A Stepwise Approach to Hysterectomy Complicated By Mullerian Anomaly: A Case of a Bicornuate Uterus

2021 ◽  
Vol 28 (11) ◽  
pp. S36-S37
Author(s):  
E.R. Carbaugh ◽  
S. Miles ◽  
S.M. Mansuria
Keyword(s):  
Bicornuate Uterus ◽  
Stepwise Approach ◽  
Mullerian Anomaly

scholarly journals Site of pregnancy obstetrician’s dilemma

2019 ◽  
Vol 8 (8) ◽  
pp. 3406
Author(s):  
Rudrika Chandra ◽  
Sanjay Singh
Keyword(s):  
Adnexal Mass ◽  
Comprehensive Evaluation ◽  
Tubal Ligation ◽  
Intrauterine Pregnancy ◽  
Bicornuate Uterus ◽  
Unicornuate Uterus ◽  
Mullerian Anomaly ◽  
New Finding ◽  
History Of ◽  
Operative Notes

A 28-yr-old P2L2 lady, with history of two previous caesarean deliveries and tubal ligation, presented at 6weeks of amenorrhea with pain lower abdomen. The operative notes from her previous caesarean section stated that she had a unicornuate uterus without a rudimentary horn (ASRM Class II D Mullerian anomaly)5 and only right fallopian tube was visualised, which was ligated by Parkland’s method.On workup, she had a positive urine pregnancy test and ultrasound showed a left adnexal mass without any evidence of intraperitoneal collection, possibly an unruptured left ovarian ectopic pregnancy secondary to failed tubal ligation. Further investigation by MRI revealed an entirely new finding. The suspicious left adnexal mass was the left horn of bicornuate uterus which had an intrauterine gestational sac. Hence, her revised diagnosis was G3P2L2, post LSCS, bicornuate uterus (ASRM class IV B) with 6 weeks of intrauterine left horn pregnancy following failed tubal ligation.She underwent a medical followed by surgical evacuation of intrauterine pregnancy as patient was unwilling to continue the pregnancy.This case highlights the importance of a comprehensive evaluation, whenever a lady is diagnosed with a Mullerian anomaly, in order to correctly classify the patient and identify associated anomalies of urogenital tract which would avoid such erroneous diagnosis of site of pregnancy as illustrated in our case.

scholarly journals Adenomyotic cyst mimicking a congenital Müllerian anomaly: Diagnosis and treatment with laparoscopy

2021 ◽  
Vol 48 (1) ◽  
pp. 91-94
Author(s):  
Sangam Jha
Keyword(s):  
Minimally Invasive ◽  
Young Women ◽  
Needle Aspiration ◽  
Tubal Ligation ◽  
Rare Disorder ◽  
Diagnosis And Treatment ◽  
Rare Entity ◽  
Bicornuate Uterus ◽  
Mullerian Anomaly ◽  
History Of

A 28-year-old woman presented with a 1-year history of severe progressive dysmenorrhea following suction evacuation and tubal ligation. Sonography showed a bicornuate uterus with hematometra in the left horn. Hysteroscopy ruled out a diagnosis of a congenital Müllerian anomaly, as both ostia appeared normal. Under laparoscopy, a mass was seen on the left fundal region near the insertion of the round ligament, and needle aspiration of a chocolate-colored fluid confirmed the diagnosis of an adenomyotic cyst. The cyst was excised. The patient recovered well and has been symptom-free since surgery. Adenomyotic cyst is a rare entity in young women and must be differentiated from obstructive Müllerian anomaly. Laparoscopy is the preferred minimally invasive modality for managing this rare disorder.

scholarly journals Laparoscopic uterovaginal anastomosis in bicornuate uterus with cervical and vaginal aplasia

2018 ◽  
Vol 7 (8) ◽  
pp. 3400
Author(s):  
Rachita Munjal ◽  
Meenakshi Sundaram ◽  
Juhul Patel
Keyword(s):  
Radiological Evaluation ◽  
Bicornuate Uterus ◽  
Rudimentary Horn ◽  
True Incidence ◽  
Vaginal Aplasia ◽  
Mullerian Anomaly ◽  
History Of ◽  
Successful Repair

