Tubocutaneous Fistula due to Endometriosis - A Differential Diagnosis in Cutaneous Fistulas with Cyclic Secretion / Fístula tubocutânea secundária à endometriose - diagnóstico diferenciado em fístulas cutâneas com secreção cíclica

ABSTRACT The development of a tubocutaneous fistula due to endometriosis in a post-cesarean section surgical scar is a rare complication that generates significant morbidity in the affected women. Surgery is the treatment of choice in these cases. Hormonal therapies may lead to an improvement in symptoms, but do not eradicate such lesions. In this report, we present a 34-year-old patient with a cutaneous fistula in the left iliac fossa with cyclic secretion. Anamnesis, a physical examination, and supplementary tests led us to suggest endometriosis as the main diagnosis, which was confirmed after surgical intervention.

RESUMO O desenvolvimento de fístula tubocutânea secundária à endometriose em cicatriz cirúrgica após cesariana é uma complicação rara, que gera importante morbidade às mulheres acometidas. A cirurgia é o tratamento de escolha nesses casos. Terapias hormonais podem conduzir a uma melhora dos sintomas, mas, de forma alguma, levam à erradicação de tais lesões. No presente relato, temos uma paciente de 34 anos de idade que apresentava uma fístula cutânea em fossa ilíaca esquerda com secreção cíclica. Anamnese, exame físico e exames complementares nos levaram a aventar como principal hipótese diagnóstica a endometriose, que foi confirmada após intervenção cirúrgica.

Absceso tubo ovárico en adolescente sin actividad sexual como primera presentación de una malformación mulleriana / A tubo-ovarian abscess in a virginal teenager female as first manifestation of a Mullerian anomaly: a case report

El absceso tubo ovárico (ATO) es considerado una complicación grave de un proceso inflamatorio pelviano, con predominio de microorganismos polimicrobianos en mujeres sexualmente activas. Este diagnóstico raramente es sospechado en mujeres púberes sin actividad sexual. Caso clínico: Adolescente de 11años sin actividad sexual con antecedente de seno urogenital operado. Consultó por un cuadro febril y dolor abdominal de difícil manejo que resultó ser un ATO en una malformación mulleriana no diagnosticada previamente. Conclusión: En todas las adolescentes sin actividad sexual con diagnóstico de ATO, debe sospecharse una malformación mulleriana en el diagnóstico diferencial...

Tubo-ovarian abscess (TAO) is considered a serious complication of a pelvic inflammatory disease. Usually present in sexually active women by polymicrobial microorganisms. This diagnosis is rarely suspected in pubertal virgin women. Case report: An 11 years old virginal female, who has surgery records of urogenital sinus repaired. Asked for a difficult management of a febrile abdominal pain, which results to be a TAO in a mullerian anomaly. Conclusion: In every virginal female adolescent with a TAO, should be consider a mullerian anomaly in the differential diagnosis...

El factor tubario en la era de la fertilización in vitro / Tubal factor infertility in the era of assisted reproduction

El desarrollo de las técnicas de fecundación asistida ha desplazado a la cirugía como procedimiento de elección en el tratamiento de la infertilidad tubaria secundaria a procesos inflamatorios pelvianos, ligadura tubaria y endometriosis. Sin embargo, la cirugía aún conserva un sitio reconocido, especialmente en casos de daño tubario leve o moderado o cuando existen limitaciones económicas y conflictos éticos o religiosos con las técnicas de fecundación asistida.

The development of Assisted Reproductive Technologies has displaced surgery as first-line treatment of tubal infertility secondary to pelvic inflammatory disease, tubal sterilization or endometriosis. However surgery might still have some place in minimal or moderate tubal damage and when financial, ethical or religious conflicts exist.

