[ case of cutaneous endometriosis developed on abdominal scar]

Endometriosis is characterized by the presence of an ectopic endometrial tissue. It affects between 1% and 5% of women in reproductive age. Its main clinical symptoms are dysmenorrhoea and infertility. Among women having had abdominal surgery for any gynecological reason, the prevalence of endometriosis is between 15% and 50%. We report the case of a 15 year-old patient who underwent surgery twice: once for appendicitis two years before and once for acute salpingitis and tubo-ovarian abscesses one year before. Laparotomy was performed by Pfannenstiel incision. The post operative course was uneventful. The patient reported the gradual emergence of two bluish nodes on the abdominal scar. These nodules became painful and turgid during the menstrual period. She also reported the issue of blood from the abdominal scar during menstruation. The abdominal examination, performed during the menstrual period, showed a scar of good quality and two regular shiny and gluish cutaneous nodules measuring 1 cm in size. These elements were firm and painless. An endometriosis node on the scar of laparotomy was suspected. Surgery was performed in order to remove both nodules. At surgery the depth of nodules reached the top of the abdominal fascia of the major rights. The content of these nodules was chocolate brown. The histo-pathological examination confirmed that these nodules contained ectopic endometrial tissue. The etiopathogeny of endometriosis is still a subject of debate. This case illustrates the possibility of occurrence of endometriosis on abdominal scars after laparotomy: an unusual location

Imperforate hymen A13-cases series

Imperforate hymen is a rare congenital malformation. Patients often remain asymptomatic until puberty and present in early adolescence with cyclic abdominal pain. Early diagnosis and treatment must be performed in order to prevent morbidity. This study was to assess management of this disease. A retrospective study of 13 cases of impe rforate hymen diagnosed in the department of obstetrics and gynecology "A" of Charles Nicolle hospital of Tunis from January 1980 to December 2008. The clinical features and the management are discussed. The mean age was 14 years. All patients were single and had primary amenorrhea. They presented with pelvic pain in 9 cases and bladder urinary retention in 4 cases. Secondary sexual characters were present and normal in all cases. Inspection of the vulva could establish the diagnosis in all cases. Pelvic ultrasounds showed the hematocolpos in all cases. The latter was associated to a hematometria and a Douglas pouch liquid in 2 cases. Hematocolpos was evacuated by hymenectomy under oxytocin. Infusion in all cases. Eight patients were treated by cruciform incisions and five patients were treated by radial incisions of the hymen. The volume of hematocolpos varied from 250 ml to 2000 ml. One patient underwent surgery twice for restenosis of the imperforate hymen. Imperforate hymen is a rare anomaly. Its diagnosis is simple and could be established at birth by a systematic screening. More frequently, the diagnosis must be suspected in front of a primary amenorrhea associated to abdominal pain in order to prevent complications

Ovarian abscess as a complication of assisted reproduction techniques: a case report

AMP makes true great strides these last decades. Logically some complications were noticed even due to ovarian puncture such as hemorrhage, perforation or infection. The aim of this report is to try, through a review of literature, to draw the attention of physicians to a rare entity, ovarian abscess after follicle aspiration for in-vitro fertilization, and to means of prevention. We report a 38-year-old woman who was compolaining from lower abdominal pain located in the left iliac fossa one month after failed IVF trial. The pain was associated with fever and vomiting. The patient's past medical history involves 2 myomectomys [2003-2007]. On admission, her temperature was 38.9°C and her blood pressure was 90/60 mm Hg. Physical examination found nondistended abdomen. Tenderness to deep palpation in the left lower quadrant, without peritoneal signs, was detected. No masses were palpated. Mild tenderness in the left cul-de-sac was found. A full blood count showed a white cell count of 17,500 cells/mm3 with 84.5% polymorph nuclear cells, CRP 173 mg/dl. Pelvic ultrasound shows a left latero uterine mass; right ovary and the uterus are unremarkable; there was no free abdominal fluid. The laparotomy was performed 24 hours later and a left ovarian abscess was found. The treatment was conservative. Antibiotics were associated during 15 days. The clinical evolution was satisfying. The ovarian puncture might be technically difficult, incomplete, and even impossible which exposes to a greater infection risk. An ultrasound evaluation of ovarian accessibility is necessary before starting an IVF attempt, especially in case of overweight or history of abdominal or pelvic surgery, endometriosis tubal abnormalities or myomas. The treatment is based on surgery and antibiotics

[Diagnostic value of immunohistochemistry in ovarian sex cord-stromal tumors]

The ovarian tumors' diagnosis is bused on biological and radiologic tests but only the histological examination associated to an immunohistochemical study allow best diagnosis. The purposes of this study is to examine inhibin and other markers immunoreactivity to ovarian sex cord-stromal tumors and their histological mimics and to discuss its value in the differential diagnosis. We report a retrospective study of 31 cases of ovarian sex cord-stromal tumors and review the clinical, pathologic and immunohistochimical features of these tumors. The average age of our patients was 51.3 years with an average size of 8,4 cm. Immunostaining for inhibin was positive in 66% of granulosa cell tumor, in 50% of Sertoli-Leydig cell tumor and in 54% of thecoma-fibroma group. Inhibin immunoreactivity was more important than with cytokeratin and epithelial membrane antigen, but less marked than with CD99, vimentin, smooth muscle actin, desmin and 5-100 protein. The results of this study show that although it is not complete specificity, inhibin, contrarily to the other markers, can be used to help in the distinction between ovarian sex cord-stromal neoplasms and the other primary and metastatic tumors

[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

[Laparoscopic management of ovarian cysts in postmenopausal women]

To report our experience with laparoscopic treatment of ovarian cysts in postmenopausal women. During the period January 2000 to December 2006, 18 postmenopausal women were admitted for laparoscopy. The indications for the operation were an ovarian cyst that did not meet the criteria of a simple cyst, or was larger than 4 cm. The median age of the patients was 55 [range 43-82]. The mean time since menopause was 6 years [range: 1-30 years]. All laparoscopies were successfully accomplished. No case of malignancy was found. Histological examination revealed 15 serous cysts, one mucinous cyst, one endometroid cyst and one functional cyst. Neither intraoperative nor post-operative complications occurred. There was no surgery-related mortality. Mobilization of all women was carried out within 12 h of the operation. The mean hospitalization stay was 2 days. Laparoscopic management of carefully selected ovarian cysts is an appropriate alternative for exploratory laparotomy even in elderly patients with or without underlying diseases

Spontaneous ovarian hyper stimulation syndrome and deep vein thrombosis in a non pregnant woman: case report

To assess aetiological factors and complications in a patient with severe ovarian hyperstimulation syndrome [OHSS] and internal jugular vein thrombosis

Case: A 27-year-old non pregnant woman with bilateral ovarian masses who had underwent laparotomy for suspicion of malignant tumor. The pathological examination disclosed malignancy and the diagnosis of OHSS were confirmed. The postoperative evolution was complicated by internal jugular, subclavian vein thrombosis and pulmonary embolism. All biological parameters were negative. The evolution was good

Conclusion: The incidence of thromboembolism in women with OHSS is low and the typical finding is deep venous thrombosis in the neck area. Preventive measure of OHSS is very important, and the patients must be treated timely and correctly once OHSS occurs