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At least 181 records · Page 10Linked to original sources

PubMed1994

Pudendal enterocele with bladder involvement.

A 72-year-old diabetic women presented with a large left labial mass following multiple prior vaginal surgeries to correct vaginal vault prolapse, including two failed right-sided sacrospinalis fixation procedures and a near total colpocleisis. After failure of conservative management, a translabial repair of this pudendal hernia containing bladder was performed. Return of the labial mass 9 months later prompted a more extensive abdominal approach. To close the defect in the urogenital diaphragm and prevent its recurrence, an absorbable mesh was used. Then, to prevent enterocele recurrence, vaginal vault suspension to the sacral promontory and closure of the Douglas pouch were performed. A review of the literature is presented, with an analysis of risk factors and corrective surgical techniques.

Aged↗

PubMed2002

Routine clinical examination is not sufficient for diagnosing and locating deeply infiltrating endometriosis.

STUDY OBJECTIVE: To determine whether routine clinical examination is sufficient for the diagnosis and establishing the location of deeply infiltrating endometriosis (DIE). DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. Patients. One hundred sixty women with histologically proved deeply infiltrating endometriosis. MEASUREMENTS AND MAIN RESULTS: Speculum examination allowed endometriotic lesions to be viewed in only 14.4% (23) of patients, and a classic, painful, spheric nodule was palpated in only 43.1% (69). Results of routine clinical examination varied significantly with location of DIE. Whereas a nodule was found in 80.0% (24) of patients with vaginal endometriosis, this rate dropped to only 35.3% (6) and 33.3% (34) in those with DIE of the digestive tract and uterosacral ligaments, respectively (p <0.0001). CONCLUSION: High locations of DIE lesions at the level of uterosacral ligaments, bottom of the pouch of Douglas, and upper one-third of the posterior vaginal wall explain why results of routine clinical examination are so poor. The term "deep endometriosis infiltrating the rectovaginal septum" is generally incorrect in the true anatomic sense.

Adult↗

PubMed2003

Cul-de-sac packing with a metreurynter in gasless laparoscopic cystectomy during pregnancy.

Gasless laparoscopic cystectomy was performed for a woman in the fifteenth week of pregnancy. An ovarian cyst that had been sinking behind the uterus appeared spontaneously after ballooning the metreurynter in the pouch of Douglas. This allowed extraperitoneal cystectomy, and the patient's subsequent antenatal course was uneventful. Cul-de-sac packing with a metreurynter permits gentle and atraumatic manipulation against the pregnant uterus.

Adult↗

PubMed1994

A new laparoscopic aspiration technique for ovarian dermoid cysts.

A new method for aspirating benign dermoid cysts enables removal of the collapsed cyst wall without the need for extending laparoscopic incisions or opening the pouch of Douglas. The technique has been used by one of the authors in 10 patients with good effect and minimal or no spillage of dermoid cyst contents into the peritoneal cavity.

Anti-Infective Agents, Local↗

PubMed1995

Diagnosis of early ectopic pregnancy by measurement of the maternal serum to cul-de-sac fluid beta-hCG ratio.

In patients suspected of having an ectopic pregnancy, because of a positive beta-human chorionic gonadotropin (beta-hCG) test and a sonographically undetectable gestational sac, even laparoscopy cannot always achieve a precise diagnosis, when the gestational age is very early. This means that the patient has to be followed by repeated beta-hCG measurements and repeated laparoscopy, which are expensive and inconvenient for the patient. This paper reports on a method that is simple to perform and that will provide the clinician with valuable information about the strong likelihood of a tubal pregnancy when ultrasound and beta-hCG measurements raise the suspicion but are not diagnostic. A prerequisite for this approach is the availability of a minimal volume (1-2 ml) of peritoneal fluid in the pouch of Douglas. A total of 131 patients who had a positive beta-hCG test and an undetectable gestational sac within the uterine cavity and who had a small volume of cul-de-sac fluid were studied. The fluid was obtained transvaginally by means of an ultrasound-guided automatic puncture system. The beta-hCG level was determined in the cul-de-sac fluid and in the maternal serum, for comparison. In two cases with tubal pregnancy, concentrated viscous blood samples were aspirated and beta-hCG concentrations could not be measured for technical reasons. In 129 cases, the ratio of levels of beta-hCG between serum and cul-de-sac fluid could be measured. In 42 out of 44 patients with intrauterine pregnancy, the ratio was greater than unity; in 82 out of 85 patients with a tubal pregnancy, the ratio was less than unity. With this ratio used for detection of tubal pregnancy, the diagnostic sensitivity of the test was 95.4% and the specificity was 95.2%. The positive predictive value was 97.6% and the negative predictive value 91.3%. We conclude from these findings that the measurement of the maternal serum to cul-de-sac fluid beta-hCG ratio facilitated the early diagnosis of an ectopic pregnancy in the Fallopian tube.

