[Epidemiological and therapeutic management of adnexal torsion in adolescent: retrospective study of 22 cases]

Adnexal torsion is a real surgical emergency. It may occur in girls and teenagers. It may involve the ovary, the fallopian tube or both. The main symptom is acute pelvic pain. Diagnosis is based on clinical examination and sonography. Prognosis depends on the rapidity of the surgical management. To analyse the clinical features and the management of adnexal torsion in teenagers. 22 observations of young patients, who underwent surgery for adnexal torsion in our department of obstetrics and gynaecology between January 2000 and December 2007, were retrospectively analysed. A review of literature is discussed. The mean age of the cohort was 16.3 years [range 13-19years]. Clinically, most children presented with a sudden onset of a low abdominal pain [19 cases], a low-grade fever [8 cases], nausea and vomiting [11 cases]. Ultrasound scans showed pelvic or pelvi-abdominal masses in all cases. Laparoscopy was realized in 54, 54 per cent of patients [12 cases]. Adnexal necrosis was occurred in 6 cases. Adnexal torsion was severe in 4 cases and slight in 12 cases. A Conservative treatment could be realized in 16 cases [72,72 per cent]. No major postoperative complication was noted. Histopathology concluded to benign tumour in 15 cases. Adnexal torsion is an uncommon cause of severe lower abdominal pain in young girls and teenagers. Accurate and early diagnosis is necessary after the onset of clinical symptoms in order to preserve the viability of the ovary. Ultrasound scans are useful in these situations. Surgical investigation either by laparotomy or by laparoscopy is necessary for the diagnosis and the treatment. A conservative treatment should be tried as possible in these young patients

[Medical interruption of pregnancy for severe Takayasu's disease, about two cases]

Takayasu's arteritis is a rare clinical entity characterized by a progressive obliteration of the aortic arch and the main vessels arising from it. The association with a pregnancy may lead to some maternal and fetal complications. Nevertheless, a normal outcome of pregnancy is not rare if a careful follow-up is provided. We report the observations of two patients who underwent a medical interruption of pregnancy in the department of obstetrics and gynecology "A" of Charles Nicolle hospital in Tunis because of a severe multi-visceral localization of Takayasu's arteritis. The aim of our study is to stress on the maternal and foetal prognostic factors of this association

[Isolated torsion of fallopian tube managed laparoscopically - a case report]

Isolated torsion of the fallopian tube is an uncommon event. Its incidence is estimated at 1 per 1 500 000 among women in genital activity. We report a case of isolated torsion of fallopian tube caused by a paraovarian cyst in a 24 years old patient presenting an acute pelvic pain, nausea and vomiting. The clinical examination revealed a mass of 7cm. Pelvic ultrasound showed an adnexal mass. The laparoscopy performed revealed a severe torsion of the left fallopian tube caused by a paraovarian cyst. Based on this experience as well as on other similar reported cases, characteristics of isolated torsion of the Fallopian tubes are discussed. This pathology should be considered in the differential diagnosis of acute pelvic pain in the female patient. Prompt surgical intervention may allow preservation of the tube

[Fetal intracranial haemorrhage and periventricular leukomalacia after second-trimester intrauterine fetal death in monochorionic twins]

Intrauterine fetal death of one twin in a monochorionic pregnancy may be associated with adverse neurologic sequelae in the surviving co-twin. The aim of this report is to try, through a review of literature, to predict the risk of cerebral impairment in the survivor co-twin and to assess the feasability of neurosonography and magnetic resonance imaging in the prenatal diagnosis of brain damage. We report a case of monochorionic twins complicated by a fetal death at approximately 23 weeks' gestation with pathologically confirmed leukomalacia in the surviving twin. A detailed sonographic evaluation of the intracranial anatomy of the surviving twin was performed. Fetal magnetic resonance imaging was offered as well. The patient opted for termination. Evacuation was performed at 24 weeks, and pathologic evaluation revealed severe cerebral infarction with haemorrhage. However difficult, a multidisciplinary prenatal counselling should be performed in order to study the prognosis and to try to prevent cerebral palsy in the surviving co-twin

[Medical treatment of ectopic pregnancy with methotrexate about 69 cases]

Analysis of medical treatment of ectopic pregnancy with methotrexate. Via a retrospective study we have considered a sample of 69 patients having ectopic pregnancy treated with methotrexate [1mg/Kg IM]. All patients were diagnosed at the Gynecology and Obstetrics Unit A at Charles Nicole Hospital, Tunisia. the average age is around 32.8 years [19-43 years]. We have noted amenorrhea in 76.81%of cases while pelvic pain and vaginal bleeding were observed respectively in 68.11%and 75 .36%of the cases. The ultrasound examination highlighted an adenexal mass in 95.65%of cases. The average size was around 20.66 +/- 7.3 mm. The average level of beta HCG was around 1067.97mtJlJml with extremes between 42 and 4163 mUI/ml. A second MTX injection was necessary for 24 patients, while a third one was compulsory only for one patient. A success rate of 58%was observed after a single dose of MTX. The same rate goes up to 88.4%with a second dose and to 89.85%with a third one. We have observed a failure in 7 cases through a symptomatic hemoperitoneum. We have conducted an operative laparoscopy in five cases out of seven and laparotomy for the two other patients. The medical treatment with MTX is considered to be a pillar in the management of ectopic pregnancy. The variety and heterogeneity of the research studies available has Led to the absence of consensus over the proposed treatment

