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Rev. chil. obstet. ginecol. (En línea) ; 87(1): 81-86, feb. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388714


INTRODUCCIÓN: Aproximadamente un 4% de mujeres embarazadas presentan tumoraciones anexiales en el primer trimestre de gestación, siendo la mayoría quistes anexiales simples. Solo el 1,5% persisten tras el primer trimestre y en torno al 0,9% son malignos. CASO CLÍNICO: Paciente de 31 años que consultó en urgencias por sangrado y amenorrea de 5 semanas. La ecografía transvaginal evidenció un saco gestacional intraútero y una tumoración anexial izquierda compleja de 68 mm, multilocular, sólida, de ecogenicidad mixta, con septos gruesos y un área sólida vascularizada de 40 mm, sospechosa de neoplasia de ovario. Se realizó manejo quirúrgico conservador mediante anexectomía bilateral laparoscópica en la octava semana de gestación. El diagnóstico fue de adenocarcinoma mucinoso infiltrante bien diferenciado en ovario derecho, coexistente con tumor mucinoso borderline en ovario izquierdo (etapa IC FIGO). El embarazo cursó con normalidad, a excepción de feto pequeño para la edad gestacional en la semana 39. Se finalizó la gestación en la semana 40 mediante parto vaginal. Debido al deseo de la paciente, la cirugía se realizó en el primer trimestre de embarazo en lugar de en el segundo como se recomienda. La cirugía se completó meses después del parto, con histerectomía y apendicectomía laparoscópica. DISCUSIÓN: El cáncer de ovario es el segundo tumor ginecológico más diagnosticado durante el embarazo. Suele diagnosticarse en el primer trimestre debido al cribado ecográfico gestacional. Ocurre en mujeres con baja paridad y en sus últimos años de edad reproductiva. Esto podría verse reflejado en un aumento de su incidencia debido al retraso de la edad materna al primer embarazo. Normalmente se diagnostica en etapa I, siendo entonces la supervivencia superior al 90% a los 5 años. En etapas iniciales en mujeres embarazadas, la laparoscopia es tan válida como la laparotomía.

INTRODUCTION: Approximately 4% of pregnant women present adnexal tumors in the first trimester of gestation, the majority being simple adnexal cysts. Only 1.5% persist after the first trimester and around 0.9% are malignant. CASE REPORT: 31-year-old patient who came to the emergency room because of spotting and 5-week amenorrhea. A transvaginal ultrasound revealed an intrauterine gestational sac and a 69 mm complex multiocular-solid left adnexal tumor, with thick septa and a solid vascularized area of 40 mm, with suspicion of ovarian neoplasia. Conservative surgical management was performed through laparoscopic bilateral salpingo-oophorectomy in eighth week of gestation. The diagnosis was a well-differentiated infiltrating mucinous adenocarcinoma in the right ovary, and a coexisting borderline mucinous tumor in the left ovary (FIGO stage IC). The pregnancy proceeded normally except for a small for gestational age fetus at week 39 and pregnancy was completed at week 40 by vaginal delivery. Due to the patients wishes, the surgery was performed in the 1st trimester of pregnancy instead in the 2nd as is recommended. Final surgery was completed after giving birth, with laparoscopic hysterectomy and appendectomy. DISCUSSION: Ovarian cancer is the second most diagnosed gynecological tumor during pregnancy. It is usually diagnosed during the first trimester with gestational ultrasound screening. It occurs in women with low parity and in their later years of reproductive age. This could be reflected in an increase in its incidence due to the delay in the age of first pregnancy. Normally it is diagnosed in stage I, when the survival rate is superior to 90% after 5 years. In early stages, laparoscopic surgery in pregnant women is as valid as laparotomy.

Humans , Female , Pregnancy , Adult , Ovarian Neoplasms/surgery , Pregnancy Complications, Neoplastic , Adenocarcinoma, Mucinous/surgery , Neoplasms, Multiple Primary/surgery , Ovarian Neoplasms/pathology , Ovarian Neoplasms/diagnostic imaging , Pregnancy Trimester, First , Laparoscopy , Adenocarcinoma, Mucinous/pathology , Adenocarcinoma, Mucinous/diagnostic imaging , Hysterectomy/methods , Neoplasms, Multiple Primary/pathology
Rev. bras. ginecol. obstet ; 44(1): 55-66, Jan. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365664


Abstract Objective To summarize the available evidence of TAP Block in efficacy in laparoscopic or robotic hysterectomy. Data Sources We searched databases and gray literature for randomized controlled trials in which transversus abdominis plane (TAP) block was compared with placebo or with no treatment in patients who underwent laparoscopic or robot-assisted hysterectomy. Method of Study Selection Two researchers independently evaluated the eligibility of the selected articles. Tabulation, Integration, and Results Seven studies were selected, involving 518 patients. Early postoperative pain showed a difference in the mean mean difference (MD): - 1.17 (95% confidence interval [CI]: - 1.87-0.46) in pain scale scores (I2=68%), which was statistically significant in favor of using TAP block, but without clinical relevance; late postoperative pain: DM 0.001 (95%CI: - 0.43-0.44; I2=69%); opioid requirement: DM 0.36 (95%CI: - 0.94-1.68; I2=80%); and incidence of nausea and vomiting with a difference of 95%CI=- 0.11 (- 0.215-0.006) in favor of TAP. Conclusion With moderate strength of evidence, due to the high heterogeneity and imbalance in baseline characteristics among studies, the results indicate that TAP block should not be considered as a clinically relevant analgesic technique to improve postoperative pain in laparoscopic or robotic hysterectomy, despite statistical significance in early postoperative pain scale scores. Clinical Trial Number and Registry: PROSPERO ID - CRD42018103573.

