Unplanned adnexectomy for ovarian cystadenoma with undiagnosed autoamputation of the contralateral ovary, lessons learned from medical mistakes

Autoamputation of the ovary is a rare occurrence of uncertain aetiology with only a few cases reported in literature. It usually develops following ovarian torsion or torsion of a dermoid cyst with subsequent necrosis of the pedicle and autoamputation. We present the case of a 42 year-old woman was admitted for a laparoscopic removal of a right ovarian cyst. The ultrasound showed a right ovarian cystic mass suggestive of a cystadenoma, and another heterogeneous small echogenic cyst of the left ovary. During laparoscopy, excessive bleeding from the ovarian cortex complicated the cyst stripping and, considering the age of the patient and the emerging technical difficulty of the procedure, a total adnexectomy for the right ovary was performed. While exploring the small cyst on the left ovary, a dermoid cyst was found in the Douglas pouch. This finding could be interpreted as an autoamputation of the adnexa due to an asymptomatic torsion of a previous ovarian cyst arising from the left ovary. Medical errors could occur due to lack of knowledge, expertise, as well as lack of training and surgical skills, but also due to an unfortunate association of very rare confounding factors. Even in the hands of experts, following the basic rules of surgery remains a milestone in teaching and preventing surgical complications.

Sciatic hernia: repair after recurrence

Sciatic hernia is a rare pelvic floor hernia. A variety of treatment modalities were proposed, but a guideline is lacking although a mesh-based tension-free repair may be preferred. A 67-year-old woman with an uncomplicated sciatic hernia received primarily closing of the hernia orifice that was covered with a preperitoneal mesh in March 2019. Six months later, she developed a clinical and radiographical recurrence requiring remedial surgery. Due to the previous mesh fixation, the preperitoneal plane was obliterated. Therefore, the pouch of Douglas was closed, leaving the hernia sac in place, by folding two opposing peritoneal layers and covering it with a Ventralight ST mesh. After 9 months, the hernia had not recurred and the patient was symptom-free. It is concluded that recurrent sciatic hernia may be treated by obliterating the Douglas pouch and subsequent mesh coverage.

Relationship between the Severity of Endometriosis Symptoms (Dyspareunia, Dysmenorrhea and Chronic pelvic pain) with the Spread of the Disease on Ultrasound

Objectives: About 10-15% of women of childbearing age have endometriosis. The present study aimed to investigate the relationship between the severity of symptoms of endometriosis and the spread as well as the stage of the disease on ultrasonography. The present cross-sectional study evaluates the relationship between the severity of endometriosis symptoms and the spread of disease on ultrasonography in patients with endometriosis.Results: Considering different analyses, the cumulative size of posterior Deep Infiltrative Endometriosis (DIE) (less than 1 cm) is significantly correlated with minimal severity of dyspareunia and chronic pelvic pain. The incidence of dyspareunia was more prevalent in patients with complete stenosis of Douglas pouch than those with incomplete stenosis. Furthermore, the incidence of severe and very severe pain in patients with Douglas pouch stenosis is relatively higher than that in patients without stenosis. Only dyspareunia is related to the stage of endometriosis, and patients with dyspareunia are five times more at risk of a higher stage of the disease. The severity of dyspareunia is related to the stage of endometriosis and the severity of Douglas pouch stenosis. The results showed a correlation between chronic pelvic pain and r-ASRM score (revised American Society for Reproductive Medicine score).

Relationship between the severity of endometriosis symptoms (dyspareunia, dysmenorrhea and chronic pelvic pain) and the spread of the disease on ultrasound

Objectives About 10–15% of women of childbearing age have endometriosis. The present study aimed to investigate the relationship between the severity of symptoms of endometriosis and the spread as well as the stage of the disease on ultrasonography. The present cross-sectional study evaluates the relationship between the severity of endometriosis symptoms and the spread of disease on ultrasonography in patients with endometriosis. Results Considering different analyses, the cumulative size of posterior deep infiltrative endometriosis (DIE) (less than 1 cm) is significantly correlated with minimal severity of dyspareunia and chronic pelvic pain. The incidence of dyspareunia was more prevalent in patients with complete stenosis of Douglas pouch than those with incomplete stenosis. Furthermore, the incidence of severe and very severe pain in patients with Douglas pouch stenosis is relatively higher than that in patients without stenosis. Only dyspareunia is related to the stage of endometriosis, and patients with dyspareunia are five times more at risk of a higher stage of the disease. The severity of dyspareunia is related to the stage of endometriosis and the severity of Douglas pouch stenosis. The results showed a correlation between chronic pelvic pain and r-ASRM score (revised American Society for Reproductive Medicine score).