[Recurrent omphalocele a case report]

Abdominal wall defects include a broad spectrum of structural malformations with variable severity and prognosis. The purpose of prenatal ultrasound examination is to correctly diagnose and classify these malformations according to their localization [paincularly their relation to the umbilical cord insertion], their contents, their size and associated malformations or karyotypic abnormalities. We report one case of recurrent omphalocele which happened three times in the same patient

[Laparoscopic management of ectopic pregnancy about 166 cases]

The ectopic pregnancy [EP] is a frequent and serious pathology. It represents a medical and surgical emergency. To study the epidemiologic profile and to evaluate the laparoscopic management of ectopic pregnancy by comparing our results with those of the literature. Retrospective study of 166 cases of ectopic pregnancies treated by laparoscopy in the department of obstetric and gynaecology of the Charles Nicolle Hospital, over one period of five years [January 2002-December 2006]. The mean age of the patients was 32.07 years [21-41]. The mean parity was 1, 42 [27.71%when nulliparous]. 9.03%of our patients had a history of ER Clinical symptomatology was dominated by the pelvic pains and the bleeding in 90%of the cases. The amenorrhoea missed in 32 patients. The rate of beta HCG was superior to 1500 at 47.61%of the patients. The pelvic ultrasonography carried out in all the patients, objectified a pelvic mass in 81.92%of the cases. Serology of chlamydiaewas positive at 9.03%of the patients. The laparoscopy was initially indicated in 155 patients; a medical treatment with methotrexate was begun in the six other patients. A laparoconversion was indicated in 16 cases, 9 times for operational difficulties and 7 times for a hemorrhagic complication. A salpingectomy was practised in 79.72%of the cases. The treatment was conservative in 20.27%of the cases. The laparoscopic treatment at best conservative should be the gold standard in the treatment of EP in order to preserve the fertility of the patients. who are generally young

[Endometrectomy. Analytical study of 20 cases]

Endometrial removal represents a therapeutic alternative to hysterectomy. Through a retrospective study of 20 cases of endometrial removal collected over a period of 4 years, the authors try to determine the indications of this therapeutic method, its efficiency, its advantages as well as its contra indications. Average age of the patients was 44 years. Average parity was 4. Functional menstrual disorders were found in 90% of cases. Gynaecological examination revealed a uterus of normal size in 85% of cases, and increased in size in 15% of cases. All the women had a preoperative diagnostic hysteroscopy. A simple endometrectomy was performed in 70% of the cases, an endometrectomy with a polypectomy in 25% of the cases and an endometrectomy with a myomectomy in 5% of the cases. The rate of success was 90%. We had a case of uterine perforation, because of uncontrollable bleeding a hysterectomy had to be carried out in 2 cases. Endometrectomy is an alternative to hysterectomy in cases of menorrhagia due to mild functional disorders resistant to medical treatment

[Pregnancy and fetal autcomes in macrosomic delivery about 400 cases]

Fetal macrosomy represents a materno-fetal high-risk pathology in front of which obstetricians face diagnostic, therapeutic and prognostic problems. We report a retrospective analytical study of 400 deliveries of macrosomes brought together in the gynaecology and obstetrics C departement of the maternity center of Tunis over a period of 4 years from 1997 till 2001. The aim of our study is to stress on the materno-fetal risk factors of macrosomy. The frequency the macrosomy was of 7, 11%. The average maternal age was of 30, 9 years. Pathologies associated with pregnancy were dominated by gestational diabetes in 19% of cases and by toxemia in 17% of cases. The antecedents of big baby were noted in 23% of cases. Screening of macrosomy was based on excessive uterine height [>35 cm] found in 43 % of cases and near term ultrasounds, which suspected macrosomy in 21, 8% of the cases. Delivery was made naturally in 68 % of the cases, with instrumental help in 5, 25% of cases and by cesarian section in 32% of cases. The mean weight of macrosomes was of 4233g. Maternal complications were dominated by delivery hemorrage in 2% of cases and obstetrical trauma in 2, 75% of the cases. Fetal complications were dominated by shoulder dystocia in 2, 25% of the cases, respiratory distress 2, 75% of cases and hypoglycemia in 2% of the cases