Renal Calyceal Rupture following Ureteral Injury after Total Laparoscopic Hysterectomy.

Ureteral injury (UI) complicates 0.1%-2.5% of total laparoscopic hysterectomies (TLHs). Renal calyceal rupture (RCR) is predominantly seen in patients with ureteral stones causing ureteral obstruction. Iatrogenic (surgical and nonsurgical) causes are responsible for only 3.5% of RCR. A 45-year-old gravida 4, para 2 female with a body mass index of 20 and no previous abdominal surgeries underwent a TLH due to hypermenorrhea and secondary anemia in the presence of a myomatous uterus. Intraoperatively, pelvic endometriosis and an isthmic myoma, 4 cm in diameter, were documented. On the 2nd postoperative day, the patient reported right-sided loin pain. The computed tomography scan revealed a right-sided RCR with urine extravasation and a retroperitoneal and intra-abdominal urinoma. The patient was treated with a transitory nephrostomy for 6 months, and subsequently finally with ureteroneocystostomy (psoas hitch). This case extends the spectrum of iatrogenic RCR causes as well as UI manifestations after TLH.

Delivery through cervicovaginal fistula - literature review and case report.

Less than 10 deliveries via cervicovaginal fistula (CVF) with closed cervical os were reported so far. In the majority of cases, the patients had a history of induced abortions. The CVF was usually recognized due to postpartum hemorrhage. The facilitating role of prostaglandins used for labor induction was supposed. In all cases, the babies remained unaffected by the delivery route. We report a new case of a 37-year-old gravida 2, para 0, with a history of a paracervical tear following a first trimester abortion 11 years ago. The abortion and the laceration were not reported in the current obstetrical documentation. After labor induction using oral misoprostol in the 41 + 5 weeks of pregnancy, the patient delivered a healthy baby through a left-sided CVF, which imposed as bleeding paracervical laceration, 6 cm in diameter, extending to the vaginal fornix in the 3 o'clock position. The cervical os was only 1-1.5 cm dilated and imposed as an inelastic band ("squid ring") in the 9 o'clock position. The laceration was sutured under spinal anesthesia. The patient recovered quickly, and the postpartum hemoglobin drop was 2.8 g/dl. In conclusion, the possibility of CVF should be considered in women with a history of induced abortion.

Uterine rupture after balloon inflation of the intrauterine Foley catheter during laparoscopic chromopertubation.

Laparoscopic chromopertubation is considered "gold standard" for checking the tubal patency. Foley catheter is frequently used for blue dye during chromopertubation. Complications associated with the intra-uterine use of Foley catheter are infrequent. The mean normal capacity of the uterine cavity is about 9 ml, and an inflation of up to 30 ml (e. g. during thermal balloon ablation procedures) is considered safe. We report a uterine rupture in a 36-year-old woman undergoing laparoscopic chromopertubation due to primary infertility. Thirteen years ago, the patient had three consecutive laparotomies because of appendicitis, peritonitis and retroperitoneal abscess. For the present laparoscopy, the Foley catheter (Nelaton, charier 10, balloon 5 ml) was used. The first blocking of the balloon with 3.5 ml saline was insufficient; however after inflating with 5 ml, a rupture of the uterine fundus occurred. The balloon remained intact and both tubes appeared patent. The myometrium was sutured and the postoperative course was uneventful. We presume that-in the present case-the expansive capacity of the uterine wall may have been reduced after the series of severe pelvic inflammations. Nevertheless, if using a Foley catheter for the chromopertubation, the optimal pressure for its intrauterine fixation needs still to be determined.