Relationship between the Severity of Endometriosis Symptoms (Dyspareunia, Dysmenorrhea and Chronic pelvic pain) with the Spread of the Disease on Ultrasound

Objectives: The prevalence of endometriosis among women of childbearing age is about 10-15%. The present study aimed to investigate the relationship between the severity of symptoms of endometriosis and the spread as well as the stage of the disease on ultrasonograghy. The present cross-sectional study evaluates the relationship between the severity of endometriosis symptoms and the spread of disease on ultrasonography in patients with endometriosis.Results: Considering different analyses, the cumulative size of posterior Deep infiltrative endometriosis (DIE) (less than 1 cm) is significantly correlated with minimal severity of dyspareunia and chronic pelvic pain. The incidence of dyspareunia was more prevalent in patients with complete stenosis of Douglas pouch than those with incomplete stenosis... Further, the incidence of severe and very severe pain in patients with Douglas pouch stenosis is relatively higher than that in patients without stenosis. Only dyspareunia is related to the stage of endometriosis, and patients with dyspareunia are 5 times more at risk of a higher stage of the disease. The severity of dyspareunia is related to the stage of endometriosis and the severity of Douglas pouch stenosis. The results show the correlation between chronic pelvic pain and r-ASRM score (revised American Society for Reproductive Medicine score).

Relationship between the Severity of Endometriosis Symptoms (Dyspareunia, Dysmenorrhea and Chronic pelvic pain) with the Spread of the Disease on Ultrasound

Objectives The prevalence of endometriosis among women of childbearing age is about 10–15%. Although many patients with endometriosis do not have any symptoms, they may suffer from dysmenorrhea, dyspareunia, and chronic pelvic pain. our aim of this study is to investigate the relationship between the severity of symptoms of endometriosis with the spread of disease on ultrasonography as well as the stage of the disease. Results Regarding the various analyzes were performed, the cumulative size of posterior DIE less than 1 cm significantly correlated with minimal severity of dyspareunia and chronic pelvic pain. The incidence of dyspareunia was more in patients with complete stenosis of Douglas pouch comparing with cases with incomplete Douglas pouch stenosis. The incidence of severe and very severe pain in patients with Douglas pouch stenosis is relatively higher than patients without stenosis. This study demonstrated only dyspareunia is related to the stage of endometriosis and patients with dyspareunia are 5 times more at risk of a higher stage of the disease.

Influence of laterality on endometriosis severity in patients with unilateral endometrioma: a retrospective study.

Background: We compared the revised American Society for Reproductive Medicine (ASRM) scores determined during laparoscopic surgery to evaluate the effect of the location of the endometrioma (right vs. left ovary) on the severity of endometriosis. Methods: The medical records of 151 patients, including 58 right-sided and 93 left-sided cases, who underwent an initial laparoscopic surgery for unilateral ovarian endometrioma were reviewed retrospectively. We extracted the ASRM scores determined during surgery and some representative factors related to endometriosis that are separate from the tumour characteristics, such as the coexistence of uterine fibroids, adenomyoma, or other ovarian tumours, a history of use of assisted reproductive technology (ART), and tumour marker values. A statistical analysis was performed to assess the impact of each factor. We classified the ASRM scores into 4 categories to compare the tendency towards endometrial lesion spread with a focus on the “sidedness” of the endometrioma. We defined contralateral endometrial lesion (CEL), Douglas pouch endometrial lesion (DEL), same endometrial lesion (SEL) and peritoneal endometrial lesion (PEL). Results: The ASRM scores of patients with a right-sided endometrioma were significantly higher than patients with a left-sided endometrioma (41.5 ± 22.1 points vs. 32.9 ± 15.8 points, p<0.05). The higher ASRM scores of the patients with right-sided endometrioma may be caused by the frequent detection of endometrial lesions in the left tube, left ovary and Douglas pouch. According to the statistical analysis, the coexistence of uterine fibroids also exerted significant positive effects on increasing the ASRM score. Conclusions: Higher ASRM scores are possible in patients with right-sided endometrioma. The laterality of endometriosis severity should be considered.

Influence of laterality on endometriosis severity in patients with unilateral endometrioma: a retrospective study

Background: To evaluate the influence of the location of endometrioma (right vs. left ovary) on endometriosis severity, we compared the revised American Society for Reproductive Medicine (ASRM) scores determined by laparoscopic surgery. Methods: The medical records of 151 patients, including 58 right-sided and 93 left-sided cases, who underwent initial laparoscopic surgery for unilateral ovarian endometrioma were reviewed retrospectively. We extracted the ASRM scores determined during surgery and some representative factors relating to endometirosis that are separate from tumour characteristics, such as the coexistence of uterine fibroid, adenomyoma, or other ovarian tumours, a history of assisted reproductive technology (ART), and tumour marker values. Multivariate analysis was performed to assess the impact of each factor. We classified the ASRM scores into 4 categories to compare the tendency towards endometrial lesion spread with a focus on the “sidedness” of the endometrioma. Opposite endometrial lesion (OEL), Douglas pouch endometrial lesion (DEL), same endometrial lesion (SEL) and peritoneal endometrial lesion (PEL) were defined. Results: The ASRM scores of patients with right-sided endometrioma were significantly higher than those of patients with left-sided endometrioma (41.5 ± 22.0 points vs. 33.5 ± 16.3 points, p<0.05). The higher ASRM scores of the patients with right-sided endometrioma may be caused by the frequent detection of endometrial lesions in the left-sided tube, left-sided ovary and Douglas pouch. Multivariate analysis revealed that the coexistence of uterine fibroid or adenomyoma also had significant positive impacts on increasing the ASRM score. Conclusions: Higher ASRM scores are possible in patients with right-sided endometrioma. The laterality of endometriosis severity should be considered.