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INTRODUCCIÓN: El piometra es una afección infrecuente, pero grave, que en general se diagnostica en mujeres posmenopáusicas. En adolescentes es sumamente raro, y si se acompaña de amenorrea primaria hay que tener en mente las anomalías congénitas. CASO CLÍNICO: Adolescente de 13 años, sin antecedentes personales de interés salvo amenorrea primaria, que acude con abdomen agudo y es intervenida por una peritonitis difusa causada por un piometra secundario a disgenesia (estenosis) cervical congénita. Se realizó dilatación cervical y se dejó una sonda vesical intrauterina para prevenir la reestenosis. CONCLUSIONES: Un diagnóstico precoz y un tratamiento conservador con dilatación cervical y colocación temporal de un catéter urinario son esenciales para un manejo seguro y efectivo de la estenosis cervical en adolescentes.
INTRODUCTION: Pyometra is an uncommon but serious condition that is generally diagnosed in postmenopausal women. In adolescents it is extremely rare; if accompanied by primary amenorrhea, consider congenital abnormalities. CASE REPORT: A 13-year-old adolescent, with no relevant personal history except primary amenorrhea, who presented with an acute abdomen and was operated on for diffuse peritonitis caused by pyometra secondary to congenital cervical dysgenesis (stenosis). Cervical dilation was performed and a urinary catheter was temporarily placed inside the uterus to prevent restenosis. CONLUSIONS: An early diagnosis and conservative treatment with cervical dilation and temporary placement of a urinary catheter are essential for the safe and effective management of cervical stenosis in adolescents.
Subject(s)
Humans , Female , Adolescent , Uterine Cervical Diseases/etiology , Constriction, Pathologic/etiology , Pyometra/complications , Urinary Catheterization , Stents , Uterine Cervical Diseases/congenital , Uterine Cervical Diseases/therapy , Constriction, Pathologic/congenital , Constriction, Pathologic/therapy , DilatationABSTRACT
Hematometra is a collection or retention of blood in the uterine cavity. This condition is most commonly associated with congenital uterine anomalies that result from abnormal formation, fusion or resorption of Mullerian ducts during fetal life or may be due to prior surgical procedures, causing an obstruction of the genitourinary outflow tract. We report an unusual case of hematometra with endometriosis secondary to cervical stenosis. This is a rare and important case report due to the complexity of diagnosis as cervical stenosis was not presented as primary amenorrhoea as its usual presentation. This case was successfully managed by Hysteroscopic cervical dilatation under USG guidance followed by transcervical insertion of a catheter to prevent recurrent stenosis.
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The Torg-Pavlov ratio is a method used to detect cervical stenosis. A Torg-Pavlov ratio ≤0.80 suggests significant stenosis. This ratio is obtained by dividing the anteroposterior diameter of the cervical canal by the anteroposterior diameter of the vertebral body. The aim of this study was to evaluate these parameters and determine if there are significant differences with respect to sex and age. This is an anatomical and comparative study in which 1020 cervical vertebrae from C2-C7 from an osteological collection were evaluated. We determined the anteroposterior diameter from the vertebral body, the anteroposterior diameter from the vertebral canal and the Torg-Pavlov ratio. The pieces studied were divided into groups according to sex and age, resulting in six groups of study. A statistical analysis was made to determine the significance of the differences between sex and age groups. The size of the vertebral body diminished form C2-C3 and increased from C4-C7. The canal diminished form C2-C4 and increased from C5-C7. The Torg-Pavlov ratio decreased from C2-C7. The body and the canal were higher in men, while the Torg-Pavlov ratio was higher in women. With age, in men, the size of the body increased, the canal maintained its size, and the Torg-Pavlov ratio diminished significantly. In the group of women ≥60 years, the size of the body decreased, and the canal and the Torg-Pavlov ratio increased. In men, the Torg-Pavlov ratio is determined by the vertebral body and canal, because these did not show differences in most of the age groups. While in women, it is determined mostly by the spinal canal because it presented more variability between the age groups.
