Femoral hernia containing the right fallopian tube: a rare finding / Hérnia femoral contendo a trompa de falópio direita: um achado raro

Abstract Femoral hernias comprise a small proportion of all groin hernias. They are more common in women and have a high rate of incarceration and strangulation, leading to emergency repair. A 61-year-old female patient was admitted to the emergency department complaining of a 2-day painful lump in the right groin, that had become more intense in the last 24 hours. Physical examination suggested the presence of a strangulated femoral hernia, and the patient underwent emergency surgical repair. Intraoperatively, the right fallopian tube was observed in the hernia sac. Since there were no signs of ischemia, the tube was reduced back into the pelvic cavity and the hernia was repaired. The postoperative period was uneventful, and the patient was discharged without complications, 3 days after surgery.

Resumo As hérnias femorais representamuma pequena fração de todas as hérnia da região inguinal. Elas são mais comuns entre as mulheres e estão associadas a elevadas taxas de complicações, como encarceramento e estrangulamento, com necessidade de cirurgia urgente. Uma paciente do sexo feminino, de 61 anos, recorreu ao serviço de emergência por quadro de dor e tumefação da região inguinal direita com 2 dias de evolução e agravamento nas últimas 24 horas. O exame objetivo sugeria a presença de uma hérnia femoral encarcerada, e a paciente foi submetida a cirurgia urgente. Intraoperatoriamente, confirmou-se o diagnóstico de hérnia femoral encarcerada, que continha a trompa de falópio direita no interior do saco herniário. Uma vez que a que a trompa não apresentava sinais de isquemia, o conteúdo da hérnia foi reduzido, e procedeu-se à sua reparação. O período pós-operatório decorreu sem intercorrências, e a paciente teve alta no 3° dia após a cirurgia.

Analysis of Fallopian Tubes seen in the Lagos State University Teaching Hospital; Ikeja; Lagos; Nigeria:- An Histopathological Survey

OBJECTIVE: The aim of this study is to appraise the major diseases of the fallopian tubes and causes of damage in this environment. MATERIALS AND METHODS: A retrospective study of a 4-year review of consecutive fallopian tube specimens received at the Department of Morbid Anatomy of the Lagos State University Teaching Hospital (LASUTH); Ikeja; Lagos; conducted between 1st of May; 2001 and 31st July; 2005. RESULTS: Over the study period; a total of 237 fallopian tubes were studied. The ages of the patients range from 18 to 54 years with the peak incidence in the 21 to 30 years with the median age of 26. 85(46.4) of the specimens received from 183 patients had ages indicated. Ectopic pregnancy is the commonest indication for sending fallopian tubes to the laboratory for investigation in 63.9 of cases. No case of cancer of the fallopian tubes or tuberculous salpingitis was seen in this study. CONCLUSION: Tubal pregnancy is the commonest indication for sending fallopian tubes to the laboratories for analysis in 63.9 of cases. Malignant tumours of the fallopian tubes and tuberculous salpingitis are rare in this environment

Tubal patency following surgical and clinical treatment of ectopic pregnancy

CONTEXT AND OBJECTIVE: As there is little information about fertility outcomes among women following clinical treatment (methotrexate and expectant management) and surgery (salpingectomy) consequent to ectopic pregnancy, we evaluate the results from hysterosalpingography subsequent to treatment. The objective was to evaluate contralateral tubal patency using hysterosalpingography following surgery and clinical treatment of tubal pregnancy. DESIGN AND SETTING: This was a prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center. METHOD: Among 115 patients who underwent hysterosalpingography following surgery and clinical treatment of tubal pregnancy between April 1994 and February 2002, 30 were treated with a single intramuscular dose of methotrexate (50 mg/m²), 50 were followed up expectantly and 35 underwent salpingectomy. RESULTS: The patency of the ipsilateral tube was 84 percent after methotrexate treatment and 78 percent after expectant management. In addition, contralateral tubal patency was 97 percent after methotrexate treatment, 92 percent after expectant management and 83 percent after salpingectomy. There were no statistically significant differences between the clinical treatment and surgery groups. CONCLUSIONS: The findings from this study suggest similar contralateral tubal patency rates following salpingectomy, methotrexate treatment and expectant management.

CONTEXTO E OBJETIVO: Como existem poucas informações a respeito do futuro reprodutivo das pacientes tratadas de gravidez ectópica através do tratamento clínico (metotrexato e conduta expectante) e da cirurgia (salpingectomia), avaliamos as histerossalpingografias após o tratamento da gravidez ectópica. O objetivo foi avaliar a permeabilidade da tuba contralateral pela histerossalpingografia após o tratamento cirúrgico e clínico da gravidez tubária. TIPO DE ESTUDO E LOCAL: Estudo prospectivo realizado no Departamento de Obstetrícia da Universidade Federal de São Paulo (centro terciário). MÉTODOS: Foram realizadas 115 histerossalpingografias após o tratamento clínico e cirúrgico da gravidez tubária no período de 1994 a 2002, sendo que 30 após o tratamento com dose única de metotrexato (50 mg/m²) intramuscular, 50 após a conduta expectante e 35 após a salpingectomia. RESULTADOS: A permeabilidade tubária ipsilateral foi de 84 por cento após o tratamento com metotrexato e de 78 por cento após a conduta expectante. A permeabilidade da tuba contralateral foi de 97 por cento após o tratamento com metotrexato, 92 por cento após a conduta expectante e 83 por cento após a salpingectomia. Não houve diferença estatisticamente significante entre os grupos de tratamento cirúrgico e clínico. CONCLUSÃO: Os dados deste estudo sugerem que a permeabilidade tubária contralateral é similar após a salpingectomia, o tratamento com metotrexato e a conduta expectante.

