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Results for “DOUGLAS' POUCH”

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At least 271 records · Page 15Linked to original sources
PubMed1995

CT in patients with blunt abdominal trauma: clinical significance of intraperitoneal fluid detected on a scan with otherwise normal findings.

OBJECTIVE: The purpose of this study was to determine the clinical significance of intraperitoneal fluid seen on CT scans with otherwise normal findings in patients with blunt abdominal trauma. MATERIALS AND METHODS: We retrospectively analyzed the CT scans of 60 patients with blunt abdominal trauma who had scans showing normal findings except for the presence of intraperitoneal fluid. The location of the fluid was determined (pouch of Douglas, pelvis, paracolic gutters, mesentery, Morison's pouch, perihepatic or perisplenic spaces). The amount of fluid in each location was categorized as minimal, moderate, or marked. The total volume of fluid in each patient was estimated as small (+1), intermediate (+2), or large (+3) on the basis of the sum of the amount of fluid in the individual peritoneal locations. The amount and location of fluid were compared between patients who required exploratory laparotomy and those who were managed conservatively. RESULTS: In most patients, the total fluid volume was small (44 patients, 73%) as opposed to intermediate (11 patients, 18%) or marked (five patients, 8%). Thirty-seven patients had fluid in one location, 12 patients had fluid in two locations, and 11 patients had fluid in three or more locations. Intraperitoneal fluid tended to accumulate in the pouch of Douglas (67%) and Morison's pouch (33%). Patients requiring laparotomy had a higher total fluid volume score compared with the patients managed conservatively (2.2 versus 1.3, p < .002) and had larger amounts of fluid in the upper abdomen. Laparotomy was required in only one patient (2%) who had a small amount of fluid compared with three patients (27%) with intermediate and two patients (40%) with marked amounts. Mesenteric and/or bowel injuries were noted in all six patients at laparotomy. One patient had a small superficial liver laceration that was not diagnosed with CT. No other injuries to the solid viscera were missed on the scans. Two of the four patients with mesenteric fluid seen on the CT scan had mesenteric lacerations found during surgery, and the remaining two did well with conservative management. CONCLUSION: Patients with blunt abdominal trauma who have small amounts of intraperitoneal fluid as the sole abnormality shown by CT may generally be treated conservatively. However, patients with even a small quantity of mesenteric fluid may benefit from peritoneal lavage to help exclude bowel or mesenteric injury. Intermediate and large amounts of fluid are less common as the sole CT abnormality but have a higher likelihood of being associated with bowel or mesenteric injury.

Abdominal Injuries↗
PubMedDate not supplied

Surgical treatment of deep endometriosis and risk of recurrence.

STUDY OBJECTIVE: To evaluate the risk of recurrence of deep endometriosis after conservative surgery. DESIGN: Retrospective analysis (Canadian Task Force classification II-3). SETTING: Tertiary care university hospital. PATIENTS: One hundred fifteen symptomatic patients operated on in our department from 1996 through 2002 with postoperative follow-up of at least 12 months. INTERVENTION: All patients underwent conservative surgery for deep infiltrating endometriosis. MEASUREMENT AND MAIN RESULTS: Risk factors for recurrence of symptoms and clinical findings and for repeated surgery were evaluated by univariate and multivariate analysis. During follow-up, we observed 28 patients with pain recurrence and 15 patients with recurrent clinical findings, and 12 patients required reoperation for deep endometriosis. Recurrence rates of pain and clinical findings during 36 months were 20.5% and 9%, respectively. Multivariate analysis showed that only age was a significant predictor of pain recurrence (OR 0.9, 95% CI 0.81-0.99, p<.05), enhancing the risk in younger patients. Recurrence of clinical signs of deep endometriosis was predicted by obliteration of the pouch of Douglas (OR 1.46, 95% CI 1.16-16.2, p<.05). Reoperation for deep endometriosis was predicted only by the incompleteness of first operation (OR 21.9, 95% CI 3.2-146.5, p<.001). CONCLUSION: Our study indicates that age, obliteration of the pouch of Douglas, and surgical completeness may have a significant influence on the recurrence of the disease.

Actuarial Analysis↗
PubMed1984

[Surgical treatment of severe dyspareunia (personal technic)].

UNLABELLED: Deep dyspareunia is taken to describe pain "in the base of the abdomen" which, without interfering with penetration, accompanies (or follows) sexual intercourse. Amongst uterine malpositions, two forms have been widely described: retroflexion and retroversion. Emphasis should be placed upon another aspect where the uterus, without any break in the angle between cervix and body, falls as a whole onto the anterior surface of the cervix and the posterior perineum. Clinical manifestations are identical in all three forms. OPERATIVE TECHNIQUE: this is designed not only to restore the physiological angulation of the uterus but to ensure that the vagina is of adequate functional width. It is a compromise between posterior hysteropexy (Huguier), "douglassectomy" and exclusion of the pouch of Douglas (Bret and Bardiaux). This technique has been used in a total of 144 operations in the treatment of 71 cases of malposition and the results compared with other techniques: anterior fixation (4 cases), posterior hysteropexy (38 cases), exclusion of the pouch of Douglas (25 cases) and round ligament plasty (5 cases).

