Department of Urology, Shanghai JiaoTong University School of Medicine, Ruijin Hospital, Shanghai, China (all authors).

ABSTRACT

Introduction: The occurrence of pregnancy with Cushing syndrome (CS) is rare but with high risks, posing a great challenge to the clinical diagnosis and treatment of the disease.

Case Description: From Aug 2016 to Aug 2019, we admitted two pregnant women with CS caused by adrenal tumors. After multidisciplinary consultation, they underwent emergency Cesarean section because of heart failure and severe hypoxemia, and finally delivered a living baby after adjuvant therapy. Both patients underwent retroperitoneal laparoscopic adrenectomy (RLA) 2.6 and 1.5 months postpartum to have the adrenal tumors removed successfully. The post- operative pathology confirmed the adrenal tumor as adrenocortical adenoma. Partial hormone replacement therapy was initiated postoperatively and withdrawn uneventfully 1 year after RLA in both patients, and both patients have recovered well.

Conclusion: It is difficult to find CS in early pregnancy, and when it is detected in late pregnancy, it often poses a great risk because it is necessary to consider the safety of both mother and fetus, which requires multidisciplinary coordination and cooperation to positively adjust the cardiopulmonary function and internal environment after Cesarean section, knowing that timely RLA to remove the adrenocortical adenoma can effectively cure CS.

Key Words: Pregnancy, Cushing syndrome, Adrenal tumor, Heart failure, Hypertension.

The post Diagnosis and Treatment of High-risk Pregnant Women With Cushing Syndrome Caused by Adrenal Tumor first appeared on JSLS.

Department of Biliary Surgery, Shengjing Hospital of China Medical University, Shenyang City, People’s Republic of China (both authors).

ABSTRACT

Introduction: Symptomatic Meckel’s diverticulum during pregnancy and inverted Meckel’s (“ windsock ”) divertic- ulum are rare occurrences. Preoperative diagnosis is difficult, and inverted diverticulum can be misdiagnosed as lipoma.

Case Description: We report a case of Meckel’s diverticulum during pregnancy, causing a hernia of the small intestine, and a case of inverted Meckel’s diverticulum causing an ileocolic intussusception.

Discussion: When dealing with small-bowel obstruction of unknown origin, Meckel’s diverticulum is a cause that is easy to miss. Early laparoscopic exploration helps as an auxiliary diagnostic tool and can avoid small-bowl necrosis or intestinal perforation caused by long-standing small bowel obstruction.

Key Words: Bowel malformation, Laparoscopic surgery, Meckel’s diverticulum, Pregnancy.

The post Rare Cases of Two Types of Meckel’s Diverticulum first appeared on JSLS.

Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, Florida (both authors).

ABSTRACT

Introduction: An ovarian artery pseudoaneurysm is a rare disorder of pregnancy.

Case Description: We present a case of an unruptured ovarian artery pseudoaneurysm during the first trimester, managed laparoscopically. The patient had undergone a previous right salpingo-oophorectomy and presented several weeks later with severe right adnexal pain. Doppler sonography and magnetic resonance arteriography revealed a right ovarian artery pseudoaneurysm. The patient declined selective embolization. Laparoscopic ligation of the pseudoaneurysm resulted in resolution of her symptoms. A complete description of the case, radiologic imaging, and a review of the literature are provided.

Discussion: Laparoscopy is an option for treating unruptured pelvic pseudoaneurysms during early pregnancy.

Key Words: Aneurysm, Laparoscopy, Ovarian artery, Pregnancy, Pseudoaneurysm

[gview file=”https://crsls.sls.org/wp-content/uploads/2015/09/jls103153512001.pdf”]

The post Laparoscopic Ligation of a First-Trimester Ovarian Artery Pseudoaneurysm first appeared on JSLS.

Department of Obstetrics and Gynaecology (Drs. L. Eghdami and M. A. Bedaiwy), Division of Reproductive Endocrinology and Infertility (Dr. M. A. Bedaiwy), University of British Columbia, Vancouver, BC, Canada; Department of Obstetrics and Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA (Drs. S. Elguero and B. Patel).