Epidemiología, resultados clínicos y costos del tratamiento del absceso tuboovárico, en un hospital público de Santiago / Epidemiology, clinical results and costs of treatment of the tuvoovarian abscess, in a public hospital in Santiago

Objetivos: Conocer frecuencia y factores de riesgo del absceso tuboovárico (ATO), complicaciones y costos del tratamiento. Método: Estudio retrospectivo de 64 pacientes operadas con el diagnóstico de ATO. Las pacientes se manejaron con criterio médico-quirúrgico: uso de antibióticos y cirugía en casos de peritonitis difusa, fiebre persistente con masa palpable y masa anexial mayor de 6 cm sin fiebre. Se evaluaron en fertilidad futura y en complicaciones: infección y dehiscencia de herida operatoria, reoperación por ATO residual, lesión intestinal, lesión vesical y complicaciones médicas. Resultados: El ATO representó el 73,6 por ciento de los casos hospitalizados por enfermedad inflamatoria pélvica, con frecuencia de 1,5 casos por mes y 17,2 por ciento de actinomicosis. La edad media de las pacientes fue 40,5 años. El dispositivo intrauterino (DIU) se asoció con ATO en 84,4 por ciento de los casos, 94,4 por ciento sin control y con media de uso de 10,2 años. El ATO unilateral fue el más frecuente (57,8 por ciento) y la anexectomía unilateral la operación más común. El 17,2 por ciento de las pacientes presentaron complicaciones y el 85,9 por ciento quedaron con infertilidad. El costo total de los 64 casos fue $86.331.713 (UF 3.788), con una media de $1.348.933 (UF 59,2). Conclusión: Existe un aumento de la frecuencia del ATO y de la actinomicosis pélvica, con incremento consiguiente de la infertilidad y de los costos, asociados al uso de DIU, sin control y por tiempo prolongado.

Objective: To determine frequency and risk factors of tuboovarian abscess (TOA) and observe complications, fertility damages and surgical costs of medical-surgical treatment. Method: Retrospective study in 64 patients operated with TOA diagnosis. Patients were managed with medical-surgical treatment: use of antibiotics and then surgery in cases of peritonitis diffuse, persistent fever with palpable mass and adnexial mass greater than 6 cm without fever. They were evaluated in future fertility and complications: infection and of surgical wound dehiscence, reoperation by residual TOA, intestinal injury, bladder injury and medical complications. Results: The TOA accounted for 73.6 percent of hospitalized cases of pelvic inflammatory disease (PID), 1.5 cases per month and 17.2 percent of actinomycosis. The mean age of patients was 40.5 years. The intrauterine device (IUD) was associated with TOA in 84.4 percent of cases, 94.4 percent uncontrolled and with a 10.2 years mean use. The unilateral TOA was the most frequent (57.8 percent) and the unilateral anexectomy the most common operation. The 17.2 percent of patients presented complications and 85.9 percent remained infertile. These results showed an increase compared with those obtained in the series published in 1993. The total cost of the 64 cases was $86.331.713 (UF 3.788), with a mean of $1.348.933 (UF 59.2). Conclusion: There is an increased frequency of the TOA and of pelvic actinomycosis, with consequent increase of infertility and costs associated with the uncontrolled and long-term use of IUD.

Manejo laparoscópico de dispositivo intrauterino migrado a trompa de falopio con hidrosalpinx secundario / Laparoscopic management of translocated intrauterine contraceptive device (IUD) inserted in the right uterine tube with secondary hydrosalpinx

Se presenta el caso clínico de un dispositivo intrauterino ubicado en el lumen de la trompa de Falopio con hidrosalpinx secundario, diagnosticado en forma incidental al realizar una radiografía de columna lumbar, estudio complementado con ecotomografia transvaginal. Se realizó laparoscopia diagnóstica y salpingectomía sin complicaciones.

We present a case of asymptomatic IUD inserted in the right uterine tube, with secondary hydrosalpinx. The IUD was found during a non-related X-ray examination of lumbar spine. She underwent laparoscopic surgery and removal of the uterine tube, without any further complication. We discuss the current treatment of intraabdominal lUDs.

