251/263. Endometrial fluid collection in women with hydrosalpinx after human chorionic gonadotrophin administration: a report of two cases and implications for management. The impact of hydrosalpinx (HSPX) on in-vitro fertilization (IVF) outcome has recently been the subject of intense debate. Most, but not all, studies have reported decreased implantation and pregnancy rates and increased early pregnancy loss in HSPX patients. This has led to prophylactic salpingectomies prior to IVF in HSPX patients despite the lack of any prospective studies to suggest that any improvement will occur. women with HSPX constitute a heterogeneous population because some conceive easily with IVF while others do not until after surgical correction. HSPX also increases in size with ovarian stimulation, and can cause implantation failure by fluid reflux into the uterine cavity. Careful assessment of the endometrial lining is mandatory in HSPX to rule out fluid reflux from the HSPX. We present two case reports of patients whose HSPX enlarged with ovarian stimulation, causing fluid reflux into the uterine cavity which was only noted after human chorionic gonadotrophin (HCG) administration. ( info) |
| Ectopic pregnancy (EP) after in vitro fertilization and embryo transfer (IVF/ET) is not rare, but triplet tubal pregnancy after IVF/ET is very rare. We describe a patient with hydrosalpinx in whom a triplet tubal pregnancy occurred on the same side as the hydrosalpinx. Close hormonal and sonographic monitoring of pregnancies achieved through IVF is recommended to ensure the early diagnosis of EP and to avert complications. A triplet tubal EP was considered highly probable after 3 gestational sacs were observed outside the uterus during sonography performed at 6 weeks' gestation. Therapeutic laparoscopy was then performed because methotrexate treatment failed. Appropriate management strategies are discussed. ( info) |
253/263. prolapse of Filshie clips following vaginal hysterectomy. ( info) |
254/263. Late-onset hematometra and hematosalpinx in a woman with a noncommunicating uterine horn. A case report. BACKGROUND: Noncommunicating uterine horns are rare, occasionally presenting with functional endometrial cavities. Surgical removal of the noncommunicating horn is commonly performed to prevent endometriosis in these patients. CASE: A 41-year-old woman with a unicornuate uterus and noncommunicating uterine horn presented with a three-month history of right-sided pelvic pain. She had previously undergone multiple assisted reproductive technique attempts with superovulation and supraphysiologic serum estradiol levels and no apparent symptomatology or evidence of hematosalpinx during laparoscopy. Shortly after completing a donor oocyte recipient cycle, she developed acute right-sided pelvic pain. Diagnostic laparoscopy and subsequent laparotomy confirmed a right hematosalpinx and hematometra of the noncommunicating horn, with stage III endometriosis. CONCLUSION: Consideration of prophylactic resection of a noncommunicating uterine horn with a cavity should be considered in an asymptomatic, reproductive-age patient with this rare mullerian anomaly. ( info) |
255/263. magnetic resonance imaging with gadolinium-diethylenetriamine pentaacetic acid is useful in assessment of tubal patency in a patient with iodine-induced hypothyroidism. A 32-year-old woman presented for evaluation of primary infertility. Because she had a history of iodine-induced hypothyroidism, conventional hysterosalpingography was contraindicated. Tubal patency was assessed by magnetic resonance imaging (MRI) after infusion of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Visualization of the contrast medium in the peritoneal cavity revealed tubal patency. Our case indicates that MRI with gadolinium-diethylenetriamine pentaacetic acid is a safe, simple, and easy way to confirm that at least one tube is patent when a patient is at risk for hysterosalpingography. To our knowledge, this is the first report that tubal patency was diagnosed on MRI. ( info) |
