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Alternative Imaging Techniques for Endometriosis: Magnetic Resonance Imaging
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Flora Daley, Amreen Shakur, Susan J. Freeman
The uterosacral ligaments are usually thin low signal intensity bands on T2WI, which originate from the posterior aspect of the upper cervix (torus uterinus), course around the mesorectal fascia and then cranioposteriorly towards the sacrum. Endometriotic disease in this region is common, with an incidence of approximately 70% (28), causing the uterosacral ligaments to become thickened, nodular or spiculated (Figure 4.7). Thin-section imaging is essential to improve the success of detection, best delineated on sagittal and coronal T2W imaging (29). Endometriosis involving the uterosacral ligaments and retrocervical region may also cause fibrotic retroflexion of the uterus. Adhesions extending to the anterior serosa of the adjacent rectosigmoid can cause angulation of the bowel contour (5).
Practice exam 6: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
The typical clinical features associated with endometriosis include severe dysmenorrhoea, deep dyspareunia, chronic pelvic pain, infertility, cyclical or perimenstrual symptoms and dyschezia. Signs include pelvic tenderness, a fixed retroverted uterus and tender uterosacral ligaments (6).
Surgical treatment of endometriosis
Published in Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh, An Atlas of ENDOMETRIOSIS, 2020
Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh
LUNA involves transection of both uterosacral ligaments with the specific aim of disrupting the efferent nerve fibres supplying the uterus. The technique remains controversial, as there is no good evidence to demonstrate that it is effective. In a double-blind randomised controlled study, the addition of LUNA to laparoscopic laser vaporisation of endometriosis was not found to improve pelvic pain15. The authors believe that this procedure should not be performed if the uterosacral ligaments have a normal appearance. In the presence of deep infiltrating endometriotic lesions on the uterosacral ligaments, excision is advised (Figures 9.46–9.52).
A case of spontaneous bowel perforation in labour secondary to endometriosis
Published in Journal of Obstetrics and Gynaecology, 2021
Hannah Draper, Keith Cunningham, Siva Muthukumarasamy, Kevin Phillips
We report the case of a 33-year-old lady with spontaneous bowel perforation during a vaginal delivery secondary to known endometriosis. A recent laparoscopy had demonstrated significant endometriosis involving both uterosacral ligaments, with bowel adhered to both pelvic sidewalls and the left ovary fixed to the bowel, pelvic sidewall and uterosacral ligaments. It was noted at the time of surgery that the bowel was adhered to the posterior aspect of the uterus but was not removed due to the risk of bowel injury. She underwent laparoscopic treatment of her endometriosis, bilateral uterolysis, adhesiolysis, left salpingectomy for hydrosalpinx and the endometriotic deposits were shaved off the bowel until it was noted to be mobile. She received one dose of GnRH analogues before proceeding to in vitro fertilisation treatment for primary subfertility, which was successful at the first cycle within three months of primary surgery.
Successful management of ureteric endometriosis by laparoscopic ureterolysis – A review and report of three further cases
Published in Arab Journal of Urology, 2018
Deepa Talreja, Vivek Salunke, Shinjini Pande, Chirag Gupta
Considering the risk of loss of renal function, as well as the nonspecific symptoms, a prompt clinical suspicion and preoperative assessment including a thorough history, physical examination, and imaging can potentially help in the diagnosis. Additionally, ureteric involvement should be suspected when there is clinical involvement of the uterosacral ligaments. In all our patients, we found an endometriotic nodule at the level of the insertion of the uterosacral ligament at the site of ureteric involvement. In all our present cases, patients were evaluated thoroughly to determine the extent of the disease. Our present case series emphasised that preoperative assessment of the upper and lower urinary tract in patients with deep infiltrating endometriosis should be considered, as detailed descriptions of the involvement of ureteric or other urinary tract lesions are important for counselling of the patients and for providing information to the surgeon.
Intraoperative endoscopic ultrasound guidance for laparoscopic excision of invisible symptomatic deep intramural myomas
Published in Journal of Obstetrics and Gynaecology, 2018
Bulent Urman, Aysen Boza, Baris Ata, Sertan Aksu, Tonguc Arslan, Cagatay Taskiran
All specimens were extracted from the abdominal cavity through a culdotomy incision that was affected with the aid of the CCL Vaginal Extractor (Karl Storz, Tuttlingen, Germany). The device was inserted into the vagina and pushed firmly into the posterior fornix, thus making the cul-de-sac peritoneum more prominent. The device separates the uterosacral ligaments laterally and pushes the rectum inferiorly. After insertion of the CCL Vaginal Extractor, a transverse culdotomy incision was carried out using unipolar cutting current. A 10-mm grasping forceps was introduced through the CCL Vaginal Extractor and the specimens were removed in a specimen bag. After specimen removal, the culdotomy incision was closed from the vagina with a 0 polyglactin 910 26-mm 5/8 suture (Vicryl®, Ethicon Inc., Somerville, NJ).