O papel da videolaparoscopia nas emergências ginecológicas e obstétricas / The role of videolaparoscopy in gynecological and obstetric emergencies

Introdução: A videolaparoscopia (VLP) tem sido cada vez mais empregada na prática clínica uma vez que auxilia, tanto no diagnóstico, quanto no manejo de diversas condições ginecológicas. Essa revisão tem como objetivo esclarecer a importância da VLP nas principais emergências ginecológicas. Métodos: Foi realizada uma revisão da literatura no mês de maio de 2018 nos bancos de dados Pubmed, Medline e Portal Periódico Capes. Foram incluídos no estudo os artigos que abordavam o uso de VLP no manejo de emergências e foram excluídos os relatos de caso. Resultados: A VLP é importante na medida em que permite a visualização direta das condições que constituem emergências ginecológicas, contribuindo dessa forma para o seu diagnóstico definitivo e precoce. A abordagem VLP frequentemente está relacionada a uma menor morbidade nesses casos. Na torção ovariana a VLP é útil tanto para identificar a viabilidade do ovário acometido quanto para desfazer a torção. No abscesso tubo ovariano, entretanto, estudos indicam que não há superioridade da técnica laparoscópica em relação à laparotomia no manejo cirúrgico desses pacientes. Na rotura de cisto ovariano, a VLP é o método preferencial nas patologias benignas, enquanto a laparotomia é o método de escolha na suspeita de lesões malignas. Na gestação ectópica, a VLP pode ser empregada nos casos de instabilidade hemodinâmica, gravidez tubária rota e quando há ascensão dos títulos de ß-hCG nas dosagens séricas associada à massa de 5 cm. Conclusão: A combinação entre o conhecimento adequado das patologias ginecológicas, a correta indicação do método VLP e a habilidade do cirurgião são fatores determinantes no sucesso terapêutico desse método.

Introduction: Video-laparoscopy (VLP) has been increasingly used in clinical practice since it assists in the diagnosis and management of various gynecological conditions. This review aims to clarify the importance of VLP in major gynecological emergencies. Methods: A literature review was performed in the month of May, 2018 in Pubmed, Medline and Capes Periodical Portal databases. The articles that addressed the use of VLP in emergency management were included in the study and the case reports were excluded. Results: VLP is important because it allows direct visualization of conditions that constitute gynecological emergencies, thus contributing to its definitive and early diagnosis. The VLP approach is often related to lower morbidity in these cases. In ovarian torsion the VLP is useful both to identify the viability of the affected ovary and to undo the torsion. In the ovarian tube abscess, however, studies indicate that there is no superiority of the laparoscopic technique in relation to laparotomy in the surgical management of these patients. In ruptured ovarian cyst, VLP is the preferred method in benign pathologies, while laparotomy is the method of choice in the suspicion of malignant lesions. In ectopic pregnancy, VLP may be used in cases of hemodynamic instability, tubal rupture, and when there is a rise in ß-hCG serum levelst associated with a 5 cm mass. Conclusion: The combination of adequate knowledge of the gynecological pathologies, the correct indication of VLP and the surgeon's ability are determining factors in the therapeutic success of this method. Keywords: videolaparoscopy,

Síndrome de Allen Master: causa excepcional de abdomen agudo en el embarazo / Allen Master syndrome: exceptional cause of acute abdomen in pregnancy

Se presenta un caso de abdomen agudo en una gestante de 20 semanas, por una torsión anexial. Ante la ausencia de signos ecográficos compatibles con patología en los primeros momentos y el empeoramiento clínico, se solicitó una RMN que permitió la aproximación diagnóstica y facilitó la indicación urgente de cirugía abdominal. En el curso de la laparotomía se diagnosticó una hernia interna del anexo, con marcado componente vascular a través de un defecto del ligamento ancho, que obligó a la anexectomía. Tras el diagnóstico y el tratamiento realizado, la gestación continúa con buenos resultados materno-fetal. Estos orificios han sido presentados excepcionalmente como causa de hernias internas digestivas, urológicas y anexiales, siendo controvertido su origen, congénito, inflamatorio o traumático. Se repasan las pruebas complementarias indicadas en el manejo diagnóstico del dolor abdominal en el embarazo, incluyendo las últimas recomendaciones de la European Society of Urogenital Radiology-ESUR.

A case of acute abdomen in a pregnant 20 weeks is presented with an adnexal torsion. In the absence of pathologic ultrasound signs with in the early stages and clinical worsening, was requested an MRI that allowed the diagnostic approach and the indication for urgent abdominal surgery. During laparotomy was observed an internal adnexal hernia through a defect in the broad ligament, with marked vascular component which forced the adnexectomy. After the diagnosis and treatment performed, the pregnancy continues with good maternal and fetal outcomes. These defects were presented exceptionally as a cause of digestive, urological and adnexal internal hernias. The origin remains controversial, congenital, inflammatory or traumatic. Complementary tests in the diagnostic management of abdominal pain in pregnancy are reviewed, including the latest recommendations of the European Society of Urogenital Radiology-ESUR.

Role of transabdominal sonography in diagnostic evaluation of pelvic masses

To find out the accuracy of ultrasound in differentiating different pelvic masses This descriptive study was conducted in the department of Obstetrics and Gynaecology unit A, Khyber Teaching Hospital Peshawar during the years 2001-2002. Total 69 cases with the clinical suspicion of pelvic masses were included in the study. All the patients were admitted and underwent detailed clinical examination and then Transabdominal Ultrasonography [US]. Final diagnosis was confirmed at operation findings. Out of 18 [26.1%] cases of fibroid uterus on US, 14 [77.8%] cases were confirmed on laprotomy. US showed 14 cases of simple ovarian tumours and 11 cases of malignant ovarian tumours while postoperatively 13 and 12 cases had simple and malignant ovarian tumours respectively. Out of 10 cases of chronic ectopic pregnancy on US, 7 cases were confirmed on laprotomy. Dermoid cysts, haemtocolpos and haematometra were correctly diagnosed in all case. Diagnosis was misleading in 8/69 [11.6%] cases. Out of 4 cases misdiagnosed as fibroid on US, 3 cases had endometriotic cysts and one case had fibroma ovary. Three patients labeled as chronic ectopic pregnancy on US had pelvic abscess, right broad ligament hemorrhagic cyst and right broad ligament fibroid [one case each]. One case of malignant ovarian tumour was misdiagnosed as simple ovarian tumour on US. Ultrasonography can be helpful in the diagnosis of various pelvic masses. It can help the surgeon to plan the technique of surgery and anticipate intraoperative complications

Transvaginal scan and transabdominal sonogram pre and postoperative comparison

Transvaginal [TV] scan replaced transabdominal [TA] sonography in evaluation and scanning of certain conditions. TV and TA sonography were compared in a prospective study. A total of 88 patients [66 pelvic and 22 pregnancy] examinations were performed by two techniques at time, patients ranging in age from 14 to 60 years. The improved anatomic detail on TV scans yielded new information in 60 patients and better visualization of pelvic structures in 50 patients. Sonoclinical diagnosis was altered on the basis of TV sonographic findings in 75. Statistically comparison of the two techniques indicated that TV scanning was significantly better than TA scanning in the visualization of gestational sac content, detection of fetal heart motion, detection of twin in early pregnancy and evaluation of the endometrial canal in the retroverted or retroflexed uterus. TV scanning was significantly better than TA scanning in folliculometry, detection of ovarian mass or cyst especially with patients having leiomyomas obscuring the ovaries. Also, useful in detection of uterine small fibroids and cervical tumors staging