Uterocutaneous Fistula after a C-Section in a Patient with Second Trimester Fetal Demise and Chorioamnionitis

Uterocutaneous fistulae are very rare entities with only about 120 cases reported in the literature. They are mostly described after a C-section or other pelvic surgery. We hereby describe a uterocutaneous fistula in a 41-year-old patient 5 months after a C-section because of a chorioamnionitis and a 22-week fetal demise. One month after the C-section, she underwent a diagnostic hysteroscopy to exclude postoperative intrauterine adhesions. Afterwards, she complained of pelvic pain, persistent metrorrhagia, and significant weight loss during 2 months. She consulted the emergency unit several times, and lastly endometritis was diagnosed. She was treated with antibiotic therapy for 7 days, without significant clinical improvement. She presented at our institution 48 hours after a carbuncle had appeared in her right iliac fossa. A uterocutaneous fistula was diagnosed on the CT scan. The patient received IV antibiotic therapy and underwent a total hysterectomy with bilateral salpingectomy by laparotomy, as she did not want a conservative surgery. The clinical postoperative evolution was favorable. Symptoms of UCF can be very unspecific. To avoid medical wandering and improve the patient’s care, UCF should be in the differential diagnostic of abdominal pain after a pelvic surgery. Moreover, in patients with previous C-section and infectious perioperative status, the risk of PID or pelvic abscess must be careful evaluated before intrauterine diagnostic or therapeutic procedures.

Download Full-text

Right Hydronephrosis as a Complication of Acute Appendicitis

Case Reports in Emergency Medicine ◽

10.1155/2016/3231862 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

Selahattin Koray Okur ◽

Yavuz Savaş Koca ◽

İhsan Yıldız ◽

İbrahim Barut

Keyword(s):

Urinary Tract ◽

Acute Appendicitis ◽

Antibiotic Therapy ◽

Acute Abdomen ◽

Delayed Diagnosis ◽

Scoring Systems ◽

Pelvic Abscess ◽

Diagnostic Process ◽

Abdominal Ultrasonography ◽

Tract Infections

Introduction. Acute appendicitis is the most common cause of acute abdomen, but atypical appendicitis may lead to delayed diagnosis and related complications. In this report, we present a very rare case of acute appendicitis causing right hydronephrosis.Case Report. A 54-year-old male patient who had been receiving antibiotic therapy due to the diagnosis of urinary tract infection for the last one week but had no clinical improvement was admitted to the emergency service. Abdominal computed tomography (CT) showed right hydronephrosis and a pelvic abscess. After appendectomy and abscess drainage had been performed, hydronephrosis was completely recovered.Discussion. The use of appendicitis scoring systems, abdominal ultrasonography (USG), abdominal CT, and diagnostic laparoscopy can be useful for the diagnostic process in patients presenting with acute abdomen. In our patient, we considered that the surgical treatment was delayed since the symptoms of acute appendicitis were suppressed by the antibiotic therapy that was being administered due to the complaints including symptoms of urinary tract infections.Conclusion. Atypical appendicitis may cause a delay in the diagnosis of acute appendicitis and thus may lead to serious complications such as right hydronephrosis, prolonged hospital stay, increased morbidity and mortality, and increased antibiotic resistance.

Download Full-text

African experience of hysterosalpingography abnormalities tubes management by laparoscopy in infertile women

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194842 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4271

Author(s):

Mohamed Fanny ◽

Edele Aka ◽

Perel Konan ◽

Luc Olou ◽

Abdoul K. Koffi ◽

...

Keyword(s):

Pelvic Surgery ◽

Fallopian Tubes ◽

Tubal Infertility ◽

Tubal Patency ◽

Infertile Women ◽

African Experience ◽

Gynecology And Obstetrics ◽

Therapeutic Procedures ◽

History Of ◽

Sub Saharan

Background: Infertility affects about 80 million people worldwide and one in ten couples. The objective of this study was to report our experience of the contribution of laparoscopy in the diagnostic and prognostic approach of fallopian tubes pathology in infertile women in sub-Saharan Africa.Methods: We conducted a retrospective study in the Gynecology and Obstetrics unit of Yopougon Teaching Hospital over a 2-year period (January 1, 2017 to December 31, 2018) which included 49 cases of tubo-peritoneal infertility diagnosed by hysterosalpingography (HSG) then laparoscopy procedure.Results: The average age was 33 years old. 30.6 % were single. 75% had secondary infertility. 59.2% had a medical history of abortion. Pelvic Inflammatory Disease and pelvic surgery accounted 84.2% and 49 respectively. Laparoscopy showed a predominance of distal tubal damage (66.6%) whose 47% hydrosalpinx. Bilateral tubal patency was demonstrated in 77.5% of our patients during laparoscopy procedure. We observed a sensitivity, a specificity, and a concordance laparoscopy / HSG of 63.6%, 80% 63.1% respectively. Laparoscopy also allowed therapeutic procedures such as adhesiolysis or tubal plasty in 22 patients (44.89% of our cases). At the end of laparoscopy procedure, 35 patients (71.42%) were turned towards IVF.Conclusions: Laparoscopy allows an assessment of tubal abnormalities revealed by hysterosalpingography and the fertility prognostic as well as better therapeutic approach in management of tubal infertility.