Ascitic Fluid↗

PubMedDate not supplied

Peritoneal tuberculosis with pelvic abdominal mass, ascites and elevated CA 125 mimicking advanced ovarian carcinoma: a series of 10 cases.

Ten patients with peritoneal tuberculosis who were operated on for suspected advanced ovarian cancer during a 5-year period were analyzed. These 10 cases constituted 1.4% of the 728 new gynecologic cancer cases diagnosed and treated at our department during the same time period. Data were obtained from patients' files and pathology reports. The mean age of cases was 40.6 +/- 6.1 (median 37; range 18-72). Ascites was present together with ill-defined nodularities or thickening in the Douglas pouch and/or in the adnexal areas on pelvic examination in all patients but three, who presented with well-demarcated adnexal masses of about 5 cm in diameter. All patients had elevated serum CA 125 levels with a median of 331 U/ml, (40-560 U/ml). Ultrasound and abdominopelvic CT examinations revealed omental and mesenteric thickening in addition to ascites in all patients, cystic ovarian masses or ovarian enlargement in five, and peritoneal implants in two. Abdominal paracentesis performed in the six cases in whom the findings were felt to be most inconclusive for the diagnosis of ovarian cancer revealed clear exudative fluid with benign cells. Mycobacteria could not be demonstrated on direct preparations. Tuberculosis was diagnosed at laparotomy in all. Patients received antituberculous therapy and serum CA 125 levels returned to normal within 2 months after the beginning of treatment. This case series demonstrates a high rate of misdiagnosis between advanced ovarian cancer and peritoneal tuberculosis. Whereas abdominal paracentesis is useless in ruling out peritoneal tuberculosis, and serum CA 125 levels are not helpful in the differential diagnosis, the latter marker may be useful in the follow-up of patients.

Adolescent↗

PubMed1988

[HCG in serum and peritoneal fluid in suspected ectopic pregnancy].

HCG was measured in peripheral serum and peritoneal fluid (PF), obtained by punction of the Douglas pouch (n = 12) or by laparoscopy (n = 14) in 26 patients with suspected ectopic pregnancy. In 10 patients with tubal pregnancy, the hCG-concentration in the PF was in every case higher than in serum. Contrary to this, in 11 disturbed and 2 normal intrauterine pregnancies the PF-hCG was lower than in serum. No hCG-gradient could be observed in 1 patient with an interstitial pregnancy. Moreover, in 2 patients with inconclusive laparoscopic findings, the PF-hCG was higher than in serum; this pointed to a probable harbouring of a suspected missed ectopic pregnancy, and treatment was therefore conservative. The PF-hCG level 35 h after i. m. application of 5000 IU hCG to non-pregnant women varied between 11 and 42% as compared to that of the serum. It is concluded that the gradient of hCG between PF and serum can be used for the verification of a suspected ectopic pregnancy in addition to other diagnostic methods.

Abortion, Spontaneous↗

PubMed1995

[The torsion of an accessory liver lobe as the rare cause of acute abdomen].

HISTORY AND CLINICAL FINDINGS: A 35-year-old woman was admitted because of cramp-like abdominal pain with nausea and vomiting since the previous evening. There was no history of previous abdominal symptoms of jaundice. Physical examination suggested atypical appendicitis with pain on palpation of the right mid-abdomen, localized paraumbilical guarding tension and diffuse pressure pain, more on the right, on rectal examination. Body temperature was 37.8 degrees C. EXAMINATIONS: There were leucocytosis (12000/microliters) and abnormally high liver function tests (GOT 95 U/l, GPT 110 U/l, LDH 368 U/l, alkaline phosphatase 335 U/l). Ultrasonography of the abdomen demonstrated free fluid in the Douglas pouch. TREATMENT AND COURSE: Laparotomy, performed because atypical appendicitis was suspected, revealed a torsioned pedicle of a severely bleeding accessory liver lobe positioned near the gall bladder bed. The accessory lobe was removed and the patient became symptom-free. This is the 15th reported case of clinical manifestations of an accessory liver lobe.

