231/263. Hematosalpinx with pelvic pain after endometrial ablation confirms the postablation-tubal sterilization syndrome. Complications after endometrial ablation are uncommon, and published series show that the majority of women who are treated by this technique remain symptom free in the postoperative period. A 39-year-old woman with previous tubal ligation underwent laparoscopic-assisted vaginal hysterectomy for debilitating pelvic pain 1 year after endometrial ablation. Pathologic assessment of the surgical specimen showed bilateral hematosalpinges from continued cyclic occult bleeding. The symptoms and findings in this case confirm the postablation-tubal sterilization syndrome. ( info) |
| Torsion of the fallopian tube is an uncommon event with variable features, and may occur in the absence of adnexal disease. A woman had signs, symptoms, and ultrasound findings consistent with acute pelvic inflammatory disease. laparoscopy established the definitive diagnosis of tubal torsion. ( info) |
| Operative resectoscopy and endometrial ablation are often performed to treat abnormal uterine bleeding, but little is known about the potential late complications of these procedures. We reviewed the records of 305 women who underwent endometrial ablation at a midwestern obstetrics and gynecology group practice and teaching hospital between July 1990 and October 1995. For 71 women, tubal ligation, salpingectomy, or tubal sterilization was performed at the time of ablation. Of these, six (8.4%) developed intense cyclic pain 5 to 40 months after surgery. Four subsequently underwent exploratory laparotomy and hysterectomy, and two others underwent laparoscopic tubal resection and destruction. Gross pathologic findings revealed hematosalpinx, and microscopic examination showed endometriosis, acute and chronic inflammation of the fallopian tubes, and acute and chronic myometritis. We believe these characteristic clinical and pathologic findings are consistent with postablation-tubal sterilization syndrome, a distinct clinical entity arising as a late complication of endometrial ablation in patients with a history of tubal ligations and/or obstruction. ( info) |
234/263. Large torsed neonatal ovarian cysts associated with massive vesicoureteral and intrarenal reflux. The cases of two infants with large neonatal ovarian cysts complicated by salpingotorsion are reported. Both had persistent hydronephrosis after resolution of the ovarian cyst. Voiding cystourethrography in each child demonstrated massive vesicoureteral reflux with intrarenal reflux. The potential significance of this association and its possible cause are discussed. ( info) |
235/263. Torsion of a fallopian tube following Pomeroy tubal ligation: a rare case report and review of the literature. A case of unilateral fallopian tube torsion following Pomeroy tubal ligation, as well as a review of the literature, is presented. Although uncommon, this entity should be considered in the differential diagnosis of abdominal pain in the female patient. Early surgical intervention by means of laparoscopy is mandatory in order to correctly diagnose and treat this complication. ( info) |
236/263. rupture of an heterotopic pregnancy in the 15th week and normal continuation of the intrauterine gestation. Case report. A rare case report of heterotopic pregnancy, ruptured in the 15th week of gestation is presented. The intrauterine pregnancy continued after the laparotomy and removal of the extrauterine fetus and ended with a normal delivery in the 39th week. ( info) |
237/263. Late complications after systemic methotrexate treatment of unruptured ectopic pregnancies: a report of three cases. BACKGROUND: The use of methotrexate (MTX) by systemic administration in the treatment of unruptured ectopic pregnancy has been reported as a safe and effective method. CASES: We report three cases (one hematosalpinx and two pelvic hematocoeles) of complications after the use of MTX in the treatment of unruptured ectopic pregnancies. All three cases came to our observation for pelvic pain, abnormal bleeding and a pelvic mass after an interval of 3-5 months, subsequent to the disappearance of symptoms and normalization of serum human chorionic gonadotropin beta-subunit (beta-hCG) levels. CONCLUSIONS: These findings suggest that: (a) such complications should be considered before selecting the mode of treatment for ectopic pregnancy; and (b) that an early ultrasonographic control should be performed after MTX treatment even when the decline in beta-hCG levels suggests a successful resolution. This would permit an early diagnosis of these late complications. ( info) |
238/263. Ultrasound-guided fallopian tube cannulation using Albunex. OBJECTIVE: To test the role of transcervical fallopian tube catheterization under ultrasound (US) guidance using an ultrasound contrast agent. DESIGN: catheterization was performed under US guidance in a patient with bilateral proximal tubal obstruction. SETTING: This study is a case report. PATIENT(S): Proximal tubal obstruction had been diagnosed on previous roentgenogram hysterosalpingography. INTERVENTION(S): Salpingography and tubal cannulation. MAIN OUTCOME MEASURE(S): Tubal patency was assessed using Albunex (Mallinckrodt Medical, St. Louis, MO) enhanced US. RESULT(S): Transvaginal catheterization was successful in achieving tubal patency. CONCLUSION(S): This catheterization technique should be investigated for possible use in the treatment of proximally obstructed tubes. ( info) |
239/263. Genital tract tuberculosis with peritoneal involvement: MR appearance. The MR appearance of a case of genital tract tuberculosis is reported. The finding of a large amount of loculated fluid containing septations and debris on ultrasound along with bilateral hydropic fallopian tubes and a thickened omentum on MRI permitted the diagnosis to be suggested preoperatively. With increasing prevalence, such unusual manifestations of tuberculosis will be seen more frequently. ( info) |
240/263. recurrence of hydrosalpinges after transvaginal aspiration of tubal fluid in an IVF cycle with development of a serometra. The presence of hydrosalpinges has been shown to be deleterious in infertility treatment. pregnancy rates after in-vitro fertilization (IVF) with embryo transfer decline considerably. This study concerns a patient who developed bilateral hydrosalpinges during controlled ovarian stimulation in preparation for IVF treatment. Transvaginal aspiration of the tubal fluid was unsuccessful as the tubes refilled within 2 days. Additionally, on the day of embryo transfer a serometra developed which could not be seen on the day of oocyte retrieval. The uterine cavity was evacuated via an embryo transfer catheter and three embryos were transferred. The serometra reappeared 3 days after embryo transfer. A pregnancy could not be achieved. The accumulation of fluid in the uterine cavity during an IVF/embryo transfer cycle is a rare complication of hydrosalpinges. However, the retrograde flow of tubal fluid may disturb intrauterine embryo development. This study suggests that the aspiration of hydrosalpinges and intrauterine fluid accumulation during an IVF cycle is not beneficial, as the underlying pathology is not cured. Cancellation of the treatment cycle or cryopreservation of oocytes in the pronucleate stage and transfer of the cryopreserved oocytes after surgical correction of the tubes may be better options. ( info) |