256/263. Congenital or torsion-induced absence of fallopian tubes. Two case reports. Unilateral absence of a uterine tube is an extremely rare finding, for which there are two possible etiopathogenic causes: in some cases it is due to haemorrhage filling of the cavity and its reabsorption as a result of asymptomatic torsion of the uterine tube during adult life, in pediatric age or even during intrauterine life; alternatively, the absence may be congenital, associated with developmental alterations of the mesonephric and paramesonephric ducts. The article presents two cases of fallopian tube absence: a congenital monolateral absence and a tubal torsion during pregnancy. The symptomatology of the torsion of the fallopian tube in pregnancy can be milder than in the classic description with peritoneal reaction and severe clinical alteration. The main risk factors for tubal torsion are: adhesions and inflammatory processes, ovarian cysts, usually of dermoid type, menstrual period, pregnancy, abnormal long mesosalpinx and/or mesovarium, pelvic congestion induced by constipation and disturbed venous blood flow from the adnexa. A congenital defect of the mesonephric duct is followed by a homolateral defect of the paramesonephric duct. The resulting anomaly is characterized by the absence of the uterine tube, uterus-tube angle, kidney and ureter. Partial or total unilateral defects of a paramesonephric duct are more common than aplasia of both ducts. Some authors have suggested that an inadequate blood supply during the descent into the pelvis of the caudal part of the paramesonephric duct might feasibly lead to incomplete tube development. ( info) |
257/263. Laparoscopic fimbrioplasty: an evaluation of 35 cases. The aim of this prospective study was to assess the value of laparoscopic treatment of severe fimbrial occlusions. During a period of 52 months infertile patients with fimbrial lesions were treated by operative laparoscopy. Only those patients requiring incision of the tubal serosa (salpingostomy) were included, representing the most severe lesions. The most frequent cases, those patients requiring simple adhesiolysis and deagglutination of the fringes, were excluded. All tubal lesions were documented carefully. Positive chlamydia trachomatis (CT) serology was found in 65.7% of the patients. All the patients were followed up for at least 2 years. Three patients lost to follow-up were defined as failures. The global conception rate was 74.3%. The intrauterine pregnancy rate was 51.4%, and the 'take home baby rate' was 37.1% (only the first pregnancy being taken into account). The ectopic pregnancy rate was 22.9%. A positive CT serology was found to have a significant influence on the outcome. It can be concluded that the laparoscopic approach provides results similar to those obtained by microsurgery for the treatment of severe fimbrial occlusions, and represents an acceptable alternative to in-vitro fertilization (IVF) in selected cases. ( info) |
258/263. Torsion of the fallopian tube: progression of sonographic features. Isolated torsion of the fallopian tube is a rare gynecologic condition that is difficult to diagnose preoperatively. We present the sonographic and CT findings over a 48-hour period in a case of isolated torsion of the fallopian tube. The radiologic features of isolated torsion have been described previously; however, to our knowledge, the progressive findings have not been previously reported. ( info) |
259/263. Massive hemoperitoneum from endometriosis of the fallopian tube. A case report. BACKGROUND: endometriosis is a common gynecologic disease that usually presents with pelvic pain and infertility in the reproductive years. It can be complicated by bleeding, such as hematuria or hemoptysis; however, acute massive hemoperitoneum caused by tubal endometriosis without any concomitant disorder has not been reported previously. CASE: An unusual case of massive hemoperitoneum led to preshock as a result of bleeding from a tubal endometriosis implant in a previously healthy 29-year-old woman without previous history suggesting endometriosis. CONCLUSION: Although the most common gynecologic cause of hemoperitoneum in a reproductive-age woman is ruptured ectopic pregnancy, endometriosis should also be considered, especially after exclusion of pregnancy. ( info) |
260/263. Isolated torsion of the fallopian tube. A case report. BACKGROUND: While torsion of the adnexa is relatively common, isolated torsion of the fallopian tube alone remains a rare occurrence. Diagnosis and surgical intervention are often delayed. CASE: A 38-year-old woman presented with acute lower right abdominal pain initially managed as renal colic. She returned to the emergency department three days later. After surgical consultation, a computed tomography scan and ultrasound showed a cystic pelvic mass with normal ovarian flow studies. Ultimately, the gynecology team performed laparoscopy with the suspicion of intermittent adnexal torsion. A 6 x 8-cm, twisted, dusky purple right fallopian tube was noted. A laparoscopic salpingectomy was performed. CONCLUSION: In the differential diagnosis of acute lower abdominal pain, isolated torsion of the fallopian tube should be considered. A timely diagnosis and surgical intervention may allow preservation of the tube. Even when irreversible damage has occurred, laparoscopic management is recommended. ( info) |