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Caesarean Section
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
It is a good practice opening the anterior leaf of the broad ligament when a hematoma has formed. The next step could be to evacuate the hematoma and identify the bleeder. It may become extremely challenging to locate the bleeder because of the brisk pool of blood that forms on evacuating the hematoma, and the vessel retracts laterally. The bleeding vessel should preferably be identified and ligated. Blind haemostatic suture bites in the retroperitoneal space are extremely risky and are the most typical reason for postoperative uretero-vaginal fistula formation or ipsilateral ureteric ligation or partial injury of the ureter.
A Functional Approach to Gynecologic Pain
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Cysts may also form outside of the ovary, such as paratubal (also known as paraovarian) cysts that develop in the broad ligament. These paratubal cysts are remnants of the Mullerian or Wolffian ducts of embryologic development, and are usually asymptomatic, incidental findings. Occasionally, they can grow large and cause pain, and are subject to torsion similar to an enlarged ovarian cyst. In general, they are managed expectantly and can be considered a normal anatomic feature.
Broad Ligament Fibroids
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Broad ligament fibroids are classified as true and pseudo broad ligament fibroids (Table 12.2). True broad ligament fibroids arise from the muscle fibers in the mesometrium commonly located in round ligament, utero-ovarian ligament, and the connective tissue surrounding the ovarian and uterine vessels. Those arising from connective tissue can attain a very big size and can distort the fallopian tubes. However, they are entirely separate from the uterus and hence can displace but not distort the uterus. Pseudo (false) broad ligament fibroids actually originate from the lateral walls of the uterus or supravaginal cervix and grow toward the broad ligament. It is also considered that the false broad ligament fibroid with long and thin pedicles further elongates and loses its blood supply through the pedicle, leading to necrosis of the pedicle. It starts receiving its blood supply through connective tissue of the broad ligament and becomes a true broad ligament fibroid.
Preliminary study on ultrasound-guided high-intensity focused ultrasound ablation for treatment of broad ligament uterine fibroids
Published in International Journal of Hyperthermia, 2021
Yiran Wang, Yonghua Xu, Felix Wong, Yi Wang, Yu Cheng, Lixia Yang
The broad ligament fibroid originates from the uterine sidewall, growing between the anterior and posterior peritoneum of the broad ligament. It might push against the blood vessels over the lateral side of the uterus so that the larger pelvic vessels move closer to the fibroid (Figure 3(A)). Thus, both laparoscopic and open myomectomy can easily lead to vascular damage, causing intraoperative bleeding. Hemostasis following myomectomy may be difficult because of limited surgical access. A ureter can also be accidentally injured in operation if a broad ligament fibroid is in an unexpected location just next to it or oppresses it, resulting in its displacement. As a noninvasive treatment, HIFU ablation has the advantages of safety and effectiveness with minimal or no damage to surrounding tissues and organs. Therefore, HIFU ablation becomes a new option for treating broad ligament fibroids.
Acute abdominal pain due to internal herniation of the sigmoid colon, fallopian tube and left ovary, a rare presentation of Allen Masters syndrome
Published in Acta Chirurgica Belgica, 2019
C. H. Mazzetti, N. Hock, S. Taylor, J. Lemaitre, K. Crener, E. Lebrun
Herniation through a defect in the broad ligament was firstly reported by Quain in 1861 [3], in an autopsy series. Cilley classified broad ligaments defects in three categories in function of the site of laceration: type 1, the most common, occurs between fallopian tube and round ligament; type 2 between fallopian tube and ovary and type 3 between round ligament and uterus [4]. Hunt describes another type of hernia classification: fenestra type that involves a complete fenestration through both peritoneal layers, hernia sac is absent and the herniation is located lateral to the uterus and pouch type that involves only one of the layers, anterior or posterior, the herniation comes with a sac [5,6]. In female embryos, broad ligament origin from fusion of the paramesonephric ducts, but the physiopathology in congenital forms remains unknown. In nulliparous patients, it has been hypothesized that defect can result from spontaneous rupture of cystic structures remnants of mesonephric or mulleran ducts [4]. Acquired forms on the contrary seem to be due to trauma resulting from pregnancy or delivery (80% of cases have been identified in multiparous women), surgery, endometriosis or pelvic inflammatory disease [7,8].
A case of a contained uterine rupture
Published in Journal of Obstetrics and Gynaecology, 2019
Given the concern for continued bleeding with eventual hemodynamic instability, she was taken into the operating room for an abdominal exploration. A midline vertical incision was made. Upon entry into the abdomen, there was a 6 cm right broad ligament haematoma extending superiorly into the right paracolic gutter. The bladder densely adhered to the lower uterine segment and caesarean scar. The bladder was dissected off carefully and it revealed a rupture of the prior caesarean scar. The rupture was tamponaded by the bladder, giving the illusion of an intact scar on the prior vaginal exams. Once the bladder was adequately taken down, the hysterotomy was repaired in typical fashion. The right pelvic sidewall was opened and the haematoma was evacuated. After a copious irrigation, there was a good hemostasis and the patient’s abdomen was closed. She was discharged on the third postoperative day with a haematocrit of 26. On her postoperative office visits 5, 19 and 42 days later, she remained clinically well and afebrile.