Isolated Fallopian Tube Torsion: A Rare Entity

Isolated fallopian tube torsion is an extremely rare occurrence in a young female. The lady concerned presented with acute abdominal pain and the ovaries were normal on the scan with dilated fallopian tubes. On laparoscopy, it was revealed that she was suffering from fallopian tube torsion and laparoscopic salpingectomy was performed. The patient recovered well postoperatively.

The Efficacy of Gasless Reduced-port Laparoscopic Surgery for Gynecological Diseases

Objective The purpose of this study was to examine the effectiveness of gasless reduced-port laparoscopic surgery (GRP-LS) using a 5 mm endoscopic port and one surgical port for the treatment of gynecological diseases Methods We compared GRP-LS and gasless 3-port laparoscopic surgery (G3P-LS), based on patient background, operative procedures, number of surgeries performed by the surgeon, length of surgery, blood loss, blood transfusion, conversion rate to open surgery, operative complications, and the number of surgeons involved in the procedure. We compared the two techniques in patients being treated for laparoscopic myomectomy (LM), laparoscopic ovarian cystectomy (LC), and laparoscopic salpingectomy (LT). Results GRP-LS was used in 2,338 cases and G3P-LS in 2,473 cases. GRP-LS was used in 980 LM cases (41.9%); 804 LC cases (34.4%); 240 LT cases (10.3%); 180 LA cases (7.7%); and 134 cases for other conditions (5.7%). GRP-LS was used by 78 surgeons; 85.9% of the surgeons had performed fewer than 50 GRP-LS surgeries in their careers; and those surgeons performed about half of all surgeries. The time required for GRP-LS was significantly less for LM, LC, LT, and the procedure also had less blood loss for LM and LC than G3P-LS. G3P-LS required a transition to open surgery in 0.69% of cases, whereas GRP-LS showed a very low rate of 0.09%. Conclusions GRP-LS is a new type of laparoscopic surgery that has overcome disadvantages of the previous lifting methods (G3P-LS) and is easier to learn, allowing inexperienced laparoscopic surgeons to effectively perform the surgery.

Tubal Stump Ectopic: A Case Report on Repeat Ipsilateral Tubal Ectopic Pregnancy

Background: Tubal Stump Ectopic is an infrequent event with critical obstetrical consequences. A case is illustrated from Northern Ireland in which an ectopic pregnancy was discovered in the tubal stump previously undergone salpingectomy. Case Facts: A 34-year-old woman (G2 E1) with a tubal stump ectopic of a previous cornual excision two years prior, presented to EPAU complaining of mild abdominal pain and 6 weeks amenorrhoea. She was clinically stable (β-hCG 1407 mIU/mL), while TVUS revealed no evidence of IUP or adnexal mass but fluid in the Pouch of Douglas. Laparoscopic salpingectomy was performed after a diagnosis of tubal stump ectopic. Inference: Women who has had a previously ectopic pregnancy are at a significantly greater probability of relapse. To correctly and quickly identify the implanted location, a TVUS should be conducted. Laparoscopic diagnostic salpingectomy should be performed through excision by diathermy to prevent the risk of EP in the tubal stump.

Ultrasonic diagnosis of asymptomatic rupture of uterine in second trimester of pregnancy after laparoscopic surgery for interstitial pregnancy: a case report

Background Uterine rupture is a rare, life-threatening event in obstetrics that may be fatal for the mother and fetus. Therefore, obstetricians need to pay attention to and should consider the antenatal diagnosis of uterine rupture in women having its risk factors. Successful conservative management for asymptomatic uterine rupture due to previous laparoscopic surgery for interