Conservative management of hemoperitoneum associated with injury after sexual intercourse.
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Adult↗
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Results for “DOUGLAS' POUCH”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Absorption of 17 beta-estradiol in a neovagina constructed from the peritoneum.
Estrogen absorption from the neovagina was studied by administering 2.0 mg of micronized 17 beta-estradiol (E2) neovaginally to 6 patients. The neovagina in each patient was constructed by using the peritoneum from the pouch of Douglas. A mean peak of circulating E2 concentrations more than 15-times the basal level was achieved 90 min after the application. Until 12.5 h after the application, the E2 levels were significantly (P less than 10(-6)) elevated. FSH levels were significantly (P = 0.003) changed in comparison to the basal serum concentration. There was no significant (P = 0.08) change in LH levels. The resorption of estradiol from the neovagina is similar to that seen in women with normal vaginas.
Administration, Topical↗
Bilateral Sertoli-Leydig cell tumor with heterologous elements: report of an unusual case and review of the literature.
A case of bilateral ovarian Sertoli-Leydig cell tumor with heterologous elements is reported in an 18-yr-old girl with marked virilization. Panhysterectomy was performed, yet the tumor recurred shortly after the intervention. The microscopic picture was one of intermediate to poor differentiation. Despite chemotherapy, the postoperative course was rapidly malignant, and the patient died 4 wk later.
Abscess↗
Evolution of the methods of neovaginoplasty for vaginal aplasia.
The aim of vaginoplasty should be the creation without excessive morbidity of a neovagina that will be satisfying in appearance, function and feeling. The multitude of methods described in the literature indicates the fact that an ideal approach has not yet been found. In this paper the various methods are described and discussed. It is concluded that the non-operative impression technique, the peritoneum pull-through technique and the use of skin grafts are methods of choice. In cases where immediate vaginal reconstruction after oncological surgery is indicated, myocutaneous flaps are preferred. Only in cases in which other methods have failed should recto-sigmoid transplantation be considered.
Colon, Sigmoid↗
A mid-luteal phase comparison of peritoneal fluid volume and its content of PGF2 alpha and PGE2 in women with minimal stage endometriosis and a normal pelvis.
The study was carried out following the approval of our Hospital Ethics Committee and an informed patient consent. Samples of peritoneal fluid were collected from the Pouch of Douglas at laparoscopy from 32 subjects with minimal stage endometriosis (MSE) and 16 without any visible signs of endometriosis (normal group). All the subjects were in 20 to 23 day period of their menstrual cycle which was histologically confirmed. The endometriosis score was estimated according to the American Fertility Score, 1985 and the fluid samples were collected in tubes containing heparin/indomethacin and standing in ice. The samples were estimated for volume, erythrocyte count, prostaglandin(PG) F2 alpha, and PGE2. Radioimmunoassay techniques were used for the estimation of PGs. Prostaglandin F2 alpha, was measured in its parent form while PGE2 was converted into bicyclic-PGE2 before estimation. The results indicate that the peritoneal fluid in women with MSE has higher than normal levels of PGF2 alpha and lower than normal levels of PGE2 and its PGE2: PGF2 alpha ratio is also below normal. There is no difference in the volume of peritoneal fluid in the two groups. Provided the fluid sample is not contaminated with abdominal blood its erythrocyte count is not related to its prostaglandin content.
Adult↗
Follow-up study of ovarian carcinoma by cytology of cul-de-sac aspirates.
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Ascitic Fluid↗
Benign mesothelioma of the cul-de-sac. A tumor with misleading histologic pattern in an unusual localization.
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Diagnosis, Differential↗
High-field MRI and US evaluation of the pelvis in women with leiomyomas.
Magnetic resonance imaging (MRI) and real-time transabdominal ultrasonography (US) were performed on 23 women with uterine leiomyomas. The uterus, ovaries, and cul de sac were evaluated. Accurate determination of uterine volume was possible in all cases by MRI, but was limited on US in uteri larger than 140 cc. Marked enlargement also prevented visualization of contour abnormalities in eight patients on US, but none on MRI. The endometrial stripe and junctional zone could not be adequately visualized in 21/23 US examinations, whereas they were identified in all 23 MRI (8 normal and 15 distorted). Individual leiomyomas were clearly depicted on 4 US and 19 MR scans, the smallest being 1.1 cm and 0.8 cm, respectively. Of the 31 fibroids present on MRI: 13 were intramural, 4 subserosal, and 14 submucosal. MRI successfully identified 44/46 ovaries as compared to 21/46 on US. Cul de sac fluid was noted in seven women by MRI alone. This data suggests that MRI is superior to US in examination of the entire pelvis in women with leiomyomas.
Adult↗
Detection of the fetus in the cul-de-sac by transabdominal and transvaginal ultrasound. A case report.
The most common reason for a fetus in the cul-de-sac is ectopic pregnancy, such as rupture of tubal pregnancy, ovarian pregnancy, and intraabdominal pregnancy (1-3). A case of the fetus in the cul-de-sac complicated by uterine perforation was imaged transabdominally and transvaginally on September 13, 1990.
Abdomen↗
[Abdominal management of rectocele and elytrocele: place of the laparoscopic approach].
AIM OF THE STUDY: To report the results of abdominal promontory rectopexy and douglassectomy in the management of rectocele and enterocele. PATIENTS AND METHODS: Between 1992 and 2002, 72 patients were operated by one colorectal surgeon. Laparotomy was used in 37 cases between 1992 and 2001 and the laparoscopic approach in 35 cases from 1995 to 2002. Promontory rectal fixation required only one mesh secured between the anterolateral right side of the rectum and the lumbosacral ligament. The same mesh was used to fix the vagina or the cervix. Combined therapeutic or prophylactic urinary interventions are frequent in the series. RESULTS: The follow-up was more than one year in 63 patients with a mean value of 58 months with no patient lost. Recurrence of posterior vaginal prolapse was noted in only two cases. Dyschesia and urinary incontinence were improved respectively in 80 and 70% of the cases and a significant improvement in anal incontinence was observed in 95% of the patients. CONCLUSION: The abdominal way allows a suitable treatment in patients with advanced stage rectocele and enterocele and evidence of pelvic organ prolapse. The laparoscopic approach is superior in terms of morbidity and functional results.
Adult↗
Transvaginal laparoscopy.
Transvaginal laparoscopy (TvL) offers an alternative to standard diagnostic laparoscopy in subfertile patients without obvious pelvic pathology. With a specially developed needle-trocar system, access to the pouch of Douglas is gained through a needle puncture of the posterior fornix. Performed under local anaesthesia or sedation with the patient in a dorsal decubitus position and using prewarmed Ringer lactate as a distension medium, TvL allows complete exploration of the tubo-ovarian structures without supplementary manipulation. The combination of transvaginal sonography and transvaginal endoscopy, including minihysteroscopy, TvL, salpingoscopy and chromopertubation test, permits the most complete exploration of the reproductive tract and can be used as a first-line investigation of female fertility in a one-stop infertility clinic. As the transvaginal route offers easy access to the tubes, ovaries and fossa ovarica, some operative procedures are possible. However, in the absence of a panoramic view, these will be limited to minor interventions.
Ambulatory Surgical Procedures↗
Triphasic MRI of pelvic organ descent: sources of measurement error.
PURPOSE: To identify sources of error when measuring pelvic organ displacement during straining using triphasic dynamic magnetic resonance imaging (MRI). MATERIALS AND METHODS: Ten healthy nulliparous woman underwent triphasic dynamic 1.5 T pelvic MRI twice with 1 week between studies. The bladder was filled with 200 ml of a saline solution, the vagina and rectum were opacified with ultrasound gel. T2 weighted images in the sagittal plane were analysed twice by each of the two observers in a blinded fashion. Horizontal and vertical displacement of the bladder neck, bladder base, introitus vaginae, posterior fornix, cul-de sac, pouch of Douglas, anterior rectal wall, anorectal junction and change of the vaginal axis were measured eight times in each volunteer (two images, each read twice by two observers). Variance components were calculated for subject, observer, week, interactions of these three factors, and pure error. An overall standard error of measurement was calculated for a single observation by one observer on a film from one woman at one visit. RESULTS: For the majority of anatomical reference points, the range of displacements measured was wide and the overall measurement error was large. Intra-observer error and week-to-week variation within a subject were important sources of measurement error. CONCLUSION: Important sources of measurement error when using triphasic dynamic MRI to measure pelvic organ displacement during straining were identified. Recommendations to minimize those errors are made.
Adolescent↗
Sonography and MR imaging for the assessment of deep pelvic endometriosis.
Deep pelvic endometriosis may involve the uterosacral ligaments, the pouch of Douglas, the vagina, the rectum, and occasionally the bladder. Assessment by physical examination is difficult, and imaging techniques are needed to evaluate the location and extent of endometriosis. In this review, we describe transvaginal and rectal endoscopic sonographic and magnetic resonance imaging features suggestive of deep pelvic endometriosis and their diagnostic performance.
Endometriosis↗
Laparoscopic management of a ruptured benign dermoid cyst during advanced pregnancy.
Benign cystic teratomas in pregnant women may be responsible for complications such as torsion, rupture and obstruction of labor. A woman in her 31st week of pregnancy with torsion of a large dermoid cyst and lipogranulomatosis peritonitis due to spilled cyst contents was managed laparoscopically with a favorable outcome. Trocar sites were selected according to the uterine size. Open laparoscopy allowed protection of the gravid uterus from penetrative injuries. Laparoscopic management of a voluminous adnexal mass may be safely performed during advanced pregnancy.
