Department of Obstetrics and Gynecology, Duzce University School of Medicine, Duzce, Turkey (Drs Albayrak, Keskin). Department of Obstetrics and Gynecology, Abant Izzet Baysal University, Bolu, Turkey (Dr Karatas). Department of Obstetrics and Gynecology, Karacabey State Hospital, Karacabey, Bursa, Turkey (Dr Biyik).

ABSTRACT

Unexpected pregnancy with an intrauterine device (IUD) in situ is not an uncommon finding in daily practice. It is generally agreed that an IUD should be removed in the first trimester when its tail is visible vaginally. However, because of limited experience and data in the literature, uncertainty exists about the management and technique of IUD removal during pregnancy when the tails are inaccessible on examination, especially in the second trimester. The IUD may be left in situ or removed using a grasping tool under ultrasonographic guidance or by hysteroscopy. Here, we report a case of ultrasound-guided hysteroscopic removal of an IUD with retracted tail in a woman at 15 weeks’ gestation. We believe when the decision is made to remove an IUD, ultrasound-guided hysteroscopy may be a safer option in experienced hands compared with an ultrasound-guided grasping tool, especially during the second trimester.

Key Words: IUD, Hysteroscopy, Contraception, Endoscopy, Pregnancy.

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The post Ultrasound-Guided Hysteroscopic Removal of IUD with Missing Tails in a 15-Weeks’ Pregnant Woman first appeared on JSLS.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan (Drs. Wang, Chang, Yu). Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University of Medicine, Tao-Yuan, Taiwan (Dr. Wang). Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan (Dr. Wu). Department of Obstetrics and Gynecology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan (Dr. Horng). Tsai’s Women and Children Clinics, New Taipei, Taiwan (Dr. Tsai).

ABSTRACT

Introduction: We report a viable cesarean scar pregnancy with a coexistent intrauterine pregnancy, managed successfully with operative hysteroscopy and suction curettage.

Case Description: A 32-year-old woman, with previous cesarean delivery, presented with vaginal bleeding and was referred to our hospital at 9 weeks’ gestation for heterotopic pregnancy in a spontaneous cycle. An intrauterine pregnancy combined with a cesarean scar pregnancy was shown by ultrasonography. The patient underwent hysteroscopy-directed evacuation of the cesarean scar pregnancy and suction curettage with good hemostasis.

Discussion: Spontaneous heterotopic cesarean scar pregnancy is a rare but possible entity. The combination of hysteroscopy and suction curettage is an option for a minimally invasive procedure for heterotopic cesarean scar pregnancy.

Key Words: Cesarean scar, Heterotopic, Hysteroscopy, Pregnancy.

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The post Heterotopic Cesarean Scar Pregnancy in a Spontaneous Cycle first appeared on JSLS.

Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA (Dr. Pereira). Division of Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA (Drs. Grias, Della Badia).

ABSTRACT

Introduction: Perforation of the uterus or fallopian tube during microinsert placement, with subsequent migration of the microinsert into the abdominopelvic cavity, is a known complication.

Case Description: A 38-year-old woman underwent hysteroscopic tubal sterilization with Essure microinserts (Conceptus, Mountain View, California). She returned 4 months later for hysterosalpingography, during which only part of the right microinsert was identified in the right cornu of the uterus. The remaining part of the microinsert was suspected to be in the pelvic cavity. Laparoscopy showed one fragment of the right microinsert projecting from the right cornu; the remaining fragment was incorporated into the serosa of the distal ileum. After an intraoperative consultation with the colorectal surgery team, both fragments of the microinsert were left as is, and tubal fulguration for sterilization was performed.

Discussion: Although perforated microinserts can cause small-bowel obstruction or perforation, our case highlights the asymptomatic incorporation of a microinsert into the serosa of the distal ileum.

Key Words: Essure, Hysteroscopy, Complications, Small bowel, Migration.

The post Asymptomatic Serosalized Essure Microinsert in the Distal Ileum first appeared on JSLS.

Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil (all authors).

ABSTRACT

Hysteroscopic myomectomy is the surgical procedure of choice for the treatment of submucous or intramural myomas that protrude into the uterine cavity in patients with abnormal bleeding and/or infertility. It is a minimally invasive procedure associated with a low complication rate. Complications of hysteroscopy include uterine perforation, intraoperative and postoperative uterine bleeding, water intoxication, gas embolism, and injuries of the bladder, ureters, and major blood vessels, in addition to late complications, such as infections and synechiae. This case report describes iliac artery injury during hysteroscopic myomectomy. A review of the literature shows that this complication has not been recorded.

Key Words: Hysteroscopy, Myomectomy, Complications, Iliac artery injury

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The post Iliac Artery Lesion as a Severe Complication of Hysteroscopic Myomectomy first appeared on JSLS.