Abdomen, Acute↗

PubMed1995

Medical treatment of postappendectomy intraperitoneal abscesses in children.

Treatment of postappendectomy intraperitoneal abscesses is classically surgical (drainage). We report a retrospective study (1988 to 1991) of our experience in providing exclusively medical treatment for 11 such isolated abscesses in children. The abscess was detected 7 times within the 10 days following appendectomy. Ultrasonography localized the abscess 7 times in the right iliac fossa and 4 times in Douglas' pouch. In 4 cases it was larger than 5 cm in diameter. Parenteral antibiotic therapy associated ticarcillin and clavulanic acid 6 times and piperacillin, tobramycin and metronidazole 5 times. Drug efficacy was evaluated by clinical signs (fever, pain, ileus) and ultrasonography. In one case, an associated ileus led to reoperation at day 4 of treatment. In the other 10 cases, clinical signs disappeared during the first week of treatment. At day 7, parenteral was replaced by oral antibiotic therapy (metronidazole 7 times, amoxicillin-clavulanic acid 3 times) continued until the abscess was no longer visualized on ultrasonography (5 times at 3 weeks, 5 times at 1 month). Medical treatment of isolated postappendectomy abscesses in children would thus appear to be a logical choice in the absence of an associated ileus.

Abdominal Abscess↗

PubMed2003

Is laparoscopy still the gold standard in infertility assessment? A comparison of fertiloscopy versus laparoscopy in infertility. Results of an international multicentre prospective trial: the 'FLY' (Fertiloscopy-LaparoscopY) study.

BACKGROUND: The aim of this prospective multicentre study was to compare the two endoscopic techniques of laparoscopy and fertiloscopy in routine evaluation of the pelvis in infertile women. METHODS: A total of 92 women was selected in 14 University Hospitals to undergo fertiloscopy followed by transabdominal laparoscopy by a team of two surgeons in each hospital. RESULTS: A high degree of concordance was observed between these two techniques, in that if fertiloscopy did not detect any abnormalities, this was also confirmed by laparoscopy. Discordance was observed in similar numbers of cases: eight after laparoscopy and nine after fertiloscopy. The diagnostic index for fertiloscopy and laparoscopy was calculated; sensitivity (86 and 87% respectively) and negative predictive value (64 and 67% respectively) were similar. The kappa index was also calculated for each of the six structures/regions (right/left tube; right/left ovary; peritoneum of pouch of Douglas; posterior uterus), and concordance (0.78 to 0.91) was considered almost complete. CONCLUSIONS: These results confirm fertiloscopy as a minimally invasive safe procedure that may be considered as an alternative to diagnostic laparoscopy in the routine assessment of women without clinical or ultrasound evidence of pelvic disease. On the basis of the additional advantages of fertiloscopy, namely salpingoscopy or microsalpingoscopy, it is considered that fertiloscopy could replace laparoscopy as a routine procedure in such women.

Adult↗

PubMed2005

Primary omental pregnancy: case report.

Omental pregnancy is a very rare form of ectopic pregnancy. Here we presented a case of primary omental pregnancy diagnosed at surgical exploration. A 28 year old woman submitted with severe abdominal pain, without any delay of menstruation. History of the patient revealed no use of contraceptive method. There was no gestational sac in the endometrial cavity and no tubal ring in the adnexa, but free peritoneal fluid in the pouch of Douglas was detected at ultrasonography. Laparotomy was done according to pre-operative diagnosis of ruptured tubal pregnancy. Bilateral tubes and ovaries were intact; omental pregnancy was detected and partial omentectomy was performed. Although 16 cases of omental pregnancy (mostly secondary) were reported in the literature, herein we describe a primary omental pregnancy without adnexial involvement.

Abdominal Pain↗

PubMed1991

Prevalence and laparoscopic appearance of spontaneous endometriosis in the baboon (Papio anubis, Papio cynocephalus).

