomatosis of the Uterus Simulating High-Stage Endometrial Stromal Sarcoma

Symptomatic uterine lymphangioleiomyomatosis (LAM) simulating high-stage uterine sarcoma in a patient with tuberous sclerosis complex is reported. A 49-year-old female presented with abdominal pain and anemia. Preoperative workup revealed a uterine mass and a large amount of peritoneal free fluid and possible metastatic implant along the lateral edge of the liver. The patient also had a large right pleural effusion. A fungating anterior uterine fundal mass with apparent perforation and intraabdominal hemorrhage was found on laparotomy. A portion of the mass was excised and initially interpreted as an endometrial stromal sarcoma. Microscopic examination revealed multiple vascular epithelioid smooth muscle proliferations in the uterus and serosal surface of the fallopian tube and periaortic lymph node lymphangioleiomyomas. The uterine, fallopian tube, and nodal lesions were positive for smooth muscle actin, desmin, and HMB-45, findings characteristic of LAM. Additional examination of the patient revealed stigmata of tuberous sclerosis complex. Although uterine LAM is uncommon, it may be associated with pelvic and/or abdominal symptoms and may simulate a primary uterine mesenchymal neoplasm.     

Diagnostic validity of the Vabra Curettage. Compared study on 172 patients who underwent Vabra Curettage and the fractional curettage of the uterine cavity

The authors report 172 cases of patients who had to undergo a curettage of the uterine cavity and an endometrial sampling with Vabra Curettage. In 80.8% of the cases, the histologic diagnosis of the material removed with Vabra Curettage was comparable with that of the uterine curettage. In 8.7% of the sampling, the histologic diagnosis of the tissue removed with the "suction technique" was easier. In 10.5% of the cases, the diagnosis was more reliable in the samplings taken away with uterine curettage. In this last group, nevertheless, the endometrial tissue removed with Vabra curettage allowed us to exclude the presence of an adenocarcinoma or of an atypical hyperplasia. Only in 1.2% of the specimens, the Vabra Curettage did not allow us to exclude an endometrial pathology (for lack of material). On account of the increased incidence of endometrial carcinoma, the tolerability of the method proposed, its low cost, the Authors advocate a large-scale use of this method for a prevention program directed at the high-risk population for this carcinoma.     

Comparison of assessing the patency of the Fallopian tubes during laparoscopy and during hysterosalpingography on television in infertile women with endometriosis

OBJECTIVES: Sterility become nowadays not only medical, but as well socio-economic problem. One of its major causes is endometriosis. Recurrent adnexitis--one of the most common symptoms of endometriosis might be the cause of fallopian tubes occlusion. The hysterosalpingography (HSG) can be helpful to diagnose this tubal pathology. DESIGN: To compare the assessment of fallopian tubes patency during HSG with the results of laparoscopy in infertile women with endometriosis. MATERIAL AND METHODS: 331 women with endometriosis who were diagnosed during laparoscopy examination between 1998-2002 due to sterility. The presence of endometriosis was confirmed during laparoscopy. In each patient the control of the patency of both fallopian tubes was performed. These data were confirmed with those from HSG performed during follicular phase on the television path. The absence of the contrast passage through fallopian tubes as well as the only trace contrast passage into abdominal cavity were classified as tubal obstruction. RESULTS: In patients during the HSG physiological uterine shape and size in 91.3%, the bicornis uterus in 6.6%, and the unicornis uterus in 2.1% were observed. During laparoscopy we diagnosed the physiological uterine shape and size in 88.8%, the bicornis uterus in 8.2%, and the unicornis uterus in 3.0%. The diagnostic compatibility of these both examinations was 90.6%. In HSG the correct anatomical course of both fallopian tubes without occlusions in 51.7%, the only unilateral patency in 36.7%, and bilateral occlusions in 11.6% were found. During laparoscopy we diagnosed the anatomical course of both fallopian tubes without occlusions in 36.7%, the only unilateral patency in 33.3%, and bilateral occlusions in 30.0%. The diagnostic compatibility of these both examinations was 49.6% for both fallopian tubes, and 34.2% for the only one fallopian tube. In 16.2% both results were incompatible. CONCLUSIONS: The incorrect contrast passage through the fallopian tubes and its increased pressure during HSG in women with the characteristic history and clinical symptoms can suggest endometriosis. In these cases laparoscopy is necessary as the additional examination in the diagnostics of fallopian tubes patency, but the only objective method in diagnosis of endometriosis.