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2.
Ann R Coll Surg Engl ; 103(5): e151-e155, 2021 May.
Article in English | MEDLINE | ID: mdl-33930284

ABSTRACT

The diagnosis of visceral perforation during pregnancy is often delayed and the management complex. A 32-year-old primigravid woman in her second trimester presented with abdominal pain and a pre-existing ileoanal pouch. Initial imaging was negative but later imaging was suggestive of serious pathology. At laparotomy, a caesarean section was performed. Peritonitis was encountered secondary to two discrete perforations in the small bowel separate from her pouch. Histology found an ischaemic perforation secondary to a pressure effect from the gravid uterus. In pregnancy, ileoanal pouches may make the interconnected bowel vulnerable to the pressure effect of the gravid uterus and perforation. Pregnant women with such a surgical history who develop symptoms suggestive of bowel perforation should have rapid imaging and their clinical team should consider early definitive surgical intervention.


Subject(s)
Colonic Pouches , Inflammatory Bowel Diseases/complications , Intestinal Perforation , Ischemia , Pregnancy Complications , Abdominal Pain , Adult , Cesarean Section , Female , Humans , Intestinal Perforation/diagnosis , Intestinal Perforation/surgery , Intestine, Small/surgery , Ischemia/diagnosis , Ischemia/surgery , Laparotomy , Peritonitis/diagnosis , Peritonitis/surgery , Pregnancy
3.
BJOG ; 128(4): 728-736, 2021 03.
Article in English | MEDLINE | ID: mdl-32725920

ABSTRACT

OBJECTIVE: To describe the current testing practice, referral pathways and gynaecological services available to women with Lynch syndrome (LS) in the UK. DESIGN: Cross-sectional nationwide survey of gynaecological oncologists and women with LS. SETTING: United Kingdom. METHODS: Gynaecological oncologists were contacted directly. Women with LS were identified from national and regional clinical databases and the patient support group, Lynch syndrome UK. MAIN OUTCOME MEASURES: Gynaecological oncologists were asked to report rates of LS testing and current practice regarding risk-reducing strategies and gynaecological surveillance for women with LS. Women with LS were asked to describe their experiences of gynaecological care. RESULTS: In total, 41 gynaecological oncologists and 298 women with LS responded to the survey. Of the gynaecological oncologists surveyed, 37% were unfamiliar with any clinical guidelines for the management of LS. Only 29% of gynaecological oncologists supported universal testing of endometrial cancer for LS; one centre routinely performed such testing. In all, 83% said they perform risk-reducing gynaecological surgery and 43% were aware of a local gynaecological surveillance service for women with LS. Of women with LS, most had undergone a hysterectomy (n = 191/64.1%), most frequently to reduce their gynaecological cancer risk (n = 86/45%). A total of 10% were initially referred for LS testing by their gynaecologist and 55% of those eligible regularly attended gynaecological surveillance; however, 62% wanted more regular surveillance. Regional variation was evident across all standards of care. CONCLUSIONS: There is widespread variation in the services offered to women with LS in the UK. As a community, gynaecological oncologists should move towards a nationally agreed provision of services. TWEETABLE ABSTRACT: A mismatch in care for mismatch repair. Survey finds significant variation in gynaecological care for #Lynchsyndrome in the UK.


Subject(s)
Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis , Colorectal Neoplasms, Hereditary Nonpolyposis/therapy , Gynecology/organization & administration , Health Services Accessibility/organization & administration , Practice Patterns, Physicians'/statistics & numerical data , Referral and Consultation/organization & administration , Women's Health Services/organization & administration , Adult , Aged , Cross-Sectional Studies , Female , Gynecology/statistics & numerical data , Health Care Surveys , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Humans , Middle Aged , Referral and Consultation/statistics & numerical data , State Medicine/organization & administration , State Medicine/statistics & numerical data , United Kingdom , Women's Health Services/statistics & numerical data
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