Uterine-ileal perforation post pregnancy related dilatation and curettage managed by laparoscopic small bowel resection and primary anastomosis: A case report

Although rare,small bowel perforation post pregnancy related dilation and curettage presents a serious complication.Herein,we reported a case of 34-year-old female patient presenting for uterine-ileal perforation post pregnancy related dilatation and curettage managed successfully by laparoscopic small bowel resection and primary anastomosis.

Abnormal Uterine Bleeding due to Retention of Fetal Bones after Abortion: A Case Report

Background: Retention of fetal bones is a rare cause of abnormal uterine bleeding. Others may present as subfertility, chronic pelvic pain, abnormal vaginal discharge, menometrorrhagia, dysmenorrhea and spontaneous expulsion of bony fragments. Incidence is 0.26% among patients undergoing hysteroscopy. Aim: To document a pattern of presentation of retained fetal bone and its management. Case Presentation: Our patient is an 18-year old who presented with vaginal bleeding of four weeks duration and managed for abnormal uterine bleeding due to retained fetal bone following second trimester abortion. Conclusion: The use of transvaginal ultrasound in making diagnosis of retained fetal bone is effective. Treatment by removal of bones through evacuation by dilatation and curettage or hysteroscopy brings about resolution of symptoms. Use of pelvic ultrasonography to confirm complete evacuation of the uterus after abortion especially second trimester abortion could aid in early diagnosis and management of incomplete abortion.

Accuracy of tumor grade by preoperative curettage and associated clinicopathologic factors in clinical stage Ⅰ endometriod adenocarcinoma

Background Preoperative tumor grading becomes one of the most important predictors for lymphadenectomy at primary surgery for clinical stage Ⅰ endometriod adenocarcinoma. However, there is an inconsistency of tumor grade between preoperative curettage and final hysterectomy specimens, and its associated factors are poorly understood. This study aimed to evaluate the accuracy of tumor grade by preoperative curettage so as to achieve a better stratified management for clinical stage Ⅰ endometriod adenocarcinoma. Methods Clinical data of totally 687 patients with clinical stage Ⅰ endometriod adenocarcinoma who underwent preoperative curettage and primary surgery were retrospectively collected. Compared with final hysterectomy specimens, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of tumor grade by preoperative curettage were calculated and their associations with clinicopathologic parameters, including age, status of menopause, position of uterus, location and size of lesion, histological grade, depth of myometrial invasion, cervical invasion, extrauterine spread, peritoneal cytology, metastasis to retroperitoneal lymph node, serum CA125 level, and hormone receptor status, were analyzed. Results In final hysterectomy specimens, 139 of 259 grade 1 patients by curettage were upgraded to grade 1 or 2; 31 of 296 grade 2 were upgraded to grade 3, with a significantly discrepant rate of 40.9% （281/687） and an upgraded rate of 24.7% （170/687）. The specificity and negative predictive value for grade 3 were 90.7% and 89.9%, while the sensitivity and positive predictive value for grade 1 were 67.1% and 40.9%, respectively. Conclusions Preoperative tumor grade by curettage does not accurately predict final histological results, especially in those classified as grade 1. Complete surgical staging seems to be necessary for clinical stage Ⅰ endometriod adenocarcinoma.

Hysteroscopy and directed biopsy in the diagnosis of endometrial carcinoma

Background Diagnostic hysteroscopy and directed biopsy has been widely used to evaluate abnormal uterine bleeding. We aimed to explore the value of hysteroscopy and directed biopsy in the diagnosis of endometrial carcinoma.Methods Two hundred and eighty-seven patients with endometrial carcinoma who were treated in Beijing University People＇s Hospital, Beijing, China were distributed into 2 groups： Group A （90 patients） was examined using hysteroscopy and directed biopsy, and Group B （197 patients） was examined using fractional dilatation and curettage （D＆C）. The diagnostic veracity of the two methods, the rate of positive peritoneal cytology and the prognosis of the 2 groups were compared.Results In Group A, 97.8% （88/90） of patients were diagnosed pathologically before surgery; the rate was 88.8% （175/197） for Group B. The difference between the 2 groups was statistically significant （P ＜0.05）. The sensitivity,specificity, positive predictive value and negative predictive value for the two methods for detecting cervical involvement were 77.8%, 100%, 100% and 97.6% for Group Aand 65.3%, 92.6%, 74.4% and 90.0% for Group B, respectively. The positive peritoneal cytology rate was 5.6% （5/90） in Group A and 6.09% （12/197） in Group B. The difference was not statistically significant （P ＞0.05）. The 3-year and 5-year overall survival rates were 91.4% （33/36） and 82.4% （14/17） for Group A and 95.6% （87/91） and 86.7% （39/45） for Group B. There were no statistically significant differences between the two groups＇ survival rates （P ＞0.05）.Conclusion Compared with fractional D＆C, hysteroscopy and directed biopsy offered improved pathological diagnostic accuracy before surgery and discovered cervical involvement more precisely in endometrial carcinoma patients, but it did not increase the positive peritoneal cytology rate or affect the prognosis of these patients.

Comparison of the Efficacy and Safety of Different Surgical Strategies for Patients with Type Ⅱ Cesarean Scar Pregnancy

Objective:To compare the efficacy and safety of four surgical strategies currently used for the management of deep implantation cesarean scar pregnancy(CSP-Ⅱ).Methods:This was a retrospective clinical cohort study,and,in total,131 women diagnosed with CSP-Ⅱ and primarily treated in our hospital were recruited.Women treated using laparoscopy assisted by operative hysteroscopy(LAOH;Group A,n=25),uterine artery embolization(UAE)followed by LAOH(Group B,n=21),ultrasound-guided dilatation and curettage(D&C;Group C,n=24),and UAE followed by D&C(Group D,n=61)were evaluated.Univariate and multiple logistic analyses were performed to identify the risk factors.Results:No statistically significant difference was found in patient age,gestational age,size of lesion,and pretreatment serumβ-human chorionic gonadotropins(β-hCG)level.Operation time was longer(P<0.001)and the success rate was higher(P=0.01)in both Group A and Group B than in Group C and Group D.When the cohort was further analyzed regarding patients with myometrial thickness≤3 mm(n=75,defined as CSP-IIb),a lower rate of perioperative complications(P=0.036)and a higher success rate(P<0.001)remained in Group A(n=15)and Group B(n=15)but not in Group C(n=11)or Group D(n=34).In multiple logistic regression analysis,the risk factors related to lower treatment efficacy for patients with CSP-Ⅱ were thinner myometrial thickness of cesarean scar(CS)(≤3 mm)(odds ratio[OR]=5.470,P=0.062),number of cesarean sections(a2)(OR=8.877,P=0.013),mass protruding into the bladder or abdominal cavity(OR=25.507,P<0.001),and direct D&C modality(OR=38.247,P=0.010).Conclusions:Compared with D&C±UAE,LAOH±UAE showed a higher success rate for patients with CSP-Ⅱ,especially when the zygote was more deeply implanted with a myometrial thickness of CS≤3 mm.CSP-Ⅱ treatment should be individualized on the basis of many risk factors.