Resumo Objetivo Resumir as evidências disponíveis sobre a eficácia do bloqueio TAP em histerectomia laparoscópica ou robótica. Fontes de Dados Pesquisamos bancos de dados e literatura cinza por ensaios clínicos randomizados nos quais o bloqueio do plano transverso do abdome (TAP na sigla em inglês) foi comparado com placebo ou com nenhum tratamento em pacientes que foram submetidos a histerectomia laparoscópica ou assistida por robô. Métodos de Seleção de Estudos Dois pesquisadores avaliaram independentemente a elegibilidade dos artigos selecionados. Tabulação, Integração e Resultados Sete estudos foram selecionados envolvendo 518 pacientes. A dor pós-operatória precoce apresentou diferença nasmédias (DM) de: -1 17 (intervalo de confiança [IC] de 95%: - 1 87-0 46) nos escores da escala de dor (I2=68%) o que foi estatisticamente significativo a favor do uso do bloqueio TAP mas sem relevância clínica; dor pós-operatória tardia: DM 0001 (IC95%: - 043-044; I2=69%); necessidade de opioides: DM0 36 (95%CI: - 0 94-168; I2=80%); e incidência de náuseas e vômitos com diferença de 95% CI=- 011 (- 0215-0006) a favor do TAP. Conclusão Com moderada força de evidência devido à alta heterogeneidade e ao desequilíbrio nas características basais entre os estudos os resultados indicam que o bloqueio do TAP não deve ser considerado como uma técnica analgésica clinicamente relevante para melhorar a dor pós-operatória em histerectomia laparoscópica ou robótica apesar da significância estatística nas pontuações da escala de dor pósoperatória inicial. Número e Registro do Ensaio Clínico: PROSPERO ID - CRD42018103573.

Pain, Postoperative/prevention & control , Laparoscopy/methods , Robotic Surgical Procedures/methods , Analgesics, Opioid/therapeutic use , Pain, Postoperative/drug therapy , Robotics , Abdominal Muscles , Hysterectomy/methods
Article in Chinese | WPRIM | ID: wpr-936317


We report a case of giant hysteromyoma and complex pelvic adhesion treated by robotic assisted laparoscopic total hysterectomy and bilateral salpingectomy. The patient was diagnosed with uterine fibroids after physical examination in 1998 but did not receive any treatment, and regular examinations reported progressive growth of the fibroids. Ultrasound suggested multiple uterine fibroids, and pelvic MRI indicated large uterine fibroids with bleeding. Robot-assisted laparoscopic total hysterectomy and bilateral salpingectomy were performed after relevant examinations, and the operation was completed smoothly. The patient was discharged 4 days after surgery with good appearance of the abdominal wall and good recovery during the follow-up. With its unique advantages, robot-assisted laparoscopy provides a minimally invasive surgical approach for giant hysterectomy with complex pelvic adhesions.

Female , Humans , Hysterectomy , Laparoscopy , Leiomyoma/surgery , Robotics , Uterus
Chinese Medical Journal ; (24): 441-446, 2022.
Article in English | WPRIM | ID: wpr-927526


BACKGROUND@#Massive bleeding is the main concern for the management of placenta percreta (PP). Intra-abdominal aortic balloon occlusion (IABO) is one method for pelvic devascularization, but the efficacy of IABO is uncertain. This study aims to investigate the outcomes of IABO in PP patients.@*METHODS@#We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015. PP cases with/without the use of IABO were analyzed. Propensity score matching analysis was performed to reduce the effect of selection bias. Postpartum hemorrhage (PPH) and the rate of hysterectomy, as well as neonatal outcomes, were analyzed.@*RESULTS@#One hundred and thirty-two matched pairs of patients were included in the final analysis. Compared with the control group, maternal outcomes, including PPH (68.9% vs. 87.9%, χ2 = 13.984, P < 0.001), hysterectomy (8.3% vs. 65.2%, χ2 = 91.672, P < 0.001), and repeated surgery (1.5% vs. 12.1%, χ2 = 11.686, P = 0.001) were significantly reduced in the IABO group. For neonatal outcomes, Apgar scores at 1 minute (8.67 ± 1.79 vs. 8.53 ± 1.68, t = -0.638, P = 0.947) and 5 minutes (9.43 ± 1.55 vs. 9.53 ± 1.26, t = 0.566, P = 0.293) were not significantly different between the two groups.@*CONCLUSIONS@#IABO can significantly reduce blood loss, hysterectomies, and repeated surgeries. This procedure has not shown harmful effects on neonatal outcomes.

Aorta , Balloon Occlusion/methods , Blood Loss, Surgical , Female , Humans , Hysterectomy , Infant, Newborn , Placenta Accreta/surgery , Placenta Previa/surgery , Postpartum Hemorrhage , Pregnancy , Retrospective Studies
Femina ; 50(1): 35-50, 2022. ilus
Article in Portuguese | LILACS | ID: biblio-1358220


As neoplasias intraepiteliais cervicais correspondem a alterações identificadas por rastreamento citológico cervical e estudo histológico, pós-biópsia incisional guiada por colposcopia ou procedimento diagnóstico excisional. Podem ser tratadas com abordagens conservadoras e procedimentos excisionais. A vacinação anti-HPV e o tratamento excisional oportuno constituem, respectivamente, prevenção primária e secundária contra o câncer do colo uterino.(AU)

Cervical intraephitelial neoplasms correspond to changes identified by cervical citological screening and histological study, post-incisional biopsy guided by colposcopy or excisional diagnostic procedure. They can be treated with conservative approaches and excision procedures. Anti-HPV vaccination and timely excional treatment are primary and secondary prevention against cervical cancer, respectively.(AU)