The prevalence of spontaneous endometriosis was investigated by laparoscopy in 52 baboons (Papio anubis and Papio cynocephalus) of proven fertility. Clinical endometriosis was diagnosed in 9 (17%) and 4 (8%) baboons with or without a previous hysterotomy, respectively. Endometriosis was confirmed by histology in 75% of these animals. The 37 endometriotic lesions were classified as typical (13%), subtle (57%), or suspicious (30%); and the percentage of histological confirmation was 100%, 61%, and 50%, respectively. Lesions were found on the uterosacral ligaments and in Douglas' pouch (46%), on the uterine peritoneum and the uterovesical fold (38%), and on uterine-omental adhesions (11%). Only 5% of the lesions were localized on the ovarian ligament, whereas ovarian endometriosis was not found. This study for the first time demonstrates that spontaneous endometriosis occurs in healthy baboons with proven fertility. It also shows that the laparoscopic appearances, the histological aspect, and the localization of the pelvic lesions are comparable to those found in women. We therefore conclude that the baboon is a good animal model for the study of endometriosis.

Animals↗

PubMed1990

Positive results of combined therapy of surgery and intraperitoneal hyperthermic perfusion for far-advanced gastric cancer.

To evaluate the clinical efficacy of intraperitoneal hyperthermic perfusion (IPHP) for far-advanced gastric cancer, particularly with peritoneal seeding, we investigated the survival times of 59 patients who underwent distal subtotal gastrectomy, total gastrectomy, or total gastrectomy combined with concomitant resection of some of the remaining intra-abdominal organs. In all the 30 patients given IPHP, no cancer cells were present posthyperthermically in the lavage from the Douglas pouch. The 30 patients given IPHP lived longer than the 29 patients not given IPHP (p = 0.001), with a 1-year survival rate of 80.4% in the former group compared to 34.2% in the latter. With respect to a comparison of survival time of patients with peritoneal seeding, 7 patients not given IPHP had a 6-month survival rate of 57.1% and did not survive more than 9 months, whereas 20 patients given IPHP had 1- and 2-year survival rates of 78.7% and 45.0%, respectively; here the difference was significant (p = 0.001). The IPHP and control groups without peritoneal metastasis included 10 and 22 patients, respectively, and the 1-year survival rates are 85.4% and 45.3%, respectively. The survival rates of the former exceeded those of the latter, with p = 0.015 by the generalized Wilcoxon test. Thus this combined therapy offers the promise of extended survival for patients with far-advanced gastric cancer.

Combined Modality Therapy↗

PubMed2005

Improved diagnostic value of PCR in the diagnosis of female genital tuberculosis leading to infertility.

Histopathological and mycobacteriological examinations have limited utility in the diagnosis of genital tuberculosis. In this double-blind study, 61 samples, consisting of endometrial aspirates (EAs), endometrial biopsies (EBs) and fluid from the pouch of Douglas (POD), from 25 women suffering from infertility were investigated for the presence of the mpt64 gene of Mycobacterium tuberculosis by PCR and correlated with laparoscopic findings. PCR demonstrated M. tuberculosis DNA in 14 out of 25 patients (56.0 %), compared to one smear with acid-fast bacilli (1.6 %) and two culture-positive samples (3.2 %). The presence of M. tuberculosis DNA was observed in 53.3 % of EBs, 47.6 % of EAs and 16.0 % of POD fluid samples. All patients with laparoscopy suggestive of tuberculosis, 60 % of those with a probable diagnosis and 33 % of those with incidental findings were positive by PCR. However, one EA sample from an infertile patient with normal laparoscopy was also positive. Multiple sampling from different sites and amplification of the mpt64 gene segment by PCR offered increased sensitivity in determining tuberculous aetiology in female infertility.

Adult↗

PubMed2004

Atypical pleomorphic epithelioid angiomyolipoma localized to the pelvis: a case report and review of the literature.

AIMS: Angiomyolipoma is the most common mesenchymal tumour of the kidney. It has been reported in several other sites outside the kidney, mainly in the liver. We report the first case of atypical pleomorphic angiomyolipoma in a man, arising from the pouch of Douglas and extending to the entire abdominal cavity. METHODS: A 17-year-old man underwent a complete resection of a giant abdominopelvic mass. The tissue was formalin fixed and paraffin embedded and 4 micro m thick histological sections were stained with haematoxylin-eosin. Immunohistochemical stains for HMB-45, smooth muscle actin, vimentin, calponin, S100 and desmin were performed. Sections for electron microscopy were also prepared. RESULTS: Microscopic examination revealed a neoplasm composed of pleomorphic epithelioid cells with atypical features, immunoreactive for HMB-45, MART-1, actin, vimentin and calponin, while S100 protein and desmin stains were negative. Ultrastructurally, the tumour cells showed prominent nucleoli, vacuolated cytoplasm, and some premelanosomes. A diagnosis of atypical pleomorphic epithelioid angiomyolipoma was then made. CONCLUSIONS: To date five patients with abdominal epithelioid angiomyolipoma have been described in the literature. All were women. Three of the five patients reported developed metastasis, while our patient is still free of disease at 16 months of follow-up. Clear prognostic pathological features have not been identified.

