- Email: [email protected]
Missed tubal abortion
Volume Number
Communications
136 5
Fig. 3. Aortogram of patient in this case report. Internal iliac arteries are narrowed site of ligation (arrows).
situations, probably as a result of an absorbable utilized for the operation.
suture
REFERENCES
Burchell, R. C., and Olson, G.: Internal iliac artery ligation: Aortograms, AM. J. OBSTET. GYNECOL. 94:117, 1966. 2. Mengert, W. F., Burchell, R. C., Blumstein, R. W., and Da&al, J. L.: Pregnancy after bilateral ligation of the internal iliac and ovarian arteries, Obstet. Gynecol. 34:664, 1969. 1.
Missed tubal abortion STANLEY WILLIAM BERNARD
BURROWS, M.D. MOORS, D.O. PEKALA, M.D.
Departments of Pathology nrzd Obstetrics and Gynecology, Cooper Medical Center, Camden, NPW Jersey THE REPORTED incidence of tubal been as high as 22.8/1,000 live births
pregnancy has and stillbirths.’
Reprint requests: Stanley Burrows, M.D., Department of Pathology, Cooper Medical Center, Camden, New Jersey 08103. 000%9378/80/050691+02$00.20/0
@ 1980 The C. V. Mosby
Co.
in brief
691
but patent at the
However, only 1 I cases of tubal pregnancy were found in 41,753 women who presented to Planned Parenthood centers for elective first-trimester abortions and only two of these 11 cases were diagnosed prior to rupture, despite gynecologic evaluation and pathologic study of the uterine curettings.’ The great discrepancy between the low incidence of tubal pregnancy diagnosed early in pregnancy and the higher incidence relative to all births suggests that a large proportion of tubal pregnancies cannot be diagnosed early in pregnancy by the standard bimanual examination. Most of these tubal pregnancies spontaneously abort and may result in tubal rupture and life-threatening hemorrhage. The medical literature is remarkably silent on the occurrence of asymptomatic tubal abortion. We recently observed a patient with missed tubal abortion which may have occurred several years prior to its diagnosis. The patient, a 2%year-old woman, gravida 2, para 2, was admitted for a laparoscopic tubal ligation in December, 1977. Two norma term deliveries had occurred in September, 1972, and September, 1977. Oral contraceptives had been taken intermittently between the two pregnancies. Postpartum amenorrhea persisted for 3 months after the first delivery, followed by a month of metrorrhagia. An examination in January, 1973, disclosed an enlarged and slightly softened uterus, but the urine pregnancy test was negative and menses occurred 1 month later. All admission labora-
692
Communications
in brief
March 1, 1980 Am. J. Obstet. Gynecol.
Fig. 1. Fallopian tube containing organized degenerated placental villi. The mesosalpinx contains numerous hemosiderin-laden macrophages and calcific deposits. tory work was normal, including a negative radioimmunoassay blood pregnancy test. During laparoscopic sterilization, bleeding occurred in an area of mesosalpinx. which required a minilaparotomy for hemostasis. There was a 2 cm segment of the left fallopian tube which had a gray discoloration without obvious necrosis, hematoma, or tubal distention. This segment of fallopian tube was included in the tubal resection. The resected segment of the left fallopian tube contained loose fibrous tissue with degenerated remnants of placental villi (Fig. 1). There were numerous hemosiderin-laden macrophages and calcific deposits in the ad.jacent mesosalpinx. The exact age of the tubal abortion is uncertain. However, the histologic appearance suggests a very old process which may have occurred during the postpartum period of amenorrhea almost 5 years before diagnosis. Although the reported case may be relatively unique, clinicians should be aware that tubal abortion may be asymptomatic. The extreme rarity of histotogic confirmation of asymptomatic tubal abortion may be attributed to effective resorption of the products of conception and reparative abilities of the fallopian tube.
REFERENCES
1.
DOW, E: K., Wilson, J. B., and Klufio, C. A.: Tubal pregnancy: a review of 404 cases, Ghana Med. J. 14:232, 1975. 2. Schonberg, L. A.: Ectopic pregnancy and first trimester abortion, Obstet. Gynecol. (Suppl.) 49:73, 1977.
lleovaginal fistula following cryosurgery for vaginal dysplasia MORTEZA KIANOOSH
M. DINI. JAFARI,
M.D. M.D.
Division of Gynetologic Onrology, Cook County Hospital, and De@wtmnt of Obstetrics and Gynecology, Uniuersity of Health ScienceslThe Chicago Medical School, Chicago, Illinou CRYOSURGERY HAS BEEN considered asafeand effective method of treating women with benign and preinvasive neoplasia of the genitals. Recently we encountered a patient who was treated for dysplasia of the vaginal epithelium with cryosurgery, following which she developed ileovaginal fistula. This case emphasizes that a safe, therapeutic method can cause a life-threatening complication if misused or carelessly applied.
A 64-year-old black woman, gravida 4, para 0, aborta 4, whose menopause had occurred at age 40 years, presented to the emergency room complaining of passage of stool per vagina of 1 week duration. She had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy in 1966 for uterine leiomyoma. She had been treated for hypertension for 10 years. In July of 1978, she complained of vaginal disReprint requests: Dr. Morteza M. Dini, Department of Gynecologic Oncology, 1825 W. Harrison St., Chicago, Illinois 60612. 0002-9378/80/050692+02$00.20/0
0
1980
The
C. V. Mosby
Co.