Humans , Female , Cervix Uteri/cytology , Cervical Intraepithelial Neoplasia/surgery , Cervical Intraepithelial Neoplasia/diagnosis , Squamous Intraepithelial Lesions/surgery , Squamous Intraepithelial Lesions/diagnosis , Squamous Intraepithelial Lesions/diagnostic imaging , Cervical Intraepithelial Neoplasia/diagnostic imaging , Colposcopy , Conization/instrumentation , Papillomavirus Infections/pathology , High-Intensity Focused Ultrasound Ablation , Hysterectomy
Femina ; 50(1): 61-64, 2022. ilus
Article in Portuguese | LILACS | ID: biblio-1358222


O infarto agudo do miocárdio no período gravídico-puerperal é uma condição rara em que a principal causa é a dissecção espontânea da artéria coronária. É um evento comumente subdiagnosticado, com pouca literatura disponível e elevado índice de morbimortalidade. Esse relato descreve o caso de uma gestante de 36 semanas de gravidez gemelar, monocoriônica-diamniótica, com infarto agudo do miocárdio secundário à dissecção espontânea da artéria coronária. As equipes de cirurgia cardíaca e obstetrícia optaram pela realização de parto cesariano e histerectomia subtotal, seguido da revascularização da artéria mamária descendente anterior. Discutem-se as orientações adotadas na dissecção espontânea da artéria coronária, bem como a abordagem terapêutica e a conduta obstétrica, quando essa condição ocorre durante a gravidez.(AU)

Acute myocardial infarction in the pregnancy-puerperal period is a rare condition the main cause of which is the spontaneous coronary artery dissection. A commonly underdiagnosed event with little available literature and a high rate of morbidity and mortality. This case reports a 36-week pregnant woman of mono-chorionic-diamniotic pregnancy who had a myocardial infarction secondary to a spontaneous coronary artery dissection. In a joint discussion between the team of cardiac surgery and obstetrics, it was decided to perform a cesarean delivery and subtotal hysterectomy followed by revascularization of the mammary anterior descendant. It discusses the conducts to be adopted in a case of spontaneous coronary artery dissection as well as therapeutic approaches and obstetric conducts to be taken in a case of dissection during pregnancy.(AU)

Humans , Female , Pregnancy , Pregnancy Complications/surgery , Coronary Vessels/pathology , Dissection/adverse effects , Acute Coronary Syndrome/pathology , Myocardial Infarction/complications , Cesarean Section , Pregnancy, High-Risk , Pregnancy, Twin , Heart Disease Risk Factors , Hysterectomy , Myocardial Infarction/etiology
Femina ; 50(4): 254-256, 2022.
Article in Portuguese | LILACS | ID: biblio-1380703


Acretismo é um termo genérico que significa uma invasão trofoblástica anormal da placenta em parte ou, mais raramente, na totalidade do miométrio, podendo inclusive chegar à serosa. Esse evento ocorre mais comumente em uma região de cicatriz uterina prévia, onde há um defeito na decidualização. A principal consequência disso é a necessidade frequente de histerectomia puerperal, acarretando grande morbidade materna. Este artigo apresenta o caso de uma gestante com placenta percreta, com acometimento vesical e de colo uterino que necessitou de histerectomia total. Além disso, no pós-operatório, apresentou fístula vesicoabdominal. O objetivo deste artigo é demonstrar as complicações do acretismo placentário e as maneiras de tentar reduzi-lo. O aumento nas proporções de nascimentos via parto cesariana, sem que haja evidências claras de que isso interfira na queda da mortalidade e/ou morbidade materna e neonatal, sugere que estejam sendo indicadas muito mais cesarianas que o necessário. Para redução nas taxas de cesariana e, consequentemente, das complicações dela, como nos casos de acretismo, é necessário repensar a cultura do cuidado da prática clínica em obstetrícia.(AU)

Accretism is a generic term that means an abnormal trophoblastic invasion of the placenta in part or, more rarely, in the entire myometrium, which may even reach the serosa. This event most commonly occurs in a region of previous uterine scar, where there is a decidualization defect. The main consequence of this is the frequent need for puerperal hysterectomy, causing great maternal morbidity. This article presents the case of a pregnant woman with placenta percreta, with bladder and uterine cervix involvement, who required hysterectomy. In addition, postoperatively, presented a vesico-abdominal fistula. The purpose of this article is to demonstrate the complications of placental accretism and ways to try it. The increase in the proportion of births via cesarean delivery, without clear evidences that this interferes with the decrease in maternal and neonatal mortality and/or morbidity, suggests that much more cesarean sections are being indicated than necessary. To reduce cesarean rates and consequently, its complications, as in cases of accretism, it is necessary to rethink the culture of care in clinical practice in obstetrics.(AU)

Humans , Female , Pregnancy , Placenta Accreta/physiopathology , Pregnancy Complications , Placenta Previa/physiopathology , Risk Factors , Pregnancy, High-Risk , Postpartum Hemorrhage , Hysterectomy
Femina ; 50(7): 444-448, 2022. ilus
Article in Portuguese | LILACS | ID: biblio-1397873


Mundialmente, o câncer de colo uterino ocupa o quarto lugar das neoplasias em mulheres, porém, nos países em desenvolvimento, as taxas de incidência superam de forma impactante os casos de países desenvolvidos. Apesar de ser um evento incomum durante a gestação, é cada vez mais observado, o que talvez possa ser atribuído às gestações programadas em idades mais avançadas. O caso descrito refere-se a uma paciente de 32 anos de idade, diagnosticada no terceiro trimestre da gestação com adenocarcinoma de origem endocervical com estadiamento anatomopatológico final (FIGO 2018) 1B2. Ela foi submetida à abordagem cirúrgica como tratamento inicial. Foi adotada como conduta a resolução da gestação, com boa vitalidade fetal, ao final da 34ª semana, após corticoterapia para maturação pulmonar fetal. Foi realizado parto cesariano seguido de histerectomia radical tipo C1 na classificação de Querleu e Morrow associado a linfadenectomia pélvica, no mesmo ato operatório.(AU)