Hysterosalpingographic accuracy of peritubal adhesion.

The purpose of this study was to determine diagnostic accuracy of hysterosalpingography by using different diagnostic criteria in peritubal adhesion diagnosis. The authors retrospectively reviewed cases in which both hysterosalpingography and laparoscopy were performed. Fifty-nine of 84 cases had laparoscopy proved peritubal adhesion. Five hysterosalpingographic signs (convoluted tube, vertical tube, ampullary dilatation, peritubal halo and loculation of the spillage of contrast material) defined by Karasick and Goldfarb were used to diagnose peritubal adhesion. All cases were analyzed by two different diagnostic criteria: first diagnostic criterion, presence of one or more signs means abnormal; second diagnostic criterion, presence of two or more signs means abnormal. Peritubal adhesion was diagnosed in 70 of 84 cases by using the first diagnostic criterion, 53 of 84 cases by using the second diagnostic criterion. The first diagnostic criterion displayed 94.9 per cent sensitivity, 44 per cent specificity, 80 per cent positive predictive value, 79.76 per cent accuracy and the likelihood ratio of 1.69. The second diagnostic criterion showed 74.6 per cent sensitivity, 64 per cent specificity, 83 per cent positive predictive value, 71.43 per cent accuracy and the likelihood ratio of 2.07. The authors conclude that using the 2nd diagnostic criterion is more appropriate than using the 1st diagnostic criterion in diagnosing peritubal adhesion.

Histeroscopía y laparoscopía: una alternativa para el tratamiento de la infertilidad por bloqueo tubario proximal / Hysterectomy and laparoscopy: an alternative for the infertility treatment by proximal tubal blockage

Nueve mujeres infértiles, con bloqueo tubario proximal, se estudiaron con histeroscopia y laparoscopia simultánea. La edad promedio fue 32,5 años (28-36). Se encontraron antecedentes de infertilidad secundaria (9), proceso inflamatorio pelviano (4) y uso de DIU (3). Por vía histeroscópica se introdujo un catéter en la porción intramural de las trompas. En seis casos (66,6 por ciento) la laparoscopia simultánea mostró el paso de azul de metileno. En cuatro (44,4 por ciento), la permeabilidad tubaria estaba presente en la histerosalpingografia de control realizada entre 1-4 meses después. La técnca descrita, tiene la ventaja de permitir la evaluación y tratamiento quirúrgico de los genitales internos, al momento de tratar el bloqueo tubario, lo que no se logra con métodos radiológicos o ultrasonográficos

Infertility due to tubal obstruction with special reference to chlamydial and gonococcal infections

This study was conducted on 334 infertile women attending the out patient clinic of Kasr El-Aini Maternity Hospital. Out of them, 150 women with tubal cause of infertility were selected for laboratory investigations. Another 50 women attending the out patient clinic for contraception were taken as a control group. Serum and cervical mucus samples from both patients and control women were examined for the presence of antichlamydial IgG and IgA antibodies using the enzyme linked immunosorbant assay [ELISA] technique. Also, cervical mucus specimens from both patients and control women and peritoneal fluid samples from patients were cultured for Neisseria gonorrhoeae on modified New York City [MNYC] medium and chocolate agar. The study revealed 4 fold increase in the incidence of antichlamydial antibodies in tubal infertility women than in control group. It was found that serum IgG and IgA antibodies to Chlamydia trachomatis were usually correlated to cervical mucus IgG and IgA respectively. Also, no significant statistical difference between the presence of serum IgG and cervical mucus IgA were found. Tubal obstruction due to tuberculous salpingitis represented 4% of the patients included in this study. Neisseria gonorrhoeae were isolated from cervical secretions of only one patient and one woman in the control group, and could not be isolated from all peritoneal fluid specimens

Mycoplasma hominis y ureaplasma urealyticum en embarazadas e infértiles: diferencias en patologías tubaria / Mycoplasma hominis and ureaplasma urealyticum in pregnant and infertile women: differences in tube pathology

Estudiamos la frecuencia de gérmenes cérvico-vaginales en 47 pacientes embarazadas (entre 16 a 41 semanas de gestación), en 47 pacientes infértiles y en 4 pacientes ginecológicas. Al comparar la frecuencia de presentación de todos los gérmenes estudiados entre las embarazadas y las mujeres infértiles, la mayor diferencia se encontró para u. urealyticum. En efecto, la frecuencia de u. urealyticum fue de 61 por ciento en forma global, 72 por ciento en las embarazadas y 47 por ciento en las infértiles, a diferencia de lo que ocurrió con m. hominis que se presentó con una frecuencia de 18 por ciento para el total de las pacientes estudiadas, 13 por ciento en las embarazadas y 21 por ciento en las infértiles. La mayor frecuencia con que se presentó u. urealyticum en las embarazadas fue estadísticamente significativa y probablemente se deba a un efecto de los estrógenos que facilitan la proliferación de esta bacteria. Dentro del grupo de pacientes infértiles, las que tuvieron daño tubario, presentaron una frecuencia de gérmenes mayor que las sin daño tubario, a diferencia de las con daño tubario en que se presentó con una frecuencia de 25 por ciento