The presence of Cervical and Vaginal Aplasia with bicornuate uterus is a very rare mullerian anomaly. Its true incidence is still unknown. The presence of functioning bicornuate uterus poses a great challenge for a gynecologist because a successful repair could restore normal menses and may preserve a patient's fertility. Hence, we report a case of 14-year-old unmarried female, known case of Bicornuate uterus with cervical and vaginal aplasia with history of a rudimentary horn excision. On clinical and radiological evaluation, she was diagnosed with complete cervical and vaginal aplasia with haematometra in right cornua of uterus. She underwent vaginoplasty along with laparoscopic uterovaginal anastomosis in an innovative way. On follow-up, hysteroscopy showed a patent anastomosis, vagina was completely healed, and she was menstruating normally.

scholarly journals A Rare Case of Recurrent Vaginal Wall Abscess in Communicating Bicornuate Uterus with Renal Agenesis

2011 ◽  
Vol 3 (1) ◽  
pp. 33-35
Author(s):  
Sindhu Bhute ◽  
Deepti Shrivastava ◽  
Satarupa Mukherjee ◽  
Deepika Rani
Keyword(s):  
Clinical Examination ◽  
Rare Case ◽  
Vaginal Discharge ◽  
Clinical Presentation ◽  
Renal Agenesis ◽  
Vaginal Wall ◽  
Successful Pregnancy ◽  
Bicornuate Uterus ◽  
Mullerian Anomaly ◽  
Proper Diagnosis

ABSTRACT Clinical presentation of müllerian anomalies vary widely. We are reporting here a case of müllerian anomaly, had suffered from secondary infertility and purulent vaginal discharge for last two years. After thorough clinical examination and systematic investigations, her proper diagnosis of communicating bicornuate uterus (H shaped) with partial agenesis of left cervix and total agenesis of right cervix and right kidney was made and patency of right tube was restored, so that not only her symptoms were resolved but she had successful pregnancy too.

scholarly journals The Global Limb Anatomic Staging System (GLASS) for CLTI: Improving Inter-Observer Agreement

2021 ◽  
Vol 10 (16) ◽  
pp. 3454
Author(s):  
Joep G. J. Wijnand ◽  
Devin Zarkowsky ◽  
Bian Wu ◽  
Steven T. W. van Haelst ◽  
Evert-Jan P. A. Vonken ◽  
...  
Keyword(s):  
Staging System ◽  
The United States ◽  
Lessons Learned ◽  
Observer Agreement ◽  
Lesion Length ◽  
Solid Base ◽  
Stepwise Approach ◽  
Additional Tool ◽  
Atherosclerotic Lesions ◽  
Stenosis Severity

Objective: The 2020 Global Vascular Guidelines aim at improving decision making in Chronic Limb-Threatening Ischemia (CLTI) by providing a framework for evidence-based revascularization. Herein, the Global Limb Anatomic Staging System (GLASS) serves to estimate the chance of success and patency of arterial pathway revascularization based on the extent and distribution of the atherosclerotic lesions. We report the preliminary feasibility results and observer variability of the GLASS. GLASS is a part of the new global guideline and posed as a promising additional tool for EBR strategies to predict the success of lower extremity arterial revascularization. This study reports on the consistency of GLASS scoring to maximize inter-observer agreement and facilitate its application. Methods: GLASS separately scores the femoropopliteal (FP) and infrapopliteal (IP) segment based on stenosis severity, lesion length and the extent of calcification within the target artery pathway (TAP). In our stepwise approach, we used two angiographic datasets. Each following step was based on the lessons learned from the previous step. The primary outcome was inter-observer agreement measured as Cohen’s Kappa, scored by two (step 1 + 2) and four (step 3) blinded and experienced observers, respectively. Steps 1 (n = 139) and 2 (n = 50) were executed within a dataset of a Dutch interventional RCT in CLTI. Step 3 (n = 100) was performed in randomly selected all-comer CLTI patients from two vascular centers in the United States. Results: In step 1, kappa values were 0.346 (FP) and 0.180 (IP). In step 2, applied in the same dataset, the use of other experienced observers and a provided TAP, resulted in similar low kappa values 0.406 (FP) and 0.089 (IP). Subsequently, in step 3, the formation of an altered stepwise approach using component scoring, such as separate scoring of calcification and adding a ruler to the images resulted in kappa values increasing to 0.796 (FP) and 0.730 (IP). Conclusion: This retrospective GLASS validation study revealed low inter-observer agreement for unconditioned scoring. A stepwise component scoring provides acceptable agreement and a solid base for further prospective validation studies to investigate how GLASS relates to treatment outcomes.