Worldwide, cervical cancer ranks fourth in female cancers, but when assessing data from developing countries, incidence rates are significantly higher than in developed countries. Although it is an uncommon event during pregnancy, it is increasingly observed, which may perhaps be justified due to pregnancies postponed at older ages. The case described relates to a 32-year-old woman diagnosed in the third trimester of pregnancy with endocervical adenocarcinoma, whose final anatomopathological staging (FIGO 2018) was IB2. The same was submitted to the surgical approach as an initial treatment. It was adopted as a conduct, the resolution of pregnancy, with good fetal viability, at the end of the 34th week, after corticosteroid therapy for fetal lung maturation. The patient underwent cesarean section followed by radical type C1 hysterectomy in the classification of Querleu and Morrow associated with pelvic lymphadenectomy in the same surgery.(AU)

Humans , Female , Pregnancy , Adult , Pregnancy Complications/surgery , Cervical Intraepithelial Neoplasia/surgery , Adenocarcinoma, Mucinous/surgery , Adenocarcinoma, Mucinous/diagnosis , Adenocarcinoma, Mucinous/diagnostic imaging , Pregnancy Trimester, Third , Brazil , Cesarean Section , Health Status Indicators , Adrenal Cortex Hormones , Colposcopy , Pregnancy, High-Risk , Fetal Viability , Human Papillomavirus DNA Tests , Hysterectomy/methods
Arq. bras. med. vet. zootec. (Online) ; 73(6): 1269-1277, Nov.-Dec. 2021. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1355673


The objective of this study was to quantify the number and frequency of monocyte (MnOF) and multi-oocyte (MtOF) follicles in ovaries of bitches subjected to ovary salpingohysterectomy (OSH). Right and left ovaries of 38 bitches were collected after OSH, prepared, and a histological analysis was carried out. The ovaries were subjected to surface and deep histological cuts; the follicles were classified, and the number of follicles and cumulus oophorus complexes (COC) per follicle were quantified for each histological cut. MnOF and MtOF were found in all ovaries, at different developmental stages; primary follicles were grouped in the ovarian cortex, and follicles at other follicular stages presented a random distribution. MtOF containing two, three, four, or more COC were found in the ovaries of bitches, with a decreasing frequency trend, according to the number of COC in the MtOF. The effect of the age, number of estrus, estrus interval, and number of progenies per delivery was not significant for the number and frequency of MtOF in the ovaries of the bitches, whereas the size, number of pregnancies, use and number of contraceptive applications had some effect on the number and frequency of MtOF in the ovaries of the bitches.(AU)

Objetivou-se, com este estudo, quantificar o número e a frequência de folículos monocitários (MOF) e polioocitários (POF) provenientes de ovários de cadelas submetidas à ovariossalpingo-histerectomia (OSH). Para tanto, coletaram-se os ovários (direito e esquerdo) de 38 cadelas após OSH, com posterior preparação e análise histológica. Cada ovário foi submetido a dois cortes histológicos (superficial e profundo) onde se quantificou o número e a classificação dos folículos, bem como o número de complexos cumulus oophorus (COCs) por folículo em cada corte histológico. Observaram-se MOF e POF em todos os ovários estudados, em diferentes estádios de desenvolvimento, sendo os folículos primários agrupados no córtex ovariano, frente a uma distribuição aleatória dos outros estádios foliculares. FOPs contendo dois, três, quatro ou mais COCs foram observados nos ovários de todas as fêmeas estudadas, e sua frequência tendeu a diminuir de acordo com o número de COC presente no POF. Não se observou influência da idade, do número e do intervalo de estros, assim como do número de filhotes por gestação sobre o número/frequência de FOP nos ovários das cadelas estudadas, enquanto o porte, o número de gestações, o uso e o número de contraceptivo apresentaram algum grau de influência sobre o número/frequência de FOP nos ovários das cadelas estudadas.(AU)

Animals , Female , Cats , Oocytes/classification , Cumulus Cells/classification , Ovarian Follicle , Periodicity , Ovariectomy/veterinary , Hysterectomy/veterinary
Rev. colomb. cir ; 37(1): 106-114, 20211217. fig
Article in Spanish | LILACS | ID: biblio-1357582


Introducción. El objetivo de este artículo fue dar a conocer el protocolo institucional del manejo de la placenta percreta como un procedimiento varias horas después de la cesárea, con embolización de arterias placentarias de forma selectivas, previo a la práctica de la histerectomía, y presentar los resultados. Métodos. Estudio de serie de casos, donde se evaluaron las pacientes con placenta percreta, manejadas durante un año en un hospital de cuarto nivel de complejidad en la ciudad de Bogotá, D.C., Colombia. Se efectuó cesárea fúndica y se dejó la placenta in situ, 48 a 72 horas después se realizó embolización ultra selectiva y luego de 2 a 3 días se procedió a practicar la histerectomía vía abdominal. Resultados. Se evaluaron 5 pacientes, con paridad de 3,8 embarazos promedio, con diagnóstico de placenta percreta. El tiempo promedio de espera entre la embolización y la histerectomía fue de 1,6 días. No se presentaron complicaciones asociadas a la embolización, ni morbimortalidad materno fetal. Los volúmenes de sangrado en promedio durante la histerectomía de cada paciente fueron de 1160 ml. Conclusión. Existen datos limitados sobre el tratamiento óptimo del acretismo placentario. La sospecha diagnóstica permite planificar de forma favorable el manejo intraparto y, es por ello, que el surgimiento de nuevas técnicas, como la embolización de arterias placentarias, constituyen alternativas para un manejo más seguro de las pacientes.

