Acute abdomen due to ovarian congestion caused by coiling of the fallopian tube accompanied by paratubal cyst around the utero-ovarian ligament

Torsion of uterine adnexa is an important cause of acute abdominal pain in females. The main organ which can cause torsion is the ovaries, but torsions of the fallopian tube, subserosal myoma, paratubal cyst, and even the uterine body have been reported. The incidence of isolated fallopian tubal torsion is very rare. Even more rarely, it can coil around nearby organs such as the utero-ovarian ligament, showing similar clinical manifestations with those of adnexal torsion. We experienced an extremely rare case of acute abdomen induced by ovarian congestion triggered by the fallopian tube accompanying a paratubal cyst coiling around the utero-ovarian ligament. The right paratubal cyst was misinterpreted as being part of a cystic component of the left ovary on preoperative sonographic examination, and the coiling of the right fallopian tube accompanying the paratubal cyst was misdiagnosed as torsion of the right ovary. We report this rare case with a brief literature review.

Laparoscopic vaginal vault closure with conventional straight instruments in single-port access total laparoscopic hysterectomy

OBJECTIVE: Laparoscopic vaginal vault closure with conventional straight instruments is the final barrier to single-port access total laparoscopic hysterectomy (SPA-TLH). The aim of this study is to find out the safer, easier, simpler, faster, and even cheaper way to overcome it. METHODS: Vaginal vault suturing techniques of 152 consecutive single-port access total laparoscopic hysterectomy cases performed by the author in Gangnam CHA Hospital, CHA University from October 1, 2003 to June 30, 2012, were retrospectively analysed with medical records and DVDs. RESULTS: Of 152 patients who were attempted SPA-TLH, 119 patients (78%) were finished their operations without conversion to multi-port laparoscopy or laparotomy. Of women with successful SPA-TLH, 8 cases (7%) were closed their vaginal vaults vaginally (median, 20 minutes; range, 15-44 minutes), and 111 cases (93%) laparoscopically (median, 44 minutes; range, 13-56 minutes). Laparoscopic vault closure techniques were continuous suture (4 cases, 3%; median, 36 minutes; range, 30-45 minutes), interrupted sutures using knot-pusher (7 cases, 6%; median, 52 minutes; range, 48-56 minutes) Endo Stitch suture (2 cases, 2%; median, 32 minutes; range, 13-50 minutes), continuous vault closure using percutaneous sling sutures (PCSS) (92 cases, 77%; median, 40 minutes; range, 19-56 minutes), and continuous vault closure without PCSS (6 cases, 5%; median, 23 minutes; range, 16-31 minutes). CONCLUSION: Laparoscopic vault closure using PCSS in SPA-TLH only with conventional straight instruments is the best way to overcome the barrier and the short-cut to shorten the learning curve to date.

Vaginal vault evisceration after total laparoscopic hysterectomy / 대한산부인과내시경학회지

OBJECTIVE: Fourteen cases of vaginal vault evisceration after total laparoscopic hysterectomy were presented. We review pertinent literature, discuss precipitating causes, clinical manifestations, and management that was performed. METHODS: We reviewed medical records of 14 women with vaginal vault evisceration after total laparoscopic hysterectectom between March 2000 and October 2012 at 4 hospitals of CHA University. RESULTS: Between March 2000 and March 2006, 1,887 women underwent total laparoscopic hysterectomy and 12 vaginal vault eviscerations (0.6%) were presented. Thereafter, only two new cases were presented. The precipitating event was coitus in nine cases (64%), sit-ups in two cases (14%), spontaneous (urine ascites), lymphatic ascites, and unknown in one case (7%) each. Prolapsed organs were small bowels, omentum, and salpinx. Common presenting symptoms were pain, bleeding, watery discharge, and protruded mass (bowels). Eleven women underwent transvaginal repair (79%) - two laparotomic (14%) and one laparoscopic (7%), and none have exhibited sequelae. CONCLUSION: Coitus was the triggering event in most cases. For vaginal vault evisceration following total laparoscopic hysterectomy, vaginal repair should be first considered.