RESUMO
Detection of bilateral adrenal masses in any patient often presents a management dilemma. Despite extensive imaging, positron emission tomography (PET) scanning, and fine needle aspiration biopsy (FNAB), a definite diagnosis may not be reached. We report an unusual case of bilateral adrenal mass diagnosed as histoplasmosis postoperatively and managed successfully by laparoscopy. Focus is placed on the role of laparoscopic adrenalectomy (LA) as a diagnostic and therapeutic tool in such patients.
Assuntos
Doenças das Glândulas Suprarrenais/etiologia , Doenças das Glândulas Suprarrenais/patologia , Doenças das Glândulas Suprarrenais/cirurgia , Histoplasmose/diagnóstico , Doenças das Glândulas Suprarrenais/diagnóstico por imagem , Adrenalectomia , Antifúngicos/uso terapêutico , Fluordesoxiglucose F18 , Histoplasmose/tratamento farmacológico , Histoplasmose/patologia , Histoplasmose/cirurgia , Humanos , Itraconazol/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Prednisolona/uso terapêutico , Esporos Fúngicos/isolamento & purificação , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Iatrogenic ureteral injuries are among the most serious complications in gynecologic surgery. With the increasing popularity of laparoscopic gynecologic surgery, the incidence of ureteral injuries is on the rise. We report 2 cases of post laparoscopic-assisted vaginal hysterectomy (post LAVH) ureterovaginal fistulas, which were managed successfully with retrograde stenting using ureteroscopy. Three middle-aged women who underwent LAVH for symptomatic myomas of the uterus presented with ureterovaginal fistulas in the late postoperative period. Excretory urography revealed ureterovaginal fistulas involving the distal ureter. Retrograde stenting was possible in 2 patients, using a 7.5F rigid ureteroscope. Both patients became continent 2 days after surgery. Urography at 6 weeks revealed normal renal function without obstruction or extravasation of urine, and the stents were removed. Stenting failed in the third patient; the patient underwent a ureteric reimplantation successfully. Post LAVH ureterovaginal fistulas are amenable to ureteroscopic retrograde double-J stenting, which enables spontaneous recovery of the injured ureter. An attempt of ureteroscopic stenting should be considered in all patients with post LAVH ureterovaginal fistulas before subjecting them to other modalities.