Introduction. The objective of this article was to present the institutional protocol for the management of percrete placenta as a procedure several hours after cesarean section, with selective embolization of placental arteries, prior to the practice of hysterectomy, and to present the results. Methods. Case series study, where patients with percrete placenta were evaluated, managed for 1 year in a hospital of fourth level of complexity in the city of Bogotá, Colombia. A fundic cesarean section was performed and the placenta was left in situ, 48 to 72 hours later an ultra-selective embolization was performed, followed by an abdominal hysterectomy after 2 to 3 days.Results. Five patients with a diagnosis of placenta percreta were evaluated; mean wait time between embolization and hysterectomy was 1.6 days. There were no complications associated with embolization, or maternal-fetal morbidity and mortality. Average bleeding volumes during hysterectomy for each patient were 1160 ml. Conclusion. There are limited data on the optimal treatment of percrete placenta. Diagnostic suspicion allows for a favorable planning of intrapartum management and, for this reason, the emergence of new techniques, such as placental artery embolization, constitute alternatives for a safer management of patients.

Humans , Placenta Accreta , Placenta, Retained , Placenta Previa , Cesarean Section , Embolization, Therapeutic , Hysterectomy
Arq. Ciênc. Vet. Zool. UNIPAR (Online) ; 24(2, cont.): e2403, jul-dez. 2021. ilus
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1348228


O procedimento cirúrgico eletivo realizado com maior frequência na rotina veterinária é a ovário-histerectomia (OVH), com isso há uma alta casuística de complicações pós-operatórias. Entre elas, pode-se citar piometra de coto, ligadura acidental de ureter, síndrome do ovário remanescente, formação de granulomas inflamatórios e aderências a órgãos. Os granulomas de coto ovariano são formados, geralmente por um fio de sutura utilizado inadequadamente, ou a um sítio de infecção. Tais granulomas podem levar à aderências, inclusive a órgãos próximos ao sítio cirúrgico. O presente relato refere-se a uma cadela, que apresentou granulomas ovarianos com aderências no pâncreas e em diversos órgãos após a ovário-histerectomia. Para a solução do caso, foi realizado uma celiotomia exploratória para avaliação da cavidade abdominal, retirada das aderências das estruturas e das formações granulomatosas, sendo necessária a realização de uma pancreatectomia parcial para a retirada completa do granuloma. Após a cirurgia, o paciente desenvolveu quadro de pancreatite, uma complicação muito comum em cirurgias pancreáticas. Ainda assim, o resultado foi considerado satisfatório, pois a pancreatite foi solucionada e os granulomas removidos, e até a última revisão pós-operatória, o paciente encontrava-se bem clinicamente. A OVH é uma das cirurgias mais realizadas na rotina médico veterinária, ainda assim é negligenciada em diversos quesitos. Portanto, há a necessidade dessa técnica cirúrgica e suas possíveis complicações serem realizadas de maneira correta e efetiva.(AU)

The most frequently elective surgical procedure performed in the veterinary routine is the ovary hysterectomy (OVH). As such, there is a high number of post-operative complications, which include stump pyometra, accidental ligation of the ureter, remnant ovary syndrome, formation of inflammatory granulomas, and organ adhesions. Ovarian stump granulomas are usually formed by suture which has been improperly used, or to infection. Such granulomas can lead to adhesions, also affecting organs close to the surgical site. This report refers to a female dog that presented ovarian granulomas with adhesions to the pancreas and to several organs after ovary-hysterectomy. In order to solve the case, an exploratory celiotomy was performed to assess the abdominal cavity, removing the adhesions of the structures and granulomatous formations, which required the performance of a partial pancreatectomy for the thorough removal of the granuloma. After surgery, the patient developed pancreatitis, a very common complication in pancreatic surgery. Even so, the result was considered satisfactory, as the pancreatitis was resolved and the granulomas removed and until the last post-operative review, the patient was clinically well. OVH is one of the most commonly performed surgeries in the veterinary medical routine, yet it is neglected in several aspects. Therefore, there is a need for the surgical technique and its possible complications to be performed correctly and effectively.(AU)

El procedimiento quirúrgico electivo que se realiza con mayor frecuencia en la rutina veterinaria es la ovario-histerectomía (OVH), con que existe un elevado número de complicaciones postoperatorias. Estos incluyen piometra del muñón, ligadura accidental del uréter, síndrome de ovario remanente, formación de granulomas inflamatorios y adherencias a órganos. Los granulomas del muñón ovárico se forman por lo general por una sutura mal utilizada o en un sitio de infección. Dichos granulomas pueden provocar adherencias, incluso a órganos cercanos al sitio quirúrgico. El presente informe se refiere a una perra, quien presentó granulomas ováricos con adherencias en el páncreas y en varios órganos tras ovario histerectomía. Para la solución del caso se realizó una celiotomía exploratoria para acceder la cavidad abdominal, removiendo las adherencias de las estructuras y formaciones granulomatosas, requiriendo la realización de una pancreatectomía parcial para la extirpación completa del granuloma. Después de la cirugía, la paciente desarrolló pancreatitis, una complicación muy común en la cirugía pancreática. Aun así, el resultado se consideró satisfactorio, ya que se resolvió la pancreatitis y se retiraron los granulomas, y hasta la última revisión postoperatoria la paciente se encontraba clínicamente bien. La OVH es una de las cirugías que se realizan con mayor frecuencia en la rutina médica veterinaria, pero se descuida en varios aspectos. Por tanto, existe la necesidad de que esta técnica quirúrgica y sus posibles complicaciones se realicen de forma correcta y eficaz.(AU)

