RESOLUTION OF CHRONIC PELVIC PAIN AND ABNORMAL UTERINE BLEEDING AFTER ESSURE® SURGICAL REMOVAL AND LAPAROSCOPIC STERILIZATION: A CASE REPORT

Abstract Background: Diverticulum, one of the long-term squelae of cesarean section, can cause abnormal uterine bleeding, dysmenorrhea and chronic pelvic pain. Hysteroscopic resection of diverticula is thought to reduce abnormal uterine bleeding and chronic pelvic pain. In this study, we aim to describe the improvement after hysteroscopic resection of cesarean section diverticula hysteroscopic resection of cesarean section diverticula (CSD) in women without childbearing intention, and to explore the variables associated with poor prognosis.Methods: A retrospective cohort study of women aged 25-48 with CSD diagnosis by transvaginal ultrasonography (TVS) and hysteroscopy that were enrolled at Guangzhou Women and Children’s Medical Center between June 2017 and December 2018. A total of 124 women met the inclusion criteria and all patients had undergone hysteroscopic resection and accepted a follow-up interview at the 3rd and 6th months postoperatively to record symptom improvement.Result: The mean of intraoperative blood loss and operative time of hysteroscopic resection were (12.94±12.63) ml and (33.63±6.87) min in 124 patients. Overall observed improvement rates of CSD symptom were 47.2% and 65.6% in the first 3 and 6 months, respectively. Multivariable logistic regression models revealed that timing of surgery <14 days was a good prognostic factor associated with both 3-month improvement (OR, 16.59; 95% CI, 2.62-104.90; P=0.003) and 6-month improvement (OR, 15.51; 95%CI, 1.63-148.00; P=0.02); Patients with numbers of cesarean section(CS) ≥2 had a lower rate of improvement after 6 months of CSD repair surgery compared with patients who underwent one CS(OR, 8.29; 95%CI, 1.05-65.75; P=0.04).Conclusions: A hysteroscopic repair might be an appropriate method for CSD in women who no childbearing intentions. The timing of surgery and the number of CS seems to be factors influencing the postoperative improvement of CSD.

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Success of uterus-preserving treatments for abnormal uterine bleeding, chronic pelvic pain, and symptomatic fibroids: age and bridges to menopause

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2010.12.052 ◽

2011 ◽

Vol 204 (3) ◽

pp. 272.e1-272.e7 ◽

Cited By ~ 2

Author(s):

Lee A. Learman ◽

Sanae Nakagawa ◽

Steven E. Gregorich ◽

Rebecca A. Jackson ◽

Alison Jacoby ◽

...

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding

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Occurrence of Chronic Pelvic Pain, Abnormal Uterine Bleeding, and Hysterectomy Post-procedure among Women Who Have Undergone Female Sterilization Procedures: A Retrospective Claims Analysis of Commercially Insured Women in the US

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2017.10.029 ◽

2018 ◽

Vol 25 (4) ◽

pp. 651-660 ◽

Cited By ~ 1

Author(s):

Patricia I. Carney ◽

Jianying Yao ◽

Jay Lin ◽

Amy Law

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Claims Analysis ◽

Female Sterilization ◽

Post Procedure ◽

The Us

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Adenomyosis at Hysterectomy: Prevalence, Patient Characteristics, Clinical Profile and Histopatholgical Findings

Kathmandu University Medical Journal ◽

10.3126/kumj.v10i1.6915 ◽

2012 ◽

Vol 10 (1) ◽

pp. 44-47 ◽

Cited By ~ 5

Author(s):

A Shrestha ◽

R Shrestha ◽

LB Sedhai ◽

U Pandit

Keyword(s):

Medical Therapy ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Histopathological Examination ◽