Adolescent↗

PubMed2001

Declining trend in major gynaecological surgery in The Netherlands during 1991-1998. Is there an impact on surgical skills and innovative ability?

OBJECTIVES: To assess the number of major surgical procedures in gynaecology over a period of eight years in The Netherlands and to detect possible trends. Relevance of the trends and the possible impact on surgical skills and on innovative ability are discussed. DESIGN: Observational study. SETTING: Hospital care in The Netherlands. SAMPLE: Data from a national hospital discharge database, from all 119 hospitals in The Netherlands. METHODS: When a patient is discharged from the hospital. data on the diagnosis and treatment are registered by local medical officers and administrators. Registration of surgical procedures is based on the International Classification of Procedures in Medicine (ICPM, WHO 1978), the so-called WCC-standard. All hospitals but one (a cancer centre) in The Netherlands participate in this registration, resulting in 99.3% of all admissions. Data on gynaccological manpower were obtained from the Dutch College of Obstetricians and Gynaecologists. In order to standardise the frequency numbers per 1,000 women, yearly data of the female population according to age were obtained from the Central Office for Population Statistics. RESULTS: The female population aged 20 years of age and older increased 3% between 1991 and 1998, from 5.8 million to 6.0 million. In the same period the number of gynaecologists grew from 604 to 625, also an increase of 3%. The total number of hysterectomies dropped from 21,433 in 1991 to 16,320 (-24 %) in 1998 (chi2 for trend 1,245.1. P < 0.001) Surgery of the uterine cavity, either performed hysteroscopically or blind, increased from 311 to 1,958 (+ 625%) cases per year (chi2 for trend 2,459.2, P < 0.001). No trend has been detected in the numbers of adnexal operations, including surgical treatment of tubal pregnancy (tubotomy or tubectomy). In 1998, 12% of all ovarian surgery and 28% of all surgery for ectopic pregnancies was performed laparoscopically. Surgery for female urinary incontinence experienced a strong decline of 46% in the studied period. The frequency of vaginal repair decreased with 1354 (-16%) cases. The abdominal prolapse surgery (abdominal sacral colpopexy, obliteration of the Douglas pouch) is steadily increasing, although the absolute numbers are small. In 1998 seven hundred and forty-three women underwent an abdominal approach of their prolapse repair, compared with 7239 that had the vaginal repair. CONCLUSIONS: The declining trend of major gynaecological surgery in combination with the increasing number of gynaecologists will result in more difficulty for gynaecologists to acquire and maintain surgical skills and may therefore affect their ability to innovate within the surgical profession.

Adult↗

PubMed1996

Peritoneal surgery in the treatment of endometriosis--excision or thermal ablation?

Twenty patients with Stage 2 to 4 endometriosis were referred to an Endometriosis Clinic with an average of 3.4 previous medical and surgical treatments. All were treated by peritoneal excision. Follow-up was for 9-36 months and 14 had a further laparoscopy. Seventeen of 20 patients are free of symptoms. In 1 patient recurrence occurred in a separate site and in 2 there were lesions close to the original lesion in the pouch of Douglas and bladder wall. In addition, 1 of the 14 patients having further laparoscopy had mild adhesions. The satisfactory results of the study suggest that a controlled trial comparing peritoneal excision and thermal ablation is worthwhile. There are considerable theoretical advantages in using peritoneal excision rather than peritoneal thermal ablation.

Adult↗

PubMed2004

Postcoital haemoperitoneum: a cause for shock.

Postcoital haemoperitoneum rarely occurs without evident vaginal injury. A 21-year-old second gravida woman presented to the ED in shock with a history of 8 weeks amenorrhoea and abdominal pain of 20 h duration. The ultrasound examination revealed a live intrauterine pregnancy and fluid in peritoneal cavity. There was a history of coitus 2 hours prior to the onset of pain. At laparotomy, more than 2 L of free blood was found in the peritoneal cavity. A small bleeding peritoneal vessel in pouch of Douglas was identified and ligated.

Abdominal Pain↗