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Practice exam 5: 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 intraoperative complications of this procedure include haemorrhage, perforation of the uterus and potential damage to intra-abdominal organs (2). Fluid overload can complicate the procedure, resulting in pulmonary and cerebral oedema, hyponatraemia, seizures, coma and death (2). Postoperative complications include infection, haematometra with cyclical pain and uterine synechiae (2). A late complication can be postablation pregnancy, which may be dangerous to mother and baby because of the poor quality of endometrium and synechiae (1). Fibroids or menorrhagia may recur (1). If an endometrial carcinoma develops after this procedure, it may be occult, delaying the diagnosis (1).
Müllerian Anomalies
Published in Juan Luis Alcázar, María Ángela Pascual, Stefano Guerriero, Ultrasound of Pelvic Pain in the Non-Pregnant Female, 2019
Betlem Graupera, Jean L. Browne
Patients with Robert's uterus present with recurrent abdominal pain and dysmenorrhea caused by hematometra, hematosalpinx, and in some cases endometriosis as a result of the restriction in the menstrual outflow. These patients can also present with acute pelvic pain.45 There are few cases reported in the literature.46 Di Spiezio Sardo et al. describe a case of Robert's uterus as a complete septate uterus with unilateral cervical aplasia (U2bC3V0) using the ESHRE-ESGE classification.47 The use of three-dimensional ultrasound allows a precise representation of the female genital anatomy even in the presence of complex anomalies as in the case of Robert's uterus.46,47
Test Paper 7
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Cervical carcinoma tends to be of higher signal on T2 than the surrounding cervical stroma and, in the above case, there is also disruption of the cervical stromal fibrous ring, increasing the likelihood of microscopic parametrial invasion. In this case, the cervical tumour is causing a malignant cervical stenosis and haematometra (high T1 signal is consistent with haemorrhage; tumour is usually intermediate signal/hypointense, similar to myometrium on T1 imaging). After radiotherapy to the cervix, cervical stenosis with haematometra can occur; however, post radiotherapy, the cervix becomes low signal because of fibrosis. Ovaries usually lie to either side of the midline, and it would be unusual for a cervical carcinoma metastasis of the ovary to have a high T1 signal. Imperforate hymen is congenital and is normally picked up either neonatally or at the time of menarche, if the latter commonly presents with haematometrocolpos; it would be inconsistent with a cervical cancer history, as this tumour is not seen in patients who are virgo intacta.
The Manchester operation – is it time for it to return to our surgical armamentarium in the twenty-first century?
Published in Journal of Obstetrics and Gynaecology, 2022
Ronen S. Gold, Hadar Amir, Yoav Baruch, David Gordon, Mordechai Shimonov, Asnat Groutz
There were four cases of late postoperative complications that required surgical intervention: vesicovaginal fistula, hematometra, pyometra and transvaginal small bowel evisceration. All four patients underwent uneventful Manchester operation. Three of the four patients underwent concomitant anterior and posterior colporrhaphy, two of whom also underwent TVT-O. The first patient (age 67 years, BMI 29.5) had vesicovaginal fistula that was diagnosed two months postoperatively. The second patient (age 45 years, BMI 22.6) underwent drainage of hematometra three months postoperatively with complete recovery thereafter. The third patient (age 67 years, BMI 24.2) presented with abdominal pain and fever 6 months after surgery. The presumed diagnosis following physical examination, pelvic sonography and lab tests was pyometra. The patient underwent total abdominal hysterectomy after a failed hysteroscopic attempt to drain the pyometra. The forth patient (age 57 years, BMI 19) presented 9 days after surgery with small bowel evisceration through the posterior vaginal fornix. Her past medical history has been unremarkable, with the exception of underweight and a trans urethral removal of bladder tumour (TURBT) for early stage bladder cancer 5 years earlier. The patient underwent emergency laparotomy in which the intestine was inspected and the posterior vaginal fornix was sutured. Her postoperative follow up was unremarkable.
Vulvovaginal graft-versus-host disease: a review
Published in Climacteric, 2019
M. Jacobson, J. Wong, A. Li, W. L. Wolfman
If the patient does not meet diagnostic criteria per the NIH, or if the management would be changed, a vulvar or vaginal biopsy can be undertaken using local anesthesia29. There should be a high index of suspicion for HPV-associated lower genital tract disease and annual Pap or regular HPV testing offered depending on vaginal access30. If the history or physical examination is suggestive of hematometra/hematocolpos, a transvaginal, transrectal, transperineal, or transabdominal ultrasound can be performed. Pelvic magnetic resonance imaging may be another alternative. Hematometra can present as a surgical emergency and the diagnosis should be considered with abdominal mass, urinary retention, cyclic abdominal pain, or lack of bleeding during hormonal withdrawal20,21. Screening for infectious processes or sexually transmitted diseases is not routinely recommended in the absence of clinical suspicion or risk factors, but women taking systemic glucocorticoids or immunosuppressants are at risk for reactivation of viral infections.
A non-gravid incarcerated uterus following a suction dilation and curettage: a case report
Published in Journal of Obstetrics and Gynaecology, 2022
Marie-Claire Leaf, Melissa Perez, Katherine Coakley
This case represents a rare complication of suction dilation and curettage in a patient with a retroflexed uterus. A detailed and thorough literature review revealed no published reports of uterine incarceration following a D and C. Although pathophysiology of non-gravid uterine incarceration is unclear, uterine anomalies including leiomyoma appear to be major contributors to the condition. In this case, the anterior submucosal fibroid previously seen on ultrasound likely obstructed the outflow of blood from the uterus, causing hematometra. Hematometra then lead to an enlarged uterus and eventually to its incarceration as evidence by the engorged uterus on laparoscopy.