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32: Discovery of a Previously Undescribed Anomaly Involving Ovarian Transposition
Oral Presentations volume occupied by a submucous myoma b) the high potential of a small myoma to grow during the reproductive age c) its negative impact on reproduction through normal or assisted conception d) the inability to perform a reliable and “safe” diagnosis, with respect to malignancy, without an eye-guided biopsy. 31 Accuracy of Transvaginal Sonography After Bowel Preparation to Evaluate Pelvic Endometriosis According to Surgical Findings 1 Bianchi PP, 2Gonc¸alves MM. 1Sao Paulo, Sao Paulo, Brazil; 2RDO Diagno´sticos Me´dicos, Sao Paulo, Brazil Study Objective: Evaluate the performance of transvaginal sonography after bowel preparation (TVS bowel prep) in making the diagnosis of pelvic endometriosis by anatomic location compared to surgical findings. Design: Prospective evaluation of 60 cases of pelvic endometriosis submited to TVS bowel prep followed by laparoscopy. Setting: Fertility Clinic and terciary hospitals. Patients: Sixty infertile women (age:26-40yrs) with signs and symptoms of endometriosis were evaluated between January 2005 and March 2007. Intervention: TVS after bowel preparation (Fleet enema) followed by laparoscopy. Endometriosis was defined on TVS by abnormal hypoechogenic or hyperechogenic nodules and linear thickening. Surgical criteria were typical dark blue lesions, ovarian cysts with “chocolate” fluid and atypical retraction. Measurements and Main Results: Sensitivity, specificity and accuracy of TVS were: ovaries (68.8%; 78.6%; 73.3%), bladder (50%; 100%; 96.6%) and rectosigmoid colon (85.5%; 94.1%; 91.7%). Grouping retrocervical, uterosacral and Douglas pouch as one region (posterior) the rates were 66.6%; 50%; 63.3%. Conclusion: Preoperative TVS bowel prep is an accessible method allowing broad pelvic screening for endometriosis, particularly rectosigmoid, ovarian and posterior lesions. It provides accurate information that guide the surgeon during laparoscopy allowing adequate endometriosis treatment. 32 Discovery of a Previously Undescribed Anomaly Involving Ovarian Transposition Bieber EJ, Callaway SB. Danville, Pennsylvania Study Objective: To describe a previously undescribed congenital anomaly. Design: Case report. Setting: Tertiary care academic medical center, Department of Obstetrics & Gynecology. Patient: A 26-year-old nulliparous woman was evaluated for primary infertility.
S13 Intervention: Laparoscopy, left salpingectomy, and lysis of adhesions to reveal congenital abnormality. Measurements and Main Results: A 26-year-old nulliparous woman was evaluated for primary infertility. The patient had normal infertility evaluation except hysterosalpingogram demonstating tubal disease and pelvic adhesions. On laparoscopic evaluation, the patient was found to have extensive adhesions throughout the pelvis. Left pelvis showed a hydrosalpinx and absence of an associated left ovary. Salpingolysis and eventual left salpingectomy was performed. Surprisingly, evaluation of the right pelvis showed two discrete ovaries adherent to the pelvic sidewall and underlying bowel. Salpingo-ovariolysis was performed allowing for mobilization of the right-sided pelvic structures. The patient has subsequently conceived 2 spontaneous pregnancies and delivered a viable term infant. Conclusion: We believe this to be the first case report of ovarian transposition leading to unilateral ovarian duplication. Through removal of the diseased left hydrosalpinx, extensive lysis of adhesions, and salpingo-ovariolysis of the two right ovaries, a successful intrauterine pregnancy was achieved.
33 Laparoscopic Management of Isolated Fallopian Tube Torsion Bieber EJ, Smith AL. Danville, Pennsylvania Study Objective: To describe the laparoscopic management of tubal torsion. Design: Analysis of a case. Setting: Tertiary care academic institution. Patient: Thirty-two year old gravida 2 para 1011 presenting with right-sided abdominal pain. Intervention: Laparoscopic right salpingectomy. Measurements and Main Results: Patient presented to the emergency department with right-sided abdominal pain and emesis for the previous ten hours. She reported no other symptoms. Patient had a prior left salpingectomy for an ectopic pregnancy. All blood evaluations were normal. Ultrasound and CT scan demonstrated a heterogeneous mass primarily on the right side of the abdomen, measuring 6.5 x 3.3 x 6.4 cm transvaginally with a small amount of fluid in the pelvis. Laparoscopy revealed the right fallopian tube to be markedly enlarged with torsion on the mesosalpinx times three. After relief of the torsion, the segment remained dusky and showed no evidence of viability. A right salpingectomy was preformed. Conclusion: Isolated fallopian tube torsion is an uncommon cause of acute low abdominal pain in women. Because there are no pathognomonic clinical symptoms of findings on imaging or laboratory studies, a high index of suspicion is required. Early laparoscopy is rapidly becoming the standard in diagnosis and treatment.
S13 Intervention: Laparoscopy, left salpingectomy, and lysis of adhesions to reveal congenital abnormality. Measurements and Main Results: A 26-year-old nulliparous woman was evaluated for primary infertility. The patient had normal infertility evaluation except hysterosalpingogram demonstating tubal disease and pelvic adhesions. On laparoscopic evaluation, the patient was found to have extensive adhesions throughout the pelvis. Left pelvis showed a hydrosalpinx and absence of an associated left ovary. Salpingolysis and eventual left salpingectomy was performed. Surprisingly, evaluation of the right pelvis showed two discrete ovaries adherent to the pelvic sidewall and underlying bowel. Salpingo-ovariolysis was performed allowing for mobilization of the right-sided pelvic structures. The patient has subsequently conceived 2 spontaneous pregnancies and delivered a viable term infant. Conclusion: We believe this to be the first case report of ovarian transposition leading to unilateral ovarian duplication. Through removal of the diseased left hydrosalpinx, extensive lysis of adhesions, and salpingo-ovariolysis of the two right ovaries, a successful intrauterine pregnancy was achieved.
33 Laparoscopic Management of Isolated Fallopian Tube Torsion Bieber EJ, Smith AL. Danville, Pennsylvania Study Objective: To describe the laparoscopic management of tubal torsion. Design: Analysis of a case. Setting: Tertiary care academic institution. Patient: Thirty-two year old gravida 2 para 1011 presenting with right-sided abdominal pain. Intervention: Laparoscopic right salpingectomy. Measurements and Main Results: Patient presented to the emergency department with right-sided abdominal pain and emesis for the previous ten hours. She reported no other symptoms. Patient had a prior left salpingectomy for an ectopic pregnancy. All blood evaluations were normal. Ultrasound and CT scan demonstrated a heterogeneous mass primarily on the right side of the abdomen, measuring 6.5 x 3.3 x 6.4 cm transvaginally with a small amount of fluid in the pelvis. Laparoscopy revealed the right fallopian tube to be markedly enlarged with torsion on the mesosalpinx times three. After relief of the torsion, the segment remained dusky and showed no evidence of viability. A right salpingectomy was preformed. Conclusion: Isolated fallopian tube torsion is an uncommon cause of acute low abdominal pain in women. Because there are no pathognomonic clinical symptoms of findings on imaging or laboratory studies, a high index of suspicion is required. Early laparoscopy is rapidly becoming the standard in diagnosis and treatment.