Laparoscopic Excision of Endometrial Ossification; an Evolving Cause of Chronic Pelvic Pain

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Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S152–S177

Patients: 40 yo G3P1011 with 6 weeks of amenorrhea and left lower quadrant pain. Intervention: Transvaginal ultrasound, diagnostic laparoscopy, left salpingo-oophorectomy, staging laparotomy, chemotherapy. Measurements and Main Results: 40 yo G3P1011 with 6 weeks of amenorrhea and left lower quadrant pain presented to ER. She had history of bilateral tubal reanastomosis. She had stable vitals, left lower quadrant tenderness and no palpable adnexal masses with abnormally rising -ßHCG. Transvaginal ultrasound did not demonstrate an intrauterine pregnancy. Two left adnexal masses were noted. Both had cystic lumens with hyperechoic walls and prominent vascularity suggestive of gestational sac were noted. There was no fetal cardiac activity in either of the sacs. These ultrasound findings were suggestive of left twin ectopic pregnancy. Patient underwent diagnostic laparoscopy. The left adnexa revealed a 3 x 4 cm tubal mass fused with a 7 x 8 cm ovarian mass. Laparoscopic left salpingo-oophorectomy was performed. Pathology of frozen section of resected specimen showed the tubal mass to be an ectopic pregnancy; and the ovarian mass was described as endometroid adenocarcinoma of the ovary. After the index procedure, the patient later underwent an ovarian cancer staging procedure. Her surgical stage was IC and she subsequently competed six cycles of carboplatin and paclitaxel. The patient remains free of disease after 3 years of diagnosis. Conclusion: We present the first known case of endometroid adenocarcinoma of the ovary, complicating a tubal ectopic gestation. This case emphasizes that if there is an incidental adnexal mass noted along with a tubal ectopic, the possibility of finding an ovarian neoplasm should be kept in mind. Also management of tubal pregnancy with incidental adnexal mass is discussed.

POSTER SESSION–PELVIC PAIN

596 Laparoscopic and Histopathologic Findings in Women with Chronic Pelvic Pain Jung S-K,1 Ki K-D,1 Choi Y-J,2 Jeong N-H,2 Huh C-Y.1 1Obstetrics and Gynecology, Kyung-Hee University, East-West Neo Medical Center, Seoul, Republic of Korea; 2Obstetrics and Gynecology, Kyung-Hee University Medical Center, Seoul, Republic of Korea Study Objective: To evaluate the laparoscopic and histopathologic findings in women with chronic pelvic pain. Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: University hospital. Patients: One hundred women who underwent laparoscopic surgery because of chronic pelvic pain from July 2008 through June 2009. Intervention: Diagnostic or therapeutic laparoscopy was performed. Measurements and Main Results: The mean age and parity of women with chronic pelvic pain was 43.88.39 years and 1.770.98, respectively. The mean duration of pain was 52.1264.05 months. The most common symptoms were lower abdominal and lower back pain. The most common laparoscopic finding was adhesions (59%), followed by endometriosis (43%) and pelvic congestion syndrome (17%). The most common histopathologic finding of pelvic peritoneum was fibrosis (68%), followed by endometriosis (24%). Conclusion: The most common laparoscopic and histopathologic findings were adhesion and fibrosis, respectively. Laparoscopy helps in diagnosis and treatment of chronic pelvic pain. 597 Laparoscopic Excision of Endometrial Ossification; an Evolving Cause of Chronic Pelvic Pain Ki K-D,1 Choi Y-J,2 Jung S-K,1 Huh C-Y.1 1Department of Obstetrics and Gynecology, East-West Neo Medical Center, Kyunghee University, Seoul, Metropolitan, Republic of Korea; 2Department of Obstetrics and Gynecology, Kyunghee Medical Center, Kyunghee University, Seoul, Metropolitan, Republic of Korea

Study Objective: To present an endometrial osseous metaplasia case and reemphasize that the condition is a cause of chronic pelvic pain. Design: Case report. Setting: University-affiliated teaching hospital. Patients: A 27-year-old, gravida 2, para 1 woman with chronic pelvic pain that had lasted for 2 years. On MR finding, bony fragment and intramural uterine hematoma were observed. Intervention: Laparoscopic mass removal and pathologic examination was performed. Measurements and Main Results: Four months after laparoscopic management, subjective pain symptoms were significantly improved. Conclusion: Clinicians should keep in mind this rare disorder in patient with chronic pelvic pain. 598 The Effectiveness of Laparoscopic Evaluation & Incidence of Endometriosis in Post-Hysterectomy Women with Chronic Pelvic Pain Ki K-D,1 Choi Y-J,2 Jung S-K,1 Huh C-Y.1 1Department of Obstetrics and Gynecology, East-West Neo Medical Center, Kyunghee University, Seoul, Metropolitan, Republic of Korea; 2Department of Obstetrics and Gynecology, Kyunghee Medical Center, Kyunghee University, Seoul, Metropolitan, Republic of Korea Study Objective: To laparoscopically evaluate the pelvic status of patients with chronic pelvic pain after hysterectomy, to determine any pathologic condition to the pain and incidence of endometriosis. Design: Retrospective cohort study for post-hysterectomy women with chronic pelvic pain. Setting: University-affiliated teaching hospital. Patients: From April 2008 through January 2010, Sixty-three consecutive patients with chronic pelvic pain after hysterectomy, median age was 51 years (range 39-66). Intervention: Diagnostic and therapeutic laparoscopy was performed to evaluate any pathologic condition. Measurements and Main Results: Laparoscopic and histopathologic findings of the pelvis, any associated factors to the pain, as well as subjective pain score after laparoscopic management. The most common findings in women with chronic pelvic pain after hysterectomy included adhesions, endometriosis, and peritoneal lesion. 25.4% (16/64) of patients was clearly identified as endometriosis. Most patients have significantly