ABSTRACT

An interstitial pregnancy is an ectopic pregnancy that is implanted in the interstitial segment of the fallopian tube and embedded within the muscular layer of the uterus. Because of the rich vascular supply of this region, maintaining hemostasis during surgical management of interstitial pregnancies is a recognized challenge. Visualizing the entirety of the gestational sac beneath the uterine serosa can also present a challenge, especially in cases of uncomplicated interstitial ectopic pregnancies. Here we present a case in which intraoperative transvaginal ultrasound was used to assist with a laparoscopic cornual wedge resection in a 24-year-old woman with a confirmed interstitial pregnancy. The use of intraoperative transvaginal ultrasound during the laparoscopy helped accurately delineate the location and extent of invasion of the interstitial pregnancy. It guided the placement of the uterine incision and helped ensure that the entire gestational sac and products of conception had been removed. This case demonstrates that transvaginal ultrasound can be used as an intraoperative tool to enhance surgical safety and minimize patient risk.

Key Words: Ultrasonography, Pregnancy, Ectopic, Laparoscopy.

[gview file=”https://crsls.sls.org/wp-content/uploads/2015/04/jls101153381001.pdf”]

The post Use of Transvaginal Ultrasound in the Management of an Interstitial Pregnancy first appeared on JSLS.

Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan (all authors).

ABSTRACT

Ovarian cyst torsion is a well-known cause of acute abdominal pain in female patients. However, torsion of a normal ovary is extremely rare and predominantly occurs in premenarchal female patients. The objective of this report is to describe a rare case of acute abdomen during the early postpartum period that was ultimately diagnosed as torsion of a normal ovary by laparoscopic surgery. A 29-year-old woman vaginally delivered a healthy 3530-g baby uneventfully at 40 weeks’ gestation. On postpartum day 6, she presented with acute abdominal pain in the right lower quadrant and costovertebral angle tenderness. A complete workup including laboratory examination, ultrasonography, and computed tomography was performed. Leukocytosis with a left shift and a slightly enlarged right ovary were found. Finally, diagnostic laparoscopy showed torsion of a normal ovary. The patient underwent laparoscopic detorsion of the right adnexa and was discharged on postoperative day 4 without any complications.

Key Words: Adnexal torsion, Acute abdomen, Laparoscopy, Postpartum, Pregnancy.

[gview file=”https://crsls.sls.org/wp-content/uploads/2015/03/jls101153275001.pdf”]

The post Torsion of a Normal Ovary During the Early Postpartum Period first appeared on JSLS.

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.

[gview file=”https://crsls.sls.org/wp-content/uploads/2015/03/jls101153064001.pdf”]

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

OB/GYN Hospitalist, Department of Obstetrics & Gynecology, Northwest Community Hospital, Arlington Heights, IL, USA (Dr. Markuly). Director, Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA and Director, AAGL/SRS Fellowship in Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, USA (Dr. Miller). Undergraduate, Northwestern University, Evanston, IL, USA (Szela).

ABSTRACT

Introduction: Uterine rupture is an acute obstetric emergency requiring a rapid response by a multidisciplinary team of physicians and allied health care professionals to minimize the risk of both maternal and neonatal morbidity and death. A risk factor is previous myomectomy. Robotic-assisted laparoscopic myomectomy is a technologically cutting-edge approach to a common surgical procedure, myomectomy. Pregnancy after robotic-assisted laparoscopic myomectomy has been reported in the literature.

Case Description: We report a case of spontaneous uterine rupture in a subsequent pregnancy after robotic-assisted laparoscopic myomectomy.

Discussion: With use of robotic assistance, the technique changes when compared with standard laparoscopic myomectomy. Areas of potential concern are the amount and type of energy required to excise the fibroid from the myometrial bed.