Animals , Female , Dogs , Ovary , Pancreatectomy , Postoperative Complications , Elective Surgical Procedures , Dogs/surgery , Granuloma , Hysterectomy
Prensa méd. argent ; 107(7): 374-380, 20210000. tab
Article in English | LILACS, BINACIS | ID: biblio-1358971


Introducción: La histerectomía periparto de emergencia es una cirugía de alto riesgo, que se realiza mayoritariamente después de un parto vaginal o cesárea. Dada la importancia de las complicaciones y la mortalidad de las embarazadas para el sistema de salud, el presente estudio tuvo como objetivo investigar la incidencia y las complicaciones de la histerectomía periparto de emergencia en los hospitales generales y docentes de la Universidad de Ciencias Médicas de Zahedan. Materiales y Métodos: En este estudio descriptivo-analítico transversal, luego de obtener la aprobación del Comité de Ética, se investigó la historia clínica de las pacientes con histerectomía periparto de emergencia ingresadas en el hospital Ali ibn Abitaleb de Zahedan para la interrupción del embarazo durante 2017-2018. fueron estudiados. Después de evaluar las características demográficas, incluida la edad, la educación y la ocupación, se investigaron las causas y las complicaciones de la histerectomía de emergencia. Finalmente, los datos fueron analizados por el software SPSS.Resultados: De 2438 casos, se investigaron 50 casos de histerectomía. La edad media de las madres y el número medio de embarazos fue de 31,06 ± 5,21 y 5,72 ± 2,31, respectivamente. En este estudio, se registraron 35 cesáreas (70%) y 15 partos vaginales normales (30%), y solo el 2% condujo a una histerectomía de emergencia. Las causas más comunes de histerectomía de emergencia incluyeron placenta accreta (28%), atonía uterina (24%) y rotura uterina (20%). Las complicaciones también incluyeron fiebre (24%), coagulopatía (14%) e infección de la herida (12%). Conclusión: la placenta accreta y la atonía uterina son las causas más importantes de histerectomía. Las complicaciones más comunes de la histerectomía de emergencia son fiebre, coagulopatía e infecciones de heridas. Una disminución en el parto por cesárea electiva y un mayor fomento del parto vaginal natural podrían reducir significativamente la incidencia de histerectomía periparto y la mortalidad materna

Introduction: The emergency peripartum hysterectomy is a high-risk surgery, which is mostly performed after vaginal delivery or Caesarean section. Given the importance of complications and mortality of pregnant mothers for the health system, the present study aimed to investigate the incidence and complications of emergency peripartum hysterectomy in general and teaching hospitals of Zahedan University of Medical Sciences. Materials and Methods: In this cross-sectional descriptive-analytic study, after obtaining the Ethics Committee approval, the medical record of patients with emergency peripartum hysterectomy admitted to Ali ibn Abitaleb hospital of Zahedan for pregnancy termination during 2017-2018 were investigated. were studied. After evaluating demographic characteristics, including age, education, and occupation, causes, and complications of emergency hysterectomy were investigated. Finally, data were analyzed by SPSS software. Results: Out of 2438 cases, 50 cases of hysterectomy were investigated. The mean age of mothers and the average number of pregnancies was 31.06±5.21 and 5.72±2.31, respectively. In this study, 35 caesarean sections (70%) and 15 normal vaginal delivery (30%) were recorded, with only 2% leading to emergency hysterectomy. The most common causes of emergency hysterectomy included placenta accreta (28%), uterine atony (24%), and uterine rupture (20%). The complications also included fever (24%), coagulopathy (14%), and wound infection (12%). Conclusion: Placenta accreta and uterine atony are the most important causes of hysterectomy. The most common complications of emergency hysterectomy are fever, coagulopathy, and wound infections. A decrease in elective caesarean delivery and further encouraging to natural vaginal delivery could significantly reduce the incidence of peripartum hysterectomy and maternal mortality

Humans , Female , Pregnancy , Placenta Accreta/surgery , Uterine Rupture/surgery , Cesarean Section , Epidemiology, Descriptive , Cross-Sectional Studies , Parturition , Postpartum Hemorrhage/prevention & control , Hysterectomy/mortality
Rev. cuba. anestesiol. reanim ; 20(2): e734, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1289352


Introducción: El perioperatorio en la cirugía electiva evoluciona para reducir el estrés inmunológico y metabólico causado por el trauma quirúrgico y lograr una recuperación temprana. Las enfermedades ginecológicas constituyen un problema de salud mundial, en la que la rehabilitación y reincorporación precoz a la cotidianeidad es fundamental en la disminución de la morbilidad. No existen guías y manuales en Cuba que brinden pautas metodológicas para la implementación de estos protocolos. Objetivo: Determinar la efectividad de la implementación de los protocolos de recuperación acelerada en pacientes sometidas a histerectomía abdominal. Métodos: Se realizó un estudio observacional analítico de casos-control, en pacientes sometidas a histerectomía abdominal en el Hospital General Docente Julio M. Aristegui Villamil en el año 2017. Se utilizaron las variables: grupos etáreos, tiempo de apertura de la vía oral, tiempo de inicio de la deambulación, tiempo de aparición del dolor, variación de la glicemia, presencia de náuseas, vómitos y complicaciones, estadía hospitalaria. Resultados: Predominó la edad entre 41 y 60 años en ambos grupos. En el grupo casos prevaleció la apertura de la vía oral en las primeras 4 h y la deambulación precoz según el esquema en las primeras 3 h. Se reportó mayor incidencia de dolor en el grupo control al igual que la variación de la glicemia, también reportándose náuseas, vómitos y complicaciones como fiebre e íleo paralítico. Se logró una estadía hospitalaria promedio de 24 h en el grupo de casos mientras que en el tradicional fue superior. Conclusiones: El protocolo de trabajo diseñado contribuyó a la recuperación precoz(AU)