Douglas' Pouch↗
PubMed2001

Abdominal sacrocolpopexy and anatomy and function of the posterior compartment.

OBJECTIVE: To assess the effect of abdominal sacrocolpopexy with obliteration of the pouch of Douglas on anatomy and function of the posterior compartment. METHODS: We prospectively studied 33 consecutive women with pelvic organ prolapse who had abdominal sacrocolpopexies [expanded polytetrafluoroethylene (Gore-Tex)] with pouch of Douglas obliterations and posterior extensions of mesh, using a standardized questionnaire, urodynamic studies, pelvic floor fluoroscopies, and vaginal-rectal examinations (Baden-Walker classification). Concomitant colpoperineorrhaphy was done if rectoceles remained at rectovaginal examination at the end of sacrocolpopexy. The goal was to correct rectoceles transabdominally. RESULTS: Thirty-one women returned for follow-up investigations after 12--48 months (mean 26 months). Mean age was 61 years (range 41--77 years). There was no recurrence of vaginal vault prolapse, enterocele, or anterior rectal wall prolapse. Among 28 preoperative rectoceles, 16 recurred (57%) and one occurred de novo. Defecation problems (outlet constipation) were present in 21 women (64%) preoperatively and persisted or were altered in 12 (57%) after sacrocolpopexy. Grade of rectocele was associated significantly with symptoms of outlet constipation preoperatively, but not postoperatively (P =.002). CONCLUSION: Abdominal sacrocolpopexy with obliteration of the pouch of Douglas and posterior extension of the mesh was effective for vaginal vault prolapse, enterocele, and anterior rectal wall procidentia, but not concomitant rectocele. Twenty-eight percent of women described altered defecation with stool stopping higher in the rectosigmoid colon ("high outlet constipation"), which might have been caused by denervation during rectal mobilization.

Adult↗
PubMed2002

Extrauterine placental site trophoblastic tumour in association with a lithopedion.

AIM: We describe an unusual case of extrauterine placental site trophoblastic tumour located in pouch of Douglas in association with a lithopedion. METHODS AND RESULTS: A 35-year-old female presented with acute abdomen and peritonitis following rectal perforation. The patient gave a history of 5 months amenorrhoea followed by vaginal bleeding 5 years prior to admission. At laparotomy, a lithopedion was found in pouch of Douglas with rectal perforation and peritonitis. The lithopedion was removed, rectal perforation was sutured and a colostomy was performed. The colostomy was closed later and tumour was seen in the colostomy wound as well as attached to the lithopedion removed previously. The patient presented with a repeated episode of rectal perforation and the tumour had spread to colon, small intestine, omentum, mesentery and right ovary. CONCLUSION: A high-grade malignant placental site trophoblastic tumour with aggressive clinical course occurred at an extrauterine site. It complicated calcified abdominal pregnancy and resulted in repeated rectal perforation and peritonitis.

Adult↗
PubMed1996

Laparoscopic total abdominal hysterectomy by suturing technique, with no transvaginal surgical approach: a review of 276 cases.

OBJECTIVE: To determine the effectiveness and safety of the new technique of laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal-pouch of Douglas reconstruction and vaginal vault re-suspension by suturing method, with no transvaginal surgical approach. METHODS: The clinical prospective study included 276 women, and was conducted from July 1990 through December 1995. All women were subjected to a laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal and pouch of Douglas reconstruction and vaginal vault suspension. The entire operation was executed via laparoscope with suturing and tying of extracorporeal sliding and intracorporeal two-turn flat square knot technique, and no transvaginal surgery was performed. The criteria for postoperative early (within 5 h) discharge plan were designed and assessed. RESULTS: All pre-planned instances of laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal-pouch of Douglas reconstruction and vaginal vault re-suspension were completed; no technique failure was encountered. The average operating time for both hysterectomy and prophylactic surgery was 192 min. Intraoperative complications were two bladder injuries (0.72%); one case of inferior epigastric vessels injury (0.36%); one case of autologous, cells saver processed blood transfusion (0.36%). The immediate postoperative complications were four cases of voiding difficulty (1.45%) and five patients experiencing post anesthesia inordinate nausea and vomiting (1.81%). One patient required postoperative blood transfusion (0.36%). Delayed postoperative complications included 2 patients (0.72%) with superficial incisional skin infection. Estimated hemoglobin loss was from 0.5 g/dl to 5.0 g/dl, mean loss 1.5 g/dl. The extirpated uterine average weight 163 g. Postoperatively, within 24 h, 265 patients (96.01%) out of 276 were discharged home on the day of surgery, within 5 h, 110 patients (41.51%) out of 265 left the surgical unit. There was no single hospital post surgical re-admission. CONCLUSIONS: Laparoscopic total abdominal hysterectomy with prophylactic retroperitoneal rectovaginal-pouch of Douglas reconstruction and vaginal vault suspension by suturing method is a safe, well-defined operation, executed with no need for transvaginal surgical approach, and well accepted by patients.