Menopausal Status ◽

Lower Abdominal Pain ◽

Abnormal Uterine Bleeding ◽

Clinical Findings ◽

Uterine Bleeding ◽

Clinical Profile

Background Underlying adenomyosis is often the cause of treatment failure for patients undergoing medical therapy for abnormal uterine bleeding and or chronic pelvic pain. Given the limitation of ultrasonography in diagnosing adenomyosis and MRI being unaffordable to most of the patients belonging to developing countries like us, it often remains undiagnosed before a hysterectomy. Objective To find out the clinical profile associated with adenomyosis and to determine the prevalence of adenomyosis in hysterectomy specimens; frequency distribution, as well as to correlate clinical examination with histopathological examination. Methods A total of 60 women who had undergone hysterectomy with histopathologically proven adenomyosis between April 2009 and March 2010 were included . Data were collected on indication for the intervention, age, symptoms, clinical findings, hemoglobin, menopausal status, gross and histopathological findings. Results A total of 256 women were scheduled for hysterectomy. Adenomyosis was diagnosed in 60 of 256 cases (23.4%). Menorrhagia (91.2%), dysmenorrhoea (84.2%), lower abdominal pain (84.2%) beginning later in reproductive life (mean age- 45yrs) is the classic presentation. Adenomyosis was present in 10 of 61 patients (16.3%) with fibroids; 27 of 60 (45%) with abnormal uterine bleeding; 11 of 55 (20%) with prolapse; four of 35 (11.4%) with ovarian mass; five of 25 (20%) with chronic pelvic pain; three of four (75%) with endometriosis. Conclusion Women undergoing hysterectomy with diagnosis of adenomyosis have a distinct symptomatology. The choice of therapy in adenomyosis is hysterectomy for those women who have completed family and had failed medical therapy . KATHMANDU UNIVERSITY MEDICAL JOURNAL VOL.10 | NO. 1 | ISSUE 37 | JAN - MAR 2012 | 53-56 DOI: http://dx.doi.org/10.3126/kumj.v10i1.6915

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Laparoscopic Isthmocele Repair: Efficacy and Benefits before and after Subsequent Cesarean Section

Journal of Clinical Medicine ◽

10.3390/jcm10245785 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5785

Author(s):

Stavros Karampelas ◽

Georges Salem Wehbe ◽

Laurent de Landsheere ◽

Dominique A. Badr ◽

Linda Tebache ◽

...

Keyword(s):

Cesarean Section ◽

Outcome Measures ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Secondary Infertility ◽

Significant Difference ◽

Before And After ◽

Myometrial Thickness

Objective: To evaluate the effect of laparoscopic isthmocele repair on isthmocele-related symptoms and/or fertility-related problems. The residual myometrial thickness before and after subsequent cesarean section was also evaluated. Design: Retrospective, case series. Setting: Public university hospital. Population: Women with isthmocele (residual myometrium < 5 mm) complaining of abnormal uterine bleeding, chronic pelvic pain or secondary infertility not otherwise specified. Methods: Women’s complaints and the residual myometrium were assessed pre-operatively and at three to six months post-operatively. In patients who conceived after surgery, the latter was measured at least six months after delivery by cesarean section. Main Outcome Measures: Resolution of the main symptom three to six months after surgery and persistence of laparoscopic repair benefits after subsequent cesarean section were considered as primary outcome measures. Results: Overall, 31 women underwent laparoscopic isthmocele repair. The success rates of the surgery as improvement of abnormal uterine bleeding, chronic pelvic pain and secondary infertility were 71.4% (10 of 14), 83.3% (10 of 12) and 83.3% (10 of 12), respectively. Mean residual myometrial thickness increased significantly from 1.77 mm pre-operatively to 6.67 mm, three to six months post-operatively. Mean myometrial thickness in patients who underwent subsequent cesarean section (N = 7) was 4.49 mm. In this sub-group, there was no significant difference between the mean myometrial thickness measured after the laparoscopic isthmocele repair and that measured after the subsequent cesarean section. None of these patients reported recurrence of their symptoms after delivery. Conclusion: Our findings suggest that the laparoscopic isthmocele excision and repair is an appropriate approach for the treatment of isthmocele-related symptoms when done by skilled laparoscopic surgeons. The benefit of this new surgical approach seems to persist even after a subsequent cesarean section. Further investigations and prospective studies are required to confirm this finding.

