Pneumothorax can be spontaneous or secondary to a pre-existing disorder or trauma. Pneumothorax
associated with pneumoperitoneum without thoraco-abdominal communication is a rare event poorly
...described in the literature. We report the case of a 73-year-old patient undergoing abdominal debulking
surgery for advanced stage ovarian cancer complicated by a pneumoperitoneum and a right-sided
pneumothorax without hernia or evidence of diaphragmatic trauma. Several physio-pathological hypotheses
have been suggested, including a potential COVID-19 infection without clear etiology. Our case report
emphasizes the possible association of pneumothorax with pneumoperitoneum related to a colon perforation
without visible diaphragmatic or mediastinal defects.
To evaluate in a series of patients with borderline ovarian tumors the clinical findings and the outcome after laparoscopic management.
Retrospective study of 25 patients with borderline ovarian ...tumors first treated by laparoscopic approach.
Thirteen patients had mucinous tumors and 12 had serous tumors. Twenty-one patients had ultrasound examination which detected 24 ovarian cysts including multilocular cysts in 50% of cases and unilocular sonolucent cysts in 25% of cases. The serum CA 125 and CA 199 levels were elevated in 30.7% and 23% respectively. Among the 25 patients first treated by laparoscopic approach, 24 had stage I disease: six of them had cystectomy, seven unilateral salpingo-oophorectomy, two bilateral salpingo-oophorectomy and two laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Seven patients had laparoconversion for presumption of ovarian cancer (5) and failure of laparoscopic procedure (2). One patient with stage III disease had laparoscopic biopsies and subsequent laparotomy. Among the 25 patients, 15 had conservative treatment and 10 had radical treatment. Three recurrences occurred after cystectomy. The mean follow-up was 41 months. Twenty-three patients were alive without evidence of disease, one died of intercurrent disease and one patient was lost to follow-up.
Our data suggest that the laparoscopic approach to borderline ovarian tumors is possible in early stage disease but associated with a high risk of recurrence after cystectomy.
Indications of GnRH analogues before and/or after surgery for endometriosis remain controversial. Although some studies have underlined a decrease in rAFS scores using GnRH analogues pre-operatively, ...data are insufficient to recommend their systematic use in routine. In the same way, despite an increase in symptom free period subsequent to the use of GnRH analogues post-operatively, no effect of this therapeutic on recurrence rate and fertility outcome has been proved. In addition to a meta-analysis on GnRH analogues in endometriotic women, further studies, especially in women with large endometriomas and with deep pelvic endometriosis, are required to clarify the indications of GnRH analogues associated with surgical management.
A case of septic expulsion of a leiomyoma is reported 18 weeks after uterine artery embolisation (UAE). The patient underwent UAE for a symptomatic sub-mucous leiomyoma (type 2) of 5 cm. She was ...feverish and presented pelvic pain and purulent vaginal discharges. Vaginal examination revealed a necrotic mass prolapsed through the cervix that was carefully twisted out. Histopathologic examination showed extensive necrosis of the myomatous tissue. Microbiologic cultures showed heavy growth of Escherichia coli. Such findings challenge the interest and the safety of UAE for sub-mucous fibroids. Our case report stresses that uterine artery embolisation for submucous fibroids does not constitute, because of its risks, an alternative to conventional surgical treatment represented mainly by hysteroscopic resection.
This is a review of evolutive aspects in pelvic inflammatory disease (salpingitis, endometritis, pyosalpinx, tubo ovarian abscess) assessed by different imaging modalities (Ultrasound, CT, MRI and ...hysterosalpingography).
To evaluate the accuracy of MR imaging combined with sonography for the diagnosis of persistent adnexal masses during pregnancy.
From January 1999 to November 2003, nine patients with a persistent ...adnexal masse were included in this retrospective study. All patients underwent both transvaginal and transabdominal sonography combined with MR imaging. Accuracy of imaging techniques was evaluated by comparison with histology.
Adnexal masse was detected by systematic sonography in six women whereas three patients were symptomatic. Mean gestational age at the diagnosis was 17 weeks of amenorrhea (range 5-36). Mean tumor size was 96 mm (range 2-15). Two patients underwent a surgery during pregnancy; one for acute abdominal pain related to an adnexal torsion and the second for suspicion of malignancy. One patient underwent a caesarean delivery for obstetrical reasons. In all patients, benign ovarian tumours were found. For eight patients the diagnosis suspected by imaging techniques was confirmed by histology.
The combination of sonography and MR imaging allows diagnosing accurately adnexal masses during pregnancy.
To assess the results of hysteroscopic resection of endometrial polyps and the eventual role of associated endometrial resection.
Retrospective study. Between 1998 and 2001, 367 patients had ...hysteroscopic resection of endometrial polyps, which were initially confirmed by diagnostic hysteroscopy. Fifty-four percent of these had associated endometrial resection.
Five intraoperative complications and/or incidents were noted, but there was no major complication. 83% of patients were followed up and the median follow-up period was 40 months (range 17-66 months). The success rate in this study was 96.4%. This is higher in the group of patients that had associated endometrial resection: 98.3 vs 93.7%.
Hysteroscopic resection is the optimal method for treatment of benign endometrial polyps. Associated endometrial resection in older patients or in patients not desiring to conserve their fertility potential improves the success rate and decreases the rate of recurrences.
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