Adult↗
PubMed1993

Laparoscopic culdotomy.

Laparoscopic culdotomy has been performed in 32 patients. The indications for the procedure included the removal of organs or tissue excised by operative laparoscopy, excision of vaginal endometriosis involving the pouch of Douglas and drainage of a pelvic haematoma. The surgical technique is described and no complications resulted from this technique. Laparoscopic culdotomy has advantages for the removal of lumps exceeding 1 cm, and for the drainage of a pelvic haematoma or pelvic abscess. It is also an integral step in the removal of infiltrating endometriotic lesions in the pouch of Douglas which are attached to the vagina.

Douglas' Pouch↗
PubMed2005

Detection of Tc-99m labelled albumin particles in the Fallopian tubes after intraperitoneal deposition.

OBJECTIVE: To study the Fallopian tube uptake of intra-abdominal albumin particles. STUDY DESIGN: Six healthy women volunteered for ultrasound guided deposition of Tc-99m labelled albumin particles into the pouch of Douglas, before undergoing sterilisation by salpingectomy. RESULTS: On gamma camera images radioactivity spread evenly over the parietal peritoneum. Autoradiography of the Fallopian tubes showed radioactive "hot spots" on the inner tubal surface. A rapid increase in blood radioactivity stabilised after 2-3 h while radioactivity remained high in the peritoneal cavity. Cervical mucus showed a significant radioactivity. CONCLUSION: Autoradiography strongly indicated that Tc-99m labelled particles deposited into the pouch of Douglas were transported to the Fallopian tubes. The small uptake of radioactivity identified in blood was most likely due to a rapid diffusion of free Tc-99m pertechnetate from the peritoneal cavity. The radioactivity identified in cervical mucus could be pertechnetate or labelled albumin particles or a combination of both. Future development of the present technique may be used for fertility investigation.

Adult↗
PubMedDate not supplied

Peritoneal washing cytology on fluid hysteroscopy and after curettage in women with endometrial carcinoma.

OBJECTIVE: To assess the influence of fluid hysteroscopy with target biopsy of the endometrium and the influence of added curettage on the results of peritoneal washing cytology (PWC) in endometrial carcinoma. STUDY DESIGN: In 42 women at risk of endometrial carcinoma, we performed fluid hysteroscopy with target biopsy of the endometrium and curettage. Evaluation of PWC of the pouch of Douglas was performed three times during the procedure: prior to hysteroscopy, after fluid hysteroscopy with target biopsy and after curettage. RESULTS: On cytologic slides from peritoneal washings in 11 patients with carcinoma of the endometrium, malignant endometrial cells were found after curettage in 72.7%. There was no statistically significant difference in PWC prior to hysteroscopy (two women, 20%) or after hysteroscopy with target biopsy (three women, 30%). There was a statistically significant difference (.05 level) in positive PWC after hysteroscopy with target biopsy (three women, 33.3%) and after curettage (eight women, 88.9%). CONCLUSION: Slides from carcinoma of the endometrium in PWC do not deteriorate after hysteroscopy with target biopsy of the endometrium, but tumor cells will appear in the pouch of Douglas after curettage.

Carcinoma↗
PubMed2006

Prevalance of Chlamydia trochomatis, Ureaplasma urealyticum and Mycoplasma hominis infections in the unexplained infertile women.

OBJECTIVE: To prospectively investigate the prevalence of Chlamydia trachomatis (CT), Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU) in the cervical canal and pouch of Douglas in unexplained infertile women and compare it to healthy controls in the Turkish population. MATERIALS AND METHODS: A total of 31 women presenting with a history of infertility [n = 24 (77%) primary infertility, n = 7 (23%) secondary infertility] between 20 and 38 years of age and 31 women willing to have tubal ligation between 30 and 41 years of age were consecutively included into this study. Specimens were taken from intra-abdominal washings and from the cervical canal. CT, MH and UU were detected with polymerase chain reaction (PCR). RESULTS: Results of 62 women were analyzed. None of the participants met the criteria for salpingitis during laparoscopy. The most common infection in the cervical canal in both groups was UU, which was detected in 13 cases of infertile patients and 11 controls (P = 0.602). Cervical chlamydial and mycoplasmic infection was detected in one case each in infertile and control patients. Neither MH nor UU were obtained from the pouch of Douglas in both groups. Only CT was present in peritoneal fluid of an infertile woman who had also a concomitant chlamydial infection in the cervical canal. CONCLUSION: Demonstration of cervical colonization of CT by PCR may be a promising method for the detection of asymptomatic pelvic infection in patients with unexplained infertility. However, screening for MH and UU is not cost-effective due to similar low rates of detection.

Adult↗
PubMed1955

Culdoscopy.

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Culdoscopy↗