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Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
less postoperative pain, faster recovery, reduced morbidity, no mortality, and more patient’s satisfaction without major and sever complication, and therefore may be considered a useful therapeutic option for patient with benign gynecologic disease.
248 Diagnosis and Treatment of Communicating Uterus Didelphis with Atretic Hemivagina: Utility of 3-Dimensional and Intraoperative Ultrasound Johnston EB, Batzer FR, Lev-Toaff AS. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Thomas Jefferson University Hospital/Philadelphia Women’s Institute, Philadelphia, Pennsylvania; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania Study Objective: 1. To describe this unusual malformation diagnosed by means of 3-dimensional (3D) ultrasound. 2. To demonstrate the value of intraoperative ultrasound for vaginal septum resection in a non-distended atretic hemivagina. 3. To review the literature regarding the presenting symptoms of obstructed anomalies and diagnostic imaging for genito-urinary malformations. Design: A case report and literature review of presenting symptoms and diagnostic features in patients with uterus didelphis, obstructed hemivagina and ipsilateral renal agenesis. Setting: East coast urban university teaching hospital. Patients: Nineteen year old virginal female with intermenstrual brown vaginal discharge and cyclical pelvic pain since menarche. Intervention: Preoperative 3D-ultrasound, diagnostic laparoscopy, diagnostic hysteroscopy and ultrasound guided catheter placement for wide resection and marsupialization of the vaginal septum creating the atretic hemivagina. Measurements and Main Results: The patient experienced complete resolution of her vaginal discharge and pelvic pain post resection and post fulgration of laparoscopically visualized endometrial implants. A literature review from a Medline search using keywords “didelphis,” “ultrasound,” “magnetic resonance imaging,” and “computed tomography” was performed. Conclusion: Though the utility of ultrasound and other imaging modalities in preoperative diagnosis of genito-urinary congenital malformations is well established, the value of 3D ultrasound for precise definition of utero-cervical and vaginal morphology and the use of ultrasound to guide surgical treatment merits emphasis.
249 Differential Diagnosis of Complex Pelvic Masses—A Case Report Kamergorodsky G, Aoki TT, Galva˜o Ribeiro PA, Campaner AB, Carvalho PB, Sotelo AB. Santa Casa Medical School Gynecologic Laparoscopy Clinic, Sa˜o Paulo, Sa˜o Paulo, Brazil Design: A 60 year-old patient was referred to our unit to investigate and treat a left pelvic mass. On personal and surgical history, a left renal agenesis and bladder polyp excision were remarkable. The image screening by ultrasound, MRI and CT scan showed a big cystic and complex pelvic mass, measuring 14 cm length and absence of the left kidney. Tumoral markers resulted negative. The patient was submitted to videolaparoscopy. Tubes ovaries, and uterus were found to be normal and atrophic, while a huge retroperitoneal mass mainly cystic and measuring around 12 cm was found. Mesenteric cyst was the first diagnostic hypothesis (made by the coloproctology team). Despite the rupture, and leaking of a clear citrine content, the excision of the tumor (cystectomy) was concluded. The histology revealed a mega ureter, renal parenchyma, and papilliferous adenoma. On the 7th post operative day the patient returned to our service with an acute hemorrhagic abdominal emergency. Both the ultrasound and the CT screen showed liquid abdominal collection. A second laparoscopic procedure drained 450 ml of sero-hematic secretion. A test using blue dye was applied and no fistulas were detected. The biochemistry of the drained liquid was suggestive of urine, and the accumulation of secretion was persistent after the drainage. Urology team required multiple tests in order to identify a possible fistula, and all of them resulted as negative. The patient was then submitted to a laparotomy to better explore the pelvis and its organs, and a mega ureter associated with a pelvic. Conclusion: The purpose of this case report is to point out the difficulties that even a multidisciplinary group can face on making differential diagnosis of complexes pelvic masses. 250 Evaluation of the Histological Classification of Endometriosis in Deep Pelvic Endometriosis Compared to Peritoneal Superficial Lesions Kamergorodsky G, Galva˜o Ribeiro PA, Aoki TT, Longo M. Santa Casa Medical School Gynecologic Laparoscopy Clinic, Sa˜o Paulo, Sa˜o Paulo, Brazil Study Objective: Based on data reported at the literature that associates histological characteristics of endometriotic lesions with poorer prognosis, low response to drug therapy and worsen of the illness aggressiveness, our group attempted to develop a method that could predict disease behavior in different forms of endometriosis according to the histological classification of the lesions using morpho-
Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
less postoperative pain, faster recovery, reduced morbidity, no mortality, and more patient’s satisfaction without major and sever complication, and therefore may be considered a useful therapeutic option for patient with benign gynecologic disease.