Communications
136 5
Fig. 3. Aortogram of patient in this case report. Internal iliac arteries are narrowed site of ligation (arrows).
situations, probably as a result of an absorbable utilized for the operation.
suture
REFERENCES
Burchell, R. C., and Olson, G.: Internal iliac artery ligation: Aortograms, AM. J. OBSTET. GYNECOL. 94:117, 1966. 2. Mengert, W. F., Burchell, R. C., Blumstein, R. W., and Da&al, J. L.: Pregnancy after bilateral ligation of the internal iliac and ovarian arteries, Obstet. Gynecol. 34:664, 1969. 1.
Missed tubal abortion STANLEY WILLIAM BERNARD
BURROWS, M.D. MOORS, D.O. PEKALA, M.D.
Departments of Pathology nrzd Obstetrics and Gynecology, Cooper Medical Center, Camden, NPW Jersey THE REPORTED incidence of tubal been as high as 22.8/1,000 live births
pregnancy has and stillbirths.’
Reprint requests: Stanley Burrows, M.D., Department of Pathology, Cooper Medical Center, Camden, New Jersey 08103. 000%9378/80/050691+02$00.20/0
@ 1980 The C. V. Mosby
Co.
in brief
691
but patent at the
However, only 1 I cases of tubal pregnancy were found in 41,753 women who presented to Planned Parenthood centers for elective first-trimester abortions and only two of these 11 cases were diagnosed prior to rupture, despite gynecologic evaluation and pathologic study of the uterine curettings.’ The great discrepancy between the low incidence of tubal pregnancy diagnosed early in pregnancy and the higher incidence relative to all births suggests that a large proportion of tubal pregnancies cannot be diagnosed early in pregnancy by the standard bimanual examination. Most of these tubal pregnancies spontaneously abort and may result in tubal rupture and life-threatening hemorrhage. The medical literature is remarkably silent on the occurrence of asymptomatic tubal abortion. We recently observed a patient with missed tubal abortion which may have occurred several years prior to its diagnosis. The patient, a 2%year-old woman, gravida 2, para 2, was admitted for a laparoscopic tubal ligation in December, 1977. Two norma term deliveries had occurred in September, 1972, and September, 1977. Oral contraceptives had been taken intermittently between the two pregnancies. Postpartum amenorrhea persisted for 3 months after the first delivery, followed by a month of metrorrhagia. An examination in January, 1973, disclosed an enlarged and slightly softened uterus, but the urine pregnancy test was negative and menses occurred 1 month later. All admission labora-
692
Communications
in brief
March 1, 1980 Am. J. Obstet. Gynecol.
Fig. 1. Fallopian tube containing organized degenerated placental villi. The mesosalpinx contains numerous hemosiderin-laden macrophages and calcific deposits. tory work was normal, including a negative radioimmunoassay blood pregnancy test. During laparoscopic sterilization, bleeding occurred in an area of mesosalpinx. which required a minilaparotomy for hemostasis. There was a 2 cm segment of the left fallopian tube which had a gray discoloration without obvious necrosis, hematoma, or tubal distention. This segment of fallopian tube was included in the tubal resection. The resected segment of the left fallopian tube contained loose fibrous tissue with degenerated remnants of placental villi (Fig. 1). There were numerous hemosiderin-laden macrophages and calcific deposits in the ad.jacent mesosalpinx. The exact age of the tubal abortion is uncertain. However, the histologic appearance suggests a very old process which may have occurred during the postpartum period of amenorrhea almost 5 years before diagnosis. Although the reported case may be relatively unique, clinicians should be aware that tubal abortion may be asymptomatic. The extreme rarity of histotogic confirmation of asymptomatic tubal abortion may be attributed to effective resorption of the products of conception and reparative abilities of the fallopian tube.
REFERENCES
1.
DOW, E: K., Wilson, J. B., and Klufio, C. A.: Tubal pregnancy: a review of 404 cases, Ghana Med. J. 14:232, 1975. 2. Schonberg, L. A.: Ectopic pregnancy and first trimester abortion, Obstet. Gynecol. (Suppl.) 49:73, 1977.
lleovaginal fistula following cryosurgery for vaginal dysplasia MORTEZA KIANOOSH
M. DINI. JAFARI,
M.D. M.D.
Division of Gynetologic Onrology, Cook County Hospital, and De@wtmnt of Obstetrics and Gynecology, Uniuersity of Health ScienceslThe Chicago Medical School, Chicago, Illinou CRYOSURGERY HAS BEEN considered asafeand effective method of treating women with benign and preinvasive neoplasia of the genitals. Recently we encountered a patient who was treated for dysplasia of the vaginal epithelium with cryosurgery, following which she developed ileovaginal fistula. This case emphasizes that a safe, therapeutic method can cause a life-threatening complication if misused or carelessly applied.
A 64-year-old black woman, gravida 4, para 0, aborta 4, whose menopause had occurred at age 40 years, presented to the emergency room complaining of passage of stool per vagina of 1 week duration. She had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy in 1966 for uterine leiomyoma. She had been treated for hypertension for 10 years. In July of 1978, she complained of vaginal disReprint requests: Dr. Morteza M. Dini, Department of Gynecologic Oncology, 1825 W. Harrison St., Chicago, Illinois 60612. 0002-9378/80/050692+02$00.20/0
0
1980
The
C. V. Mosby
Co.