Introduction: The perioperative period in elective surgery evolves up to reducing immune and metabolic stress caused by surgical trauma and achieving early recovery. Gynecological diseases are a global health concern in which rehabilitation and early return to daily life is essential in reducing morbidity. There are no guides and manuals in Cuba that provide methodological guidelines for the implementation of these protocols. Objective: To determine the effectiveness of implementing accelerated recovery protocols in patients undergoing abdominal hysterectomy. Methods: An analytical and observational case-control study was carried out in patients undergoing abdominal hysterectomy at Julio M. Aristegui Villamil General Teaching Hospital in 2017. The following variables were used: age groups, oral intake time, ambulation onset time, pain onset time, glycemic variation, presence of nausea, vomiting and complications, hospital stay. Results: Age between 41 and 60 years predominated in both groups. In the case group, there was a prevalence of oral intake time at four hours and of early ambulation, according to the scheme, within the first three hours. A higher incidence of pain was reported in the control group, together with glycemic variability, apart from reports of nausea, vomiting and complications such as fever and paralytic ileus. An average hospital stay of 24 hours was achieved in the case group, while it was longer in the traditional group. Conclusions: The designed work protocol contributed to early recovery(AU)

Humans , Female , Hysterectomy
Rev. Assoc. Med. Bras. (1992) ; 67(7): 937-941, July 2021. graf
Article in English | LILACS | ID: biblio-1346954


SUMMARY OBJECTIVE: To analyze the public data of hysterectomies performed in the only health system in the city of São Paulo between 2008 and 2018. METHODS: The following public health system data were extracted and analyzed: age, technique, number of surgeries, mortality during hospitalization, length of stay in the establishment (days), and amounts paid by the public network. RESULTS: A total of 20,119 procedures were analyzed. The most prevalent procedure was total hysterectomy (43.2%), followed by vaginal hysterectomy (26.7%), subtotal hysterectomy (24.3%), and laparoscopic hysterectomy (5.8%). Early discharge (hospital stay of up to 1 day) was more prevalent in cases of vaginal hysterectomy (39%). We observed a marked downward trend in the number of total hysterectomies. Total hysterectomy was the most expensive procedure; no significant difference was noted in the cost of vaginal versus laparoscopic hysterectomy. We noticed a trend of rising costs over the years. The most frequent hospital admission code was that of leiomyoma of the uterus in cases of total, subtotal, and laparoscopic hysterectomy. CONCLUSION: Despite the decrease in the number of hysterectomies over the 11-year study period in São Paulo, it remains in high demand mainly for the treatment of uterine leiomyomatosis. Laparoscopic hysterectomy has been gaining ground and showed a slightly upward trend with a shorter hospital stay. Laparoscopic and vaginal hysterectomy required less financial support from the health system than open surgery.

Humans , Female , Public Health , Laparoscopy , Brazil/epidemiology , Retrospective Studies , Hysterectomy , Hysterectomy, Vaginal
Medicina (Ribeirão Preto) ; 54(1)jul, 2021. tab
Article in Portuguese | LILACS | ID: biblio-1354346


RESUMO: INTRODUÇÃO: A histerectomia é o segundo procedimento operatório mais frequente em mulheres na idade re-produtiva, sendo superada apenas pela cesariana. É um tratamento cirúrgico de remoção parcial ou total do útero, indicado para diversas doenças do arcabouço uterino. Trata-se de uma cirurgia irreversível, com alteração da inte-gridade corporal e com implicações na identidade sexual feminina. MATERIAL E MÉTODOS: A presente pesquisa se trata de um estudo descritivo, comparativo e transversal, realizado com base em dados secundários, coletados de laudos histológicos e prontuários médicos de mulheres submetidas à histerectomia total no Hospital Universitário Professor Alberto Antunes (HUPAA), Maceió-AL, na série histórica de 2009 a 2018, com o objetivo de descrever o per-fil clínico-epidemiológico das pacientes que passaram pela histerectomia, a fim de avaliar a tendência de indicações cirúrgicas adotadas. RESULTADOS: A faixa etária de 41-50 anos correspondeu a 43,8% das pacientes que passaram pela histerectomia. A leiomiomatose uterina, em conformidade com o que demonstra a literatura, representou 60,3% das indicações. Os sintomas relacionados a alterações menstruais foram os principais citados. A ultrassonografia pélvica, considerada padrão ouro para diagnóstico desses leiomiomas, foi o exame complementar mais utilizado. CONCLUSÃO: Os dados coletados, de maneira geral, entram em consonância com a literatura disponível. Contudo, ainda existem casos em que é preciso uma melhor investigação para a indicação correta da histerectomia. (AU)