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Abnormal Uterine Bleeding in a Postmenopausal Female Following Intra-articular Knee Injection with Triamcinolone: A Case Report

PM&R ◽

10.1016/j.pmrj.2013.08.364 ◽

2013 ◽

Vol 5 ◽

pp. S231-S231

Author(s):

Lee James ◽

Kevin Carneiro

Keyword(s):

Case Report ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Postmenopausal Female

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Patient with Chronic Pelvic Pain from Endometriosis

10.2310/pm.15021 ◽

2016 ◽

Author(s):

Jianguo Cheng ◽

Yoon-Jeong Cho

Keyword(s):

Pelvic Pain ◽

Hormonal Therapy ◽

Chronic Pelvic Pain ◽

Reproductive Tract ◽

Visceral Pain ◽

Surgical Removal ◽

Antiinflammatory Drugs ◽

Persistent Symptoms ◽

Incomplete Removal ◽

Management Procedures

Endometriosis, a chronic and progressive condition characterized by the presence of endometrial tissue outside the uterus, accounts for about one third of the cases of chronic pelvic pain in women. Pain in endometriosis may be due to nociceptive, inflammatory, and/or neuropathic mechanisms. The clinical presentation is often variable between patients, and diagnostic laparoscopy for visualization and biopsy of lesions is the gold standard for diagnosis. The treatment may consist of two elements: chronic pelvic pain itself as a diagnosis and endometriosis as a disease. Hormonal therapy is used to reduce the amount of estrogen and hence reduce symptoms such as pelvic pain and dysmenorrhea. In patients with severe endometriosis, surgical removal of lesions, adhesions, and cysts and restoration of pelvic anatomy may be preferred. Both hormonal and surgical treatments have been shown to be effective in decreasing pain symptoms associated with endometriosis. A variety of analgesics, including nonsteroidal antiinflammatory drugs, opioids, tricyclic antidepressants, dual reuptake inhibitors of serotonin and norepinephrine, and antiepileptic drugs, have been used to ameliorate pain in endometriosis, with varying degrees of success. In patients with persistent symptoms, interventional pain management procedures may be performed to target the visceral and somatic organs and their innervations. Infertility is the most common complication of endometriosis. Between 10 and 20% of women with endometriosis have recurrence of the disease regardless of the treatment they receive. The recurrence of pain may be due to remodeling of the central nervous system, the role of the reproductive tract in reactivating pain, and incomplete removal or recurrence of lesions. This review contains 2 tables and 52 references Key words: chronic abdominal pain, chronic pelvic pain, dyschezia, dysmenorrhea, dyspareunia, endometrioma, endometriosis, hormonal therapy, infertility, retrograde menstruation, visceral pain

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Essure Surgical Removal and Subsequent Resolution of Chronic Pelvic Pain: A Case Report and Review of the Literature

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/6961202 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Isamarie Lora Alcantara ◽

Shadi Rezai ◽

Catherine Kirby ◽

Annika Chadee ◽

Cassandra E. Henderson ◽

...

Keyword(s):

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Late Onset ◽

Careful Examination ◽

Surgical Removal ◽

Tubal Occlusion ◽

Patient Reported ◽

Permanent Contraception ◽

Laparoscopic Removal ◽

Difficult Placement

Background. Hysteroscopic tubal sterilization (Essure) is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device.Case. A twenty-nine-year-old woman G4P4014 presented with a two-year complaint of chronic pelvic pain and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. On reviewing the images of the HSG, it was noted that although tubal occlusion was confirmed, the left Essure coil appeared curved on itself in an elliptical fashion and did not seem to follow the expected anatomic trajectory of the fallopian tube. The patient reported resolution of chronic pelvic pain following laparoscopic removal of Essure device.Conclusion. A misplaced Essure device should be considered in the differential diagnosis of chronic pelvic pain in women who had difficult placement of the device. In addition to demonstrating tubal occlusion, careful examination of the configuration of the Essure microinserts on HSG examination provides valuable information in patients with pelvic pain after Essure placement.

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Metastasis of Breast Lobular Carcinoma to Endometrium Presenting as Recurrent Abnormal Uterine Bleeding: A Case Report and Review of Literature

Case Reports in Pathology ◽

10.1155/2019/5357194 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Rodolfo Franco-Márquez ◽

Adrián Gerardo Torres-Gaytán ◽

Marcela Anahí Narro-Martinez ◽

Anahí Carrasco-Chapa ◽

Benjamín Gómez Núñez ◽

...

Keyword(s):

Breast Cancer ◽

Case Report ◽

Breast Carcinoma ◽

Lobular Carcinoma ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Review Of Literature ◽

Lobular Breast Carcinoma

There are few reports of breast cancer cases with uterine metastases. Here, we report a metastatic lobular carcinoma to endometrium presenting as abnormal uterine bleeding. Diagnosis was based in previous lobular breast carcinoma and immunohistochemistry.

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