Abscesso tubo-ovariano - revisão / Tubo-ovarian abscess - review

Pacientes com diagnóstico de doença inflamatória pélvica apresentam risco para desenvolver abscesso tubo-ovariano. Vários são os fatores que influem na sua epidemiologia, como o uso prolongado do dispositivo intra-uterino. O diagnóstico é baseado no quadro clínico e nas técnicas de imagem. O avanço na terapia antimicrobiana e no modo de abordar, com drenagem percutânea e transvaginal guiada por ultrasonografia, mudou o perfil terapêutico do abscesso tubo-ovariano. A presente revisão focaliza este novo perfil terapêutico, além da etiologia, epidemiologia e diagnóstico do abscesso tubo-ovariano

Evidence of chlamydial infection in infertile women with fallopian tube obstruction.

The study was carried out to find the prevalence of Chlamydia trachomatis seropositivity among women with infertility of tubal origin. Forty women with tubal infertility (verified at hysterosalpingography and laproscopy), 20 women with infertility due to variety of other reasons and 20 healthy fertile women of reproductive age were enrolled in the study. It was found that the presence of Chlamydia specific IgG antibody was significantly higher (70%) in women with infertility of tubal origin as compared to 35% seropositivity in healthy fertile women and 55% seropositivity in infertile women with cause of infertility other than tubal factor. Seventy eight percent of women with frequency of coitus 3-4 times/week were seropositive as compared to 34.7% when frequency of coitus was 1-2 times/week. Study also showed the silent nature of this infection as history suggestive of past pelvic inflammatory disease (PID) was lacking in majority of the seropositive women (63.75%). In the study group, both the ends of the fallopian tubes (cornual and distal block) were involved with almost equal frequency. Eighty three percent of women with seropositivity had unilateral or bilateral hydrosalpinx and 75% of women had marked pelvic adhesions. These results support the fact that there is strong association between serum anti-Chlamydial antibodies and tubal factor as a cause of infertility in infertile women.

Prevalence of chlamydial and gonococcal infections in infertile Egyptian women with tubal factor

This work was carried out to study the prevalence of chlamydial and gonococcal infections among 150 Egyptian infertile women having tubal factor as the only or the major contributing factor for infertility. Another 50 normal women were studied as a control group. Seropositive and cervical mucus positive antichlamydial IgG and IgA antibodies were found to be significantly higher in the study group when compared with corresponding ones in controls. The incidence of seropositive cases was higher among secondary infertile patients. The seropositivity was most prevalent in women aged 26 to 30 years in the study group. No significant difference was found between symptomatology of seropositive patients and control women. As regards the signs, it was found that 89% of patients having adnexal mass[es] were seropositive versus zero in controls at p <0.0001. 60.98% of patients having chronic cervicitis were seropositive compared with 5.56% in controls at p <0.0001. 72.41% of patients having purulent cervical discharge had antibodies versus 20% in controls, at p <0.02. Considering laparoscopic findings, it was found that 33.6% of patients with peritubal adhesions and all patients with frozen pelvis were seropositive. Antichlamydial antibodies were next prevalent in patients with hydrosalpinx [27%], cornual blook [26.7%] and then patients with terminal phimosis [18.5%]. Neisseria gonorrhea was isolated only from cervical secretions of patients in 0.67% of cases as gonococci are hard to find in this later stage. This study suggested that subclinical chlamydial salpingitis is an important cause of tubal infertility in Egyptian women. The presence of adnexal mass[es], chronic cervicitis or purulent cervical discharge may improve the ability to detect antichlamydial infections. A serological test for chlamydia trachomatis is recommended to be done as a routine part of infertility investigations

Role of Chlamydia trachomatis infections in infertility due to tubal factor.

The prevalence of IgG antibodies to C. trachomatis was determined in 185 infertile women who underwent laparoscopy, and 110 pregnant women with no known infertility problems. In addition, chlamydial antigens were evaluated by EIA in cervical samples taken from all subjects. Subjects with tubal infertility had the highest prevalence of chlamydial antigen and antibody (P less than 0.01). While the percentage of subjects with antigen and antibody positive was 11.6 per cent, those with antigen negative and antibody positive averaged 55.8 per cent among women with tubal related infertility. The results of our study provide additional support to the concept that infertility of tubal etiology often is a sequela of a previous chlamydial infection.