248 Diagnosis and Treatment of Communicating Uterus Didelphis with Atretic Hemivagina: Utility of 3-Dimensional and Intraoperative Ultrasound Johnston EB, Batzer FR, Lev-Toaff AS. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Thomas Jefferson University Hospital/Philadelphia Women’s Institute, Philadelphia, Pennsylvania; Thomas Jefferson University Hospital, Philadelphia, Pennsylvania Study Objective: 1. To describe this unusual malformation diagnosed by means of 3-dimensional (3D) ultrasound. 2. To demonstrate the value of intraoperative ultrasound for vaginal septum resection in a non-distended atretic hemivagina. 3. To review the literature regarding the presenting symptoms of obstructed anomalies and diagnostic imaging for genito-urinary malformations. Design: A case report and literature review of presenting symptoms and diagnostic features in patients with uterus didelphis, obstructed hemivagina and ipsilateral renal agenesis. Setting: East coast urban university teaching hospital. Patients: Nineteen year old virginal female with intermenstrual brown vaginal discharge and cyclical pelvic pain since menarche. Intervention: Preoperative 3D-ultrasound, diagnostic laparoscopy, diagnostic hysteroscopy and ultrasound guided catheter placement for wide resection and marsupialization of the vaginal septum creating the atretic hemivagina. Measurements and Main Results: The patient experienced complete resolution of her vaginal discharge and pelvic pain post resection and post fulgration of laparoscopically visualized endometrial implants. A literature review from a Medline search using keywords “didelphis,” “ultrasound,” “magnetic resonance imaging,” and “computed tomography” was performed. Conclusion: Though the utility of ultrasound and other imaging modalities in preoperative diagnosis of genito-urinary congenital malformations is well established, the value of 3D ultrasound for precise definition of utero-cervical and vaginal morphology and the use of ultrasound to guide surgical treatment merits emphasis.
249 Differential Diagnosis of Complex Pelvic Masses—A Case Report Kamergorodsky G, Aoki TT, Galva˜o Ribeiro PA, Campaner AB, Carvalho PB, Sotelo AB. Santa Casa Medical School Gynecologic Laparoscopy Clinic, Sa˜o Paulo, Sa˜o Paulo, Brazil Design: A 60 year-old patient was referred to our unit to investigate and treat a left pelvic mass. On personal and surgical history, a left renal agenesis and bladder polyp excision were remarkable. The image screening by ultrasound, MRI and CT scan showed a big cystic and complex pelvic mass, measuring 14 cm length and absence of the left kidney. Tumoral markers resulted negative. The patient was submitted to videolaparoscopy. Tubes ovaries, and uterus were found to be normal and atrophic, while a huge retroperitoneal mass mainly cystic and measuring around 12 cm was found. Mesenteric cyst was the first diagnostic hypothesis (made by the coloproctology team). Despite the rupture, and leaking of a clear citrine content, the excision of the tumor (cystectomy) was concluded. The histology revealed a mega ureter, renal parenchyma, and papilliferous adenoma. On the 7th post operative day the patient returned to our service with an acute hemorrhagic abdominal emergency. Both the ultrasound and the CT screen showed liquid abdominal collection. A second laparoscopic procedure drained 450 ml of sero-hematic secretion. A test using blue dye was applied and no fistulas were detected. The biochemistry of the drained liquid was suggestive of urine, and the accumulation of secretion was persistent after the drainage. Urology team required multiple tests in order to identify a possible fistula, and all of them resulted as negative. The patient was then submitted to a laparotomy to better explore the pelvis and its organs, and a mega ureter associated with a pelvic. Conclusion: The purpose of this case report is to point out the difficulties that even a multidisciplinary group can face on making differential diagnosis of complexes pelvic masses. 250 Evaluation of the Histological Classification of Endometriosis in Deep Pelvic Endometriosis Compared to Peritoneal Superficial Lesions Kamergorodsky G, Galva˜o Ribeiro PA, Aoki TT, Longo M. Santa Casa Medical School Gynecologic Laparoscopy Clinic, Sa˜o Paulo, Sa˜o Paulo, Brazil Study Objective: Based on data reported at the literature that associates histological characteristics of endometriotic lesions with poorer prognosis, low response to drug therapy and worsen of the illness aggressiveness, our group attempted to develop a method that could predict disease behavior in different forms of endometriosis according to the histological classification of the lesions using morpho-