China
Africa
Explore chapters and articles related to this topic
Anatomy of the Pelvis
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
It contains the pelvic organs and is considered a narrow continuation of the greater pelvis. It is of significant obstetric relevance and has a median curved axis. The superior opening of the lesser pelvis is occupied by the viscera in life while the inferior by the pelvic floor and its sphincters.
Normal Anatomy of the Female Pelvis and Sonographic Demonstration of Pelvic Abnormalities
Published in Asim Kurjak, Ultrasound and Infertility, 2020
Other anatomical structures that can be consistently demonstrated by sonography within lesser pelvis are the pelvic musculature and blood vessels. Visualization of these structures is less important from a clinical standpoint. The obturator internus muscle occupies a large part of the anterior and lateral pelvic walls and is demonstrated as a well-defined hypoechoic ovoid structure. The levator ani muscle is seen on a transverse scan at the level of the cervix and vaginal fornices and denotes the pelvic diaphragm. Other muscles forming the pelvic diaphragm are rarely seen because of their deep position.
Adnexal/Ovarian Torsion
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Hajra Takala, Mona Omar, Ayman Al-Hendy
OT is a rare cause of acute abdomen during pregnancy [15, 60]; however, the risk of adnexal torsion increases five-fold during pregnancy, with an incidence of one to five of 10,000 spontaneous pregnancies [61, 62]. It is postulated that this is because the ovaries become displaced outside of the lesser pelvis [63]. Several longitudinal studies (retrospective reviews) of OT in pregnancy estimated that 10% to 25% of women with torsion are pregnant [49, 50, 64, 65]. The main risk factors for OT in the first trimester are corpus luteum cysts or ovarian hyperstimulation. However, the main risk factor for OT in the second or third trimester is persisting ovarian cysts. A study that analyzed the risk of torsion and malignancy of adnexal masses during pregnancy found the incidence of OT is higher at 10 to 17 weeks of gestation [62]; however, it can occur at any gestational age. Adnexal tumors at high risk for torsion and malignancy should be strongly considered for aggressive management during pregnancy [66]. Functional ovarian cysts cause the majority of torsions in pregnant women [47]. Studies have found that OT usually occurs with ovarian masses >4 cm [66–68]. However, Bromley and Benacerraf and Schmeler et al. reported in their studies that adnexal masses of similar size have different effects on the incidence of OT in pregnant and nonpregnant women [69, 70]. Ovarian masses in pregnant women with adnexal masses ≥4 cm had a 1% to 6% lower incidence of torsion compared with ovarian masses in nonpregnant women [3, 70]. Pregnant women have a higher rate of OT recurrence. The gravid uterus makes it difficult to locate adnexa, which leads to delay in OT diagnosis in pregnant women. However, a multicystic ovary due to past assisted reproductive technology or ovarian stimulation with hyperstimulation syndrome carries a high risk of OT in pregnant women [47, 59, 60, 68]. Torsion of the normal ovary has been reported in the postpartum period. The postulated hypothesis of postpartum normal adnexal torsion is the rapid anatomic changes in the pelvis, accompanied by the involution of the uterus while the UO ligament remains disproportionately stretched. This provides the normal ovary with more room to move and twist [18]. In a nutshell, pregnancy is a risk factor for torsion even in the absence of a predisposing factor. However, ovarian stimulation and ovarian masses are the most frequently associated risk factors for OT in pregnancy.
Reduction of adhesion formation after gynaecological adhesiolysis surgery with 4DryField PH – a retrospective, controlled study with second look laparoscopies
Published in Journal of Obstetrics and Gynaecology, 2022
Nicole Ziegler, Rudy Leon De Wilde
The study comprises 40 patients aged 18–77, who underwent laparoscopic adhesiolysis in the period from November 2012 to August 2016. Adhesions had been caused by surgeries for various pre-existing conditions such as endometriosis, myomas, tumours and others. Only patients with a second look surgery were included in the study. Extent and severity of adhesions were scored during both interventions enabling a direct assessment of the efficacy of the adhesion prevention device. The first 23 consecutive patients received no adhesion barrier, whereas the following 17 were treated with 4DF gel. The product was either applied as a powder and subsequently dripped with saline solution in situ or the gel was premixed extracorporally. The premixed gel was prepared using either 3 g 4DF powder and about 30 mL saline solution or 5 g 4DF powder and about 50 mL saline solution. The gel was distributed on all surgically affected surfaces in the peritoneal cavity and the lesser pelvis. Examples of the application of 4DF powder with subsequent transformation into a gel are shown in Figure 1(A–F).
Topography of the pelvic autonomic nerves – an anatomical study to facilitate nerve-preserving total mesorectal excision
Published in Acta Chirurgica Belgica, 2022
Jan Gaessler, Friedrich Anderhuber, Sabine Kuchling, Ulrike Pilsl
Just upon entry into the lesser pelvis, the ureter descended along the pelvic sidewall. During its descent, it passed superiorly to the IHP at a distance of 11 (3) mm (Figure 4). Significant differences across categories of biological sex were not observed (10 (3) mm in females versus 11 (3) mm in males, p = 0.32). At the level of the ischial spine, the ureters ceased sticking to the pelvic sidewall and instead turned medially to eventually reach the urinary bladder. Observations detected the segment of the ureters' course immediately distal to the ischial spine as the one closest to the MRF with a distance of 13 (5) mm. Sex-related differences were not statistically significant (13 (5) mm in females versus 13 (2) mm in males, p = 0.85).
Total mesorectal excision – 40 years of standard of rectal cancer surgery
Published in Acta Chirurgica Belgica, 2020
J. Votava, D. Kachlik, J. Hoch
Rectum is the last segment of the large intestine, following on from the sigmoid colon. The border is not sharp and is arbitrary located at the linea terminalis (promontory) at the border between the greater and lesser pelvis in descriptive anatomy. But there can be different levels, described in surgical books, e.g. at the level of the intervertebral disc S2/S3, in front of the vertebral body of L3, at the lowest point of the peritoneal cavity (rectovesical pouch of Proust in males/rectouterine pouch of Douglas in females), or 15 cm orally to anocutaneous line (white line of Hilton).