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Pelvic Ultrasound for Endometriosis: General Features
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Caterina Exacoustos, Lucia Lazzeri
Most frequently, bladder endometriosis is located in the vesical dome on the posterior bladder wall, close to the vesicouterine pouch. The dimensions of the nodule should be recorded as well as the distance between the nodule and the ureters and the trigone (6,38,39) (Figure 3.10). Bladder adhesions of the vesicouterine pouch are evaluated by the presence or absence of the ‘sliding sign' between uterus and bladder. Bladder endometriosis is considered only in the case of infiltration of the bladder wall and not in the case of adhesions or superficial peritoneal implants on the bladder serosa.
Gynaecology
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
The non-pregnant uterus is a thick-walled, muscular, hollow organ the shape and size of a small pear; its overall length is about 8–9 cm and at its widest it measures 6 cm. The uterus lies entirely within the pelvis and separates the bladder in front from the bowel behind (Figure 9.1). The anterior and posterior surfaces of the uterus are covered in peritoneum; in front a small vesico-uterine pouch separates it from the bladder but posteriorly there is a cul-de-sac (the pouch of Douglas). Any free fluid in the peritoneal cavity will tend to collect in the pouch (Figure 9.2). Most commonly, the uterus leans forward over the empty bladder (Figure 9.2) in a position of anteversion and anteflexion, but other positions are common and normal. The uterus tapers downwards towards the neck or cervix, which protrudes into the vagina (Figure 9.2).
The Urinary System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The urinary bladder is a distensible, muscular sacm the pelvis. When empty, the bladder's walls collapse; as it fills, it expands upward. Covered at the top by peritoneum, the bladder is separated from the rectum posteriorly by the rectovesical pouch in the male and from the uterus by the vesicouterine pouch in the female. The internal floor of the bladder forms a smooth triangular area known as the urethral trigone (trigonon is Greek for "triangle"). At the posterolateral angles of the trigone, the ureters enter at the uretic orifices; at the front angle is the internal urethral orifice through which the urethra leaves the bladder. The detrusor uniae muscles, the muscles of the bladder, stretch when the bladder fills and contract in response to relaxation of the urethral sphincter to empty the contents.
A rare case of recurrences of multiple ovarian fibrothecoma
Published in Journal of Obstetrics and Gynaecology, 2021
Gianluca Raffaello Damiani, Mario Villa, Giulio Licchetta, Maria Cristina Cesana, Edoardo Dinaro, Matteo Loverro, Giuseppe Muzzupapa, Antonio Pellegrino
Fibromas and fibrothecomas are benign ovarian neoplasms of the sex cord-stromal tumours group, representing the most common solid primary tumours of the ovary. Due to the singularity of the case, its multiple recurrences, the location of the tumour, the lack of literature on the behaviour of the disease in the pelvis and abdomen and the necessity of a strict follow up to evaluate more of the early recurrences with aggressive behaviour, we report our management. A 46-year-old patient presented to our hospital complaining of pelvic pain, especially in the right iliac fossa. The patient had no medical diseases and no pregnancies. The patient’s history reported of a laparoscopic removal of a left ovarian fibrothecoma (calretinin +/desmin−) 9 years ago, the laparoscopic uterine myomectomy and excision of a neoplasm located on vesico-uterine pouch described as extragonadal recurrence of the same ovary 6 years before.
Extratubal secondary trophoblastic implants (ESTI) following laparoscopic bilateral salpingectomy for ectopic pregnancy: problems that have been neglected for a long time
Published in Gynecological Endocrinology, 2022
Although persistent ectopic pregnancy was diagnosed easily, the terrible thing was that β-HCG exceeded 4000 mIU/ml, but the location of pregnancy was unknown. Finally, the laparoscopy was initially performed. Multiple bluish round 3–20mm nodules were noted at five different sites: periumbilical peritoneum, vesicouterine pouch, rectouterine pouch, intestinal surface, and omentum majus (Figure 1). A partial omentectomy and resection of peritoneal surface lesions were completed without complications. Histopathology revealed chorionic villi in the resected tissues (Figure 2). The β-HCG decreased linearly to 490 mIU/ml 2 days after operation and was undetectable 5 weeks later (β-HCG < 5 mIU/ml).
Disseminated peritoneal leiomyomatosis after uterine artery embolization, laparoscopic surgery, and high intensity focused ultrasound for uterine fibroids：a case report
Published in International Journal of Hyperthermia, 2020
Chunyan Liu, Bojie Chen, Xingmei Tang, Yu Xiong
During laparoscopic surgery, extensive and dense multiple gray and white nodules were found on the surface of the uterus, broad ligaments, the fallopian tubes, the anterior and lateral abdominal wall, the vesicouterine pouch, the rectouterine pouch, the ovaries, liver, cecum, sigmoid colon and greater omentum (Figure 2(A)). The size of the uterus was about 5 months of gestation and the multiple nodules were ranged from 2 mm to 9 cm in size. The largest nodule of 9 cm in diameter was located at the fundus of the uterus, the other two bigger nodules, approximately 4 and 6 cm in size, respectively, were detected in the vesicouterine pouch and the rectouterine pouch. In addition, we found that the left broad ligament, the left fallopian tube, and the left ovary were surrounded by the intestinal tube, and were closely adhered to. So we first performed a laparoscopic subtotal hysterectomy with a bilateral salpingo-oophorectomy to remove the uterus, the fallopian tubes and the ovaries, then carefully excised the two bigger nodules in the vesicouterine pouch and the rectouterine pouch, as well as the visible small lesions on the liver (Figure 2(B)), partial omentectomy was also made. No intraoperative or postoperative complications occurred and the patient was discharged 3 days after surgery. The histological exam showed the multiple nodules with typical features of uterine fibroids. Neither atypia nor necrosis was detected in the specimen (Figure 3(A,B)). Based on the findings from laparoscopic surgery and the histological exam results, a diagnosis of DPL was established in this case. In April 2020, the six months follow-up after surgery, she reported no symptoms and the color Doppler ultrasound did not show any specific findings in the pelvic cavity.