El Índice de Torg-Pavlov se utiliza para la detección de estenosis del canal cervical. Un resultado ≤0.80 indica estenosis significativa. Se obtiene dividiendo el diámetro anteroposterior del canal cervical entre el diámetro anteroposterior del cuerpo. El objetivo de este estudio fue evaluar estos parámetros y determinar si existen diferencias significativas en relación con el sexo y la edad. Se realizó un estudio anatómico y comparativo, en el que se incluyeron 1020 vértebras cervicales de C2-C7 tomadas de una colección osteológica. Se determinó el diámetro anteroposterior del cuerpo vertebral, el diámetro anteroposterior del canal vertebral y el Índice de Torg-Pavlov. Las piezas evaluadas se dividieron en grupos de acuerdo al sexo y la edad, resultando en seis grupos de estudio. Se realizó un análisis estadístico para determinar si existían diferencias significativas entre estos grupos. El tamaño del cuerpo vertebral disminuyó de C2-C3 y aumentó de C4-C7. El canal disminuyó de C2-C4 y aumentó de C5-C7. El Índice de Torg-Pavlov disminuyó de C2-C7. El cuerpo y el canal vertebral fueron mayores en los hombres, mientras que el Índice de Torg-Pavlov fue mayor en las mujeres. Con la edad, en los hombres, el tamaño del cuerpo vertebral aumentó, el canal mantuvo su tamaño y el Índice de Torg-Pavlov disminuyo significativamente. En el grupo de mujeres ≥60 años, el tamaño del cuerpo disminuyó y el canal y el Índice de Torg-Pavlov aumentaron. En los hombres, el tamaño del cuerpo y el canal vertebral determinan el Índice de Torg-Pavlov, ya que estos no mostraron diferencias en la mayoría de los grupos de edad. Mientras que, en las mujeres, este está determinado principalmente, por el canal vertebral, porque este parámetro presento más variabilidad entre los grupos de edad.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Cervical Vertebrae/anatomy & histology , Cadaver , Sex Factors , Cross-Sectional Studies , Age Factors , Sex Characteristics , Anatomic VariationABSTRACT
Deliveries through cesarean section are steadily increasing since the last two decades. Although rare, complications do occur after cesarean section. A very rare complication of cesarean section is cervical stenosis, leading to hematometra and hematosalpinx. We report a case of a 38-year-old woman who presented with pain in abdomen and secondary amenorrhea since 15 years, after her last delivery which was conducted by cesarean section. On examination, a provisional diagnosis of hematometra due to cervical stenosis was made, which was confirmed at laparotomy. Due to adhesions and pinpoint stenosed cervix, she was managed by total abdominal hysterectomy with right salpingo-oophorectomy and left salpingectomy was done.
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Objective To study the causes of hematoma-induced spinal cord injury after surgical treatment of fluorosis cervical canal stenosis (FCCS) so as to conclude the methods for early diagnosis and treatment.Methods A retrospective review was conducted on 329 cases of FCCS undergone expansive laminoplasty (ELOP) between 2006 and 2009.Eighteen out of the 329 cases presented with neural deterioration in postoperative 2 weeks,including l 1 males and 7 females at age of 45-73 years (mean 56.9 years).MRI scan at postoperative 1-5 days confirmed that the injury cause was hematoma formation (incidence of 5.47％).Once the definite diagnosis was made,immediate local puncture decompression,immobilization in the prone position as well as a timely second surgical probe and spinal decompression were performed.Results Nerve symptom of the 18 cases obtained different degree of recovery.Japanese Orthopedic Association (JOA) score promoted from preoperative (7.44 ± 1.25) points to (12.6 ± 2.1)points at 12 months after second operation.Scatter plot between time of definite diagnosis and improvement value in JOA score before and after the second operation was drawn so as to establish linear equation (Y =6.240 7-0.777 8X(F =9.89,P ＜0.01).As a result,the two variables presented a negative linear relationship,which suggested a better outcome after early treatment than delayed treatment.Conclusions Hematoma compression is the main cause of spinal cord injury following operation for FCCS patients.Strict hematosis and alternate lateral clinostatism after operation were effective prevention methods.Besides,early diagnosis and timely treatment are critically important.
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Objective To evaluate the clinical results of one stage ante rior and posterior approach in the treatment of severe lower cervical injury. Me thod 8 cases of severe lower cervical injury underwent reduction, decompression and fixation through one stage anterior and posterior approach. 6 cases had fra cture and dislocation of cervical spine, and 2 cases cervical spine burst fractu re with cervical stenosis. Their clinical and radiographic records were reviewed retrospectively. Results Follow-ups of a mean period of 14 months showed that satisfactory recovery of neurological function was achieved. The Frankel Grade w as A in 7 cases and B in 1 case before operation, but D in 2 cases, C in 3 cases , and B in 1 case after operation except in 2 cases who had no improvement and r emained A. X-ray film demonstrated satisfactory stabilization of the fracture a nd dislocation, complete fusion of autograft, and preservation of the normal int ervertebral height and cervical lordosis. Conclusion One stage anterior and post erior approach operation is essential, safe and effective when radiographs demon strate that lower cervical canal is compressed from both anterior and posterior directions and clinical symptoms show severe neurological defects.
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Suction curettage is a relatively safe procedure to induce abortion of first trimester pregnancy with a very low complication rate. But, in order to do that, cervix should be dilated enough to pass operating devices. We experienced a case of first trimester pregnancy terminated successfully using transvaginal misoprostol when suction curettage was failed due to severely cervical stenosis after LEEP conization.