Download Full-text

Acute eosinophilic appendicitis simulating uncomplicated appendicitis

BMJ Case Reports ◽

10.1136/bcr-2018-227178 ◽

2018 ◽

Vol 11 (1) ◽

pp. e227178

Author(s):

Kazuya Takabatake ◽

Tsutomu Imanishi ◽

Tetsuji Yoshikawa

Keyword(s):

Acute Appendicitis ◽

Antibiotic Therapy ◽

Iliac Fossa ◽

Japanese Woman ◽

Chief Complaint ◽

Histopathological Diagnosis ◽

Uncomplicated Appendicitis ◽

Old Japanese ◽

Abdominal Emergencies ◽

The Right

Acute appendicitis is one of the most common abdominal emergencies worldwide. Uncomplicated appendicitis (UA), which does not involve perforation or peritonitis, has recently been treated with antibiotic therapy. Here, we report a case of acute eosinophilic appendicitis (AEA) that simulated UA and did not respond to antibiotic therapy. A 20-year-old Japanese woman emergently presented with the chief complaint of pain at the right iliac fossa. CT showed only swelling of the appendix. She was diagnosed with UA, and she received antibiotic therapy initially. However, the treatment was not effective and appendectomy was performed. The final histopathological diagnosis was AEA. The findings of this case suggest that AEA is likely to be diagnosed as UA. As AEA can simulate UA, the possibility of AEA should be considered when antibiotic therapy is not effective.

Download Full-text

Candida albicans pelvic abscess associated with the use of 32% Dextran-70**Hyskon Division, Pharmacia, Piscataway, New Jersey. in conservative pelvic surgery

Fertility and Sterility ◽

10.1016/s0015-0282(16)60742-2 ◽

1989 ◽

Vol 51 (6) ◽

pp. 1050-1052 ◽

Cited By ~ 3

Author(s):

I. Ray King

Keyword(s):

Candida Albicans ◽

New Jersey ◽

Pelvic Abscess ◽

Pelvic Surgery ◽

Dextran 70

Download Full-text

Practice of diagnostic hysteroscopy after myomectomy in the prevention of intrauterine adhesions: experience of Ouakam military hospital (Dakar, Senegal)

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181897 ◽

2018 ◽

Vol 7 (5) ◽

pp. 1693

Author(s):

Marie Edouard Faye Dieme ◽

Mouhamadou Mansour Niang ◽

Omar Gassama ◽

Abdoul Aziz Diouf ◽

Marietou Thiam Coulibaly ◽

...

Keyword(s):

Uterine Cavity ◽

Military Hospital ◽

Intrauterine Adhesions ◽

Mean Delay ◽

Single Center Study ◽

Laparotomy Group ◽

Diagnostic Hysteroscopy ◽

The Mean ◽

The Military ◽

Early Diagnostic

Background: Surgical treatment of myomas may be the cause of some complications, including intrauterine adhesions. The objective of the study was to evaluate the incidence of intrauterine adhesions in patients who underwent myomectomy by laparotomy or hysteroscopic resection.Methods: We carried out a prospective single center study from August 1st 2016 to May 31st 2017 in the gynaecological and obstetrical department of Ouakam the Military Hospital (Senegal). We included patients who underwent myomectomy by laparotomy with opening of the uterine cavity or myomectomy by hysteroscopy. A diagnostic hysteroscopy was performed to search post-operative intrauterine adhesions. For each patient, we studied the socio-demographic aspects, the surgical approach, the delay of diagnostic hysteroscopy, the appearance of uterine cavity and the tolerance of hysteroscopy.Results: 54 patients underwent the diagnostic hysteroscopy. The mean age was 36 years old. The main indication of myomectomy was menorrhagia. 37 patients underwent myomectomy by laparotomy and 17 by hysteroscopy. Each case was followed by a post-operative diagnostic hysteroscopy with a mean delay time of 58 days. We found post-operative intrauterine adhesions in 7 patients (5 in the laparotomy group and 2 in hysteroscopy group).Conclusions: Early diagnostic hysteroscopy after myomectomy should be done in our context to reduce post-operative intrauterine adhesions and preserve the patient’s fertility.

Download Full-text