Port site metastases after laparoscopic lymph node staging of cervical carcinoma.

The literature revealed only six cases of cervical carcinoma metastatic to a port site after laparoscopic lymphadenectomy. A woman with a poorly differentiated squamous cell carcinoma of the cervix had port site metastases after laparoscopic lymph node staging. The frequency of this event might be higher than expected. Therefore, surgeons should reduce mechanical irritation of port sites and spillage of tumor cells.

[Non-closure of peritoneum at cesarean section. Results from repeat cesarean sections]. / Offenes Peritoneum bei Sectio caesarea: Ergebnisse der Re-Sectio.

OBJECTIVES: A number of publications advocate the short-term advantages of peritoneal nonclosure at cesarean section. However, currently there are no hard data available about long-term results and the repeat cesareans. MATERIAL AND METHODS: The study group of this retrospective analysis consisted of 30 women who underwent a repeat cesarean delivery, after a previous cesarean without closure of the visceral and parietal peritoneum. The control group (n = 31) had undergone peritoneal closure at the primary operation. All cesareans were performed at the same institution between 04/01/1997 and 12/31/1998 (first operation), and 01/01/1999 and 06/30/2000 (repeat operation). RESULTS: The mean operation time was 38.9 (+/- 11.6) minutes in the study group and 44.2 (+/- 13.6) minutes in controls (p = 0.05). The mean incision-delivery time was 6.7 (+/- 3.2) minutes in the study group and 9.1 (+/- 3.9) minutes in controls (p < 0.01). No difference in intraoperative blood loss was observed between the two groups. In each cohort one case with significant intraabdominal adhesions was observed. CONCLUSION: Our results indicate that nonclosure of the peritoneum at primary cesarean section does not promote intraabdominal adhesions. This appears to be beneficial for the repeat cesareans.

[Aneurysm of the splenic artery: rupture in pregnancy]. / Aneurysma der Arteria lienalis: Ruptur in der Schwangerschaft.

The rupture of a splenic artery aneurysm during pregnancy is a rare event. Two thirds of all ruptures happen during the third trimester. We report a case of a patient at 39 weeks of gestation suffering from abdominal pain and fetal distress. At cesarean delivery an aneurysm of the splenic artery was found to be the reason for the hematoperitoneum. Spleen, aneurysm and the tail of the pancreas were removed. The patient and her infant survived without further damage. Increased blood flow and changes in the vascular wall put pregnant women at risk for rupture of an aneurysm. In case of acute abdominal pain accompanied by progressive hypotension in a pregnant patient, a rupture of the splenic artery has to be considered. Active management and operation are the most important procedures for diagnosis and therapy of the bleeding. Abdominal delivery will help to establish diagnosis and should be performed immediately.