ABSTRACT: INTRODUCTION: Hysterectomy is the second most common surgical procedure in women of reproductive age, surpassed only by cesarean section. It is a surgical treatment of partial or total removal of the uterus, indicated for several uterine framework diseases. It is an irreversible surgery, with changes in body integrity and implications for female sexual identity. MATERIAL AND METHODS: This research is a descriptive, comparative and cross-sectional study, based on secondary data, collected from histological reports and medical records of women undergoing total hysterectomy at the Hospital Universitário Professor Alberto Antunes (HUPAA), Maceió- AL, in the historical series from 2009 to 2018, to describe the clinical-epidemiological profile of patients who underwent a hysterectomy, to assess the trend of surgical indications adopted. RESULTS: The 41-50 year old age group corresponded to 43.8% of patients who underwent a hysterectomy. Uterine leiomyomatosis represented 60.3% of the indications. Symptoms related to menstrual changes were the main ones mentioned. A pelvic ultrasound, considered the gold standard for diagnosing these leiomyomas, was the most widely used complementary exam. CONCLUSION:The data collected, in general, are in line with the available literature. However, there are still cases in which a better investigation is needed for the correct indication of hysterectomy. (AU)

Humans , Male , Female , Adult , Middle Aged , Surgical Procedures, Operative , Health Profile , Epidemiology , Hospitals, University , Hysterectomy , Leiomyoma
Revagog (Impresa) ; 3(2): 62-63, Abr-Jun. 2021. graf.
Article in Spanish | LILACS, LIGCSA | ID: biblio-1344619


El hematometra es la retención de sangre en el útero y comúnmente se presenta en mujeres jóvenes con anomalías mullerianas pero puede aparecer también en mujeres postmenopausicas por causas secundarias como traumas, tumores, terapia de remplazo hormonal, estenosis cervical, entre otras. En esta presentación de caso interesante se describe una mujer postmenopáusica bajo terapia de remplazo hormonal. Dicha mujer inicia con hemorragia uterina anormal por lo que se le realiza ultrasonido evidenciando hematómetra y hematocervix. Como método diagnóstico y terapéutico de la hemorragia postmenopáusica se le realiza histerectomía abdominal en la cual la patología evidencia leiomiomatosis uterina con endometrio secretor

Hematometra is the retention of blood in the uterus and commonly occurs in young women with Mullerian abnormalities but can also appear in postmenopausal women due to secondary causes such as trauma, tumors, hormone replacement therapy, cervical stenosis, among others. In this presentation an interesting case is described a postmenopausal woman under hormone replacement therapy. She said woman began with abnormal uterine bleeding, so an ultrasound was performed showing hematometer and hematocervix. As a method diagnosis and treatment of postmenopausal hemorrhage, abdominal hysterectomy is performed in which the pathology shows uterine leiomyomatosis with secretory endometrium

Humans , Female , Middle Aged , Uterine Hemorrhage/diagnostic imaging , Menopause/drug effects , Misoprostol/pharmacology , Hormone Replacement Therapy/adverse effects , Hematometra/diagnosis , Leiomyomatosis/complications , Leiomyomatosis/drug therapy , Hysterectomy/methods
Rev. bras. ginecol. obstet ; 43(4): 311-316, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280049


Abstract A cesarean scar pregnancy (CSP) is a scary and life-threatening complication of cesarean section (CS). Nevertheless, the incidence of CS is constantly growing. The CSP incidence is 0,15% of pregnancies after CS which represents 6,1% of all ectopic pregnancies in women with condition after CS. Therefore, it should be more present in the clinical daily routine. From mild nonspecific symptoms to hypovolemic shock, diagnosis and therapy must be performed quickly. With the progressive growth of the scar pregnancy, a uterine rupture involves the risk of severe bleeding, and an emergency hysterectomy could be necessary. Prolongation of pregnancy has been successful only in a few cases.We report 11 cases from our hospital in the past 10 years. In the discussion, treatment options of this complication with an increasing incidence, which is associated with serious morbidity and mortality, are presented based on the current literature. Treatment options include drug therapy, but also surgical or combined procedures with radiological intervention.

Humans , Female , Pregnancy , Adult , Young Adult , Pregnancy, Ectopic/diagnosis , Pregnancy, Ectopic/therapy , Cesarean Section/adverse effects , Cicatrix/complications , Uterine Hemorrhage/etiology , Uterine Rupture/etiology , Abortifacient Agents, Nonsteroidal/therapeutic use , Methotrexate/therapeutic use , Risk Factors , Pregnancy, High-Risk , Dilatation and Curettage , Hysterectomy
Rev. bras. ginecol. obstet ; 43(4): 329-333, Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1280035


Abstract Introduction Malignant mesonephric tumors are uncommon in the female genital tract, and they are usually located where embryonic remnants of Wolffian ducts are detected, such as the uterine cervix. The information about these tumors, their treatment protocol, and prognosis are scarce. Case report A 60-year-old woman with postmenopausal vaginal bleeding was initially diagnosed with endometrial carcinoma. After suspicion co-testing, the patient underwent a loop electrosurgical excision of the cervix and was eventually diagnosed with mesonephric adenocarcinoma. She was subjected to a radical hysterectomy, which revealed International Federation of Gynecology and Obstetrics (FIGO) IB1 stage, and adjuvant radiotherapy. The follow-up showed no evidence of recurrence after 60 months. Conclusion We present the case of a woman with cervical mesonephric adenocarcinoma. When compared with the literature, this case had the longest clinical follow-up without evidence of recurrence, which reinforces the concept that these tumors are associated with a favorable prognosis if managed according to the guidelines defined for the treatment of patients with cervical adenocarcinomas. Though a rare entity, it should be kept in mind as a differential diagnosis for other cervical cancers.

Humans , Female , Uterine Cervical Neoplasms/diagnosis , Mesonephroma/diagnosis , Uterine Cervical Neoplasms/surgery , Uterine Cervical Neoplasms/embryology , Uterine Cervical Neoplasms/pathology , Radiotherapy, Adjuvant , Diagnosis, Differential , Hysterectomy , Mesonephroma/surgery , Mesonephroma/embryology , Mesonephroma/pathology , Middle Aged , Neoplasm Invasiveness