Adult↗
Sister Mary Joseph's nodule as the first presenting sign of primary fallopian tube adenocarcinoma.
Umbilical metastasis (Sister Mary Joseph's nodule) is often the first sign of intraabdominal and/or pelvic carcinoma. We describe the fourth case reported in the literature of Sister Mary Joseph's nodule originating from fallopian tube carcinoma. In a 54-year-old woman, Sister Mary Joseph's nodule was unexpectedly detected during umbilical hernia repair. Subsequent laparoscopy revealed a 2-cm friable tumor located at the fimbriated end of right fallopian tube and 1-cm peritoneal implant in the pouch of Douglas. Laparoscopic bilateral adnexectomy and resection of the peritoneal implant were performed. Because frozen section examination revealed fallopian tube carcinoma, the procedure was continued with laparotomy including total abdominal hysterectomy, omentectomy, and pelvic lymph node sampling. Final diagnosis was stage IIIB fallopian tube carcinoma. The patient received postoperative adjuvant chemotherapy with single-agent carboplatin and has remained alive and with no evidence of disease. It is concluded that in cases of Sister Mary Joseph's nodule, laparoscopy can be a useful tool in the search of the primary tumor in the abdomen and/or pelvis. Laparoscopy can provide crucial information with respect to the location, size, and feasibility of optimal surgical resection of the intraabdominal and/or pelvic tumors.
Abdominal Neoplasms↗
Impact of diverging anaerobic technology on cul-de-sac isolates from patients with endometritis-salpingitis-peritonitis.
The probability of obtaining accurate identification of bacteria present in the cul-de-sac in cases of polymicrobial bacterial endometritis-salpingitis-peritonitis (ESP) was analyzed on the basis of a comparison of bacteriologic data derived from the hospital laboratory and those engendered by a research anaerobic laboratory. Two sets of paired cul-de-sac specimens from 20 cases of ESP were analyzed at two different laboratories whose anaerobic technology differed from that of the reference laboratory. At University Hospital (Jacksonville, Florida), 22 of 36 (61%) aerobic bacterial isolates were correctly identified, in contrast to only eight of 52 (15.4%) anaerobic isolates. The clinical facility of the University of Florida College of Medicine (Gainesville, Florida) identified 28 of 32 (86.5%) aerobic and 16 of 34 (47.9%) anaerobic isolates. The probability of accurately delineating the anaerobic bacteria present in polymicrobial peritonitis which may develop in patients with acute salpingitis was directly related to the degree of sophistication in anaerobiology. Since most institutions cannot provide sophisticated anaerobiology, the authors contend that therapy cannot be contingent upon microbiologic data and that the clinician must rely primarily on clinical and biophysical parameters to monitor the effectiveness of therapy.
Anaerobiosis↗
[Laparoscopic treatment of symptomatic uterine retroversion].
STUDY AIM: The aim of this retrospective study was to demonstrate the feasibility of laparoscopic Jamain-Letessier procedure and to report its results. PATIENTS AND METHODS: Between August 1993 and September 1997, 19 patients (mean age: 29.7 years, range: 20-39 years) with painful uterine retroversion were operated on according to a laparoscopic Jamain-Letessier procedure. A preoperative pessary test was performed in 15 patients. The procedure included suture of the uterosacral ligaments to the midline and resection of the pouch of Douglas, followed by peritoneal suture. RESULTS: The pessary test was positive in 14 of the 15 patients. Mean operating time was 2 hours. There was no conversion to laparotomy. Postoperative urinary tract infection was observed in 3 cases. Mean postoperative hospital stay was 2.5 days. With a mean 3-year follow-up, 15 patients were completely pain-free and 2 patients were partially pain-free. The 14 patients with a positive pessary test obtained a good result. CONCLUSION: The pessary test is necessary for selection of patients. The Jalmain-Letessier procedure is easily performed laparoscopically and is associated with a low morbidity. With a mean 3-year follow-up, good results were obtained in 17 out of 19 patients (89%) and all patients with a positive pessary test obtained a good result.
Adult↗
[Hydatid cyst of the Douglas' cul-de-sac with fistula to the bladder. Report of 2 cases].
The present study reported two cases of hydatid cysts localized in Douglas space and that broke in the bladder. The clinical course was characterized by urinary symptoms and by presence the cysts in urine. Abdominopelvic ultrasonography is essential for diagnosis and identification of other sites. When diagnosis is unclear, then CT scan plays a role. Therapy included cystectomy and pericystic resection in one case and intravescical injection of H2O2 in the second case. The course was favorable in both cases.
Aged↗