Key Words: Myomectomy, Uterine Rupture, Robotic Surgery, Laparoscopy, Spontaneous, Pregnancy.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/12/2014.00208.pdf”]

The post Uterine Rupture After Robotic-Assisted Laparoscopic Myomectomy 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.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/12/13-00099.pdf”]

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

Department of Surgery, Mexican Institute of Social Security. Delicias, Chihuahua, Mexico (Drs. Lopez, Rodriguez). Department of Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (Dr. Targarona). Department of Surgery, Mexican Institute of Social Security, Juarez, Chihuahua, Mexico (Drs. Corral , Padilla). Delegational Headquarters, Mexican Institute of Social Security, Col. Centro, Chihuahua, Mexico (Drs. Gameros, Reyes).

ABSTRACT

Introduction: The third trimester of pregnancy has long been considered a suboptimal time frame for undergoing biliary laparoscopic procedures, primarily because of maternal-fetal risks and technical issues. We present the case of a 34-year-old woman at 32 weeks’ gestation who underwent laparoscopic common bile duct (CBD) exploration and cholecystectomy to treat symptomatic cholelithiasis and giant choledocholithiasis.

Case Description: The patient was complaining of right upper quadrant pain, nausea, and vomiting. Physical examination revealed tenderness and Murphy’s sign. Liver function test results showed a pattern of obstructive jaundice, and biliary ultrasonography confirmed dilation of the CBD. Endoscopic retrograde cholangiopancreatography with sphincterotomy was unsuccessful at clearing the CBD because of the size of the stones, thus a decision was made to perform a laparoscopic CBD exploration with cholecystectomy. The patient’s postoperative course was uneventful, and she delivered a healthy girl at 37 weeks.

Conclusion: This report provides insight regarding the role that laparoscopy may play in the management of CBD stones in late pregnancy when other nonoperative alternatives have proven unsuccessful.

Key Words: Laparoscopic common bile duct exploration, Choledocholithiasis, Pregnancy, Third trimester.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/12/2014.00146.pdf”]

The post Laparoscopic Clearance of Giant Common Bile Duct Stones in Late Pregnancy first appeared on JSLS.

King Faisal Specialist Hospital and Research Center, Department of Obstetrics and Gynecology, Riyadh, Saudi Arabia (Drs Al-Badawi and Alshankiti). Florida Hospital Cancer Institute, Department of Gynecologic Oncology, Orlando, FL, USA (Dr Ahmad).

ABSTRACT

Laparoendoscopic single-site surgery, also known as single incision laparoscopic surgery (SILS), is advancing the minimally invasive surgical approach. Herein, we describe our experience with 2 cases using the SILS in pregnancy and discussing the relevant peer-reviewed English literature.

Case 1: A 42-year-old woman, who was pregnant at 17-weeks gestational age, presented with sudden onset right lower abdominal pain. Pelvic ultrasonogram characteristic revealed right large adnexal cyst measuring 12cm X 12 cm X 7 cm with torsion. Diagnosis of ovarian cyst with torsion was made, which indicated surgical intervention during pregnancy. SILS was performed using a single port through a 2-cm umbilical incision to the peritoneal cavity. Right ovarian cyst with torsion was identified. Untwisting of the torted pedicle and ovarian cystectomy was performed, the patient had a spontaneous vaginal delivery at 38 weeks.

Case 2: A 27-year-old woman, 12 weeks pregnant, presented through the emergency department with severe pain, and a pelvic ultrasonogram showed a 10-cm left adnexal mass with suspicion of torsion. Emergency diagnostic laparoscopy was performed using SILS with the finding of torted left ovarian cyst. Ovarian cystectomy and untwisting of the adnexa was performed, the patient had a preterm delivery of a stillborn at 20 weeks plus 4 days. We conclude with our successful experiences of SILS in pregnancy without any complications. This report is among the early experiences using SILS in pregnancy and is likely be the first from the Arab world (Middle East) experience. Further studies would be desirable to determine short-term and long-term outcomes.

Key Words: Case reports, Gynecologic surgery, Laparoscopy, Pregnancy, Single incision.

The post Single Incision Laparoscopic Surgery in Pregnancy first appeared on JSLS.