scholarly journals Inappropriate surgery in a patient with misdiagnosed Robert’s uterus

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Iori Kisu ◽  
Kanako Nakamura ◽  
Tetsuro Shiraishi ◽  
Tomoko Iijima ◽  
Moito Iijima ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Uterine Wall ◽  
Septate Uterus ◽  
Case Presentation ◽  
Surgical Interventions ◽  
Unicornuate Uterus ◽  
Uterine Malformation ◽  
Mullerian Anomaly ◽  
Future Pregnancy

Abstract Background Robert’s uterus is a rare Mullerian anomaly, which can be described as an asymmetric, septate uterus with a non-communicating hemicavity. Herein, we present the case of a misdiagnosed Robert’s uterus, resulting in an invasive and disadvantageous surgery. Case presentation A 16-year-old woman was referred to our department because of dysmenorrhea and suspicion of uterine malformation. We misdiagnosed Robert’s uterus as a unicornuate uterus with a non-communicating rudimentary horn and hematometra, and performed laparoscopic hemi-hysterectomy. Although the patient’s symptoms were relieved, our surgical procedure left the lateral uterine wall weak, making the patient’s uterus susceptible to uterine rupture in any future pregnancy. Conclusions Although the early diagnosis of Robert’s uterus is challenging, it is important in order to determine appropriate surgical interventions and management for maintaining the quality of life and ensuring safety in future pregnancies.

scholarly journals Robotic natural-orifice IntraCorporeal anastomosis with Extraction (NICE procedure) for complicated diverticulitis

2021 ◽  
Author(s):  
Eric M. Haas ◽  
Thais Reif de Paula ◽  
Roberto Luna-Saracho ◽  
Melissa Sara Smith ◽  
Jean-Paul J. LeFave
Keyword(s):  
Complicated Diverticulitis ◽  
Intracorporeal Anastomosis ◽  
Natural Orifice ◽  
Abdominal Incision ◽  
Stepwise Approach ◽  
Stapling Device ◽  
Video Recordings ◽  
Conversion Rates ◽  
Technical Modifications ◽  
Instrument Control

Abstract Background Totally intracorporeal surgery for left-sided resection carries numerous potential advantages by avoiding crossing staple lines and eliminating the need for an abdominal incision. For those with complicated diverticulitis, minimally invasive surgery is known to be technically challenging due to inflamed tissue, distorted pelvic anatomy, and obliterated tissue planes, resulting in high conversion rates. We aim to illustrate the stepwise approach and modifications required to successful complete the robotic Natural-orifice IntraCorporeal anastomosis with transrectal specimen Extraction (NICE) procedure in this cohort. Methods Consecutive, elective, unselected patients presenting with complicated diverticulitis defined as fistula, abscess and stricture underwent the NICE procedure over a 24-month period. Demographic and intraoperative data were collected, and video recordings were reviewed and edited on encrypted server. Results A total of 60 patients (50% female) underwent the NICE procedure for complicated diverticulitis with a mean age of 58.9 years and mean BMI of 30.7 kg/m2. The mean operative time was 231.6 min. All cases (100%) were achieved with intracorporeal anastomosis using a circular stapling device. All but one patient (98.3%) had successful transrectal extraction of the specimen. Forty-four (73%) of the specimens required a specimen-thinning maneuver to successfully extract the specimen and there were no conversions. We identified seven key technical modifications and considerations to facilitate successful completion of the procedure which are illustrated, including early release of the disease, mesentery-sparing dissection, dual instrument control of the mesenteric vasculature, release of the rectal reflection, use of NICE back table, specimen-thinning maneuver, and closure of the rectal cuff. Conclusion We present a stepwise approach with key modifications to successfully achieve totally robotic intracorporeal resection for those presenting with complicated diverticulitis. This approach may help overcome the technical challenges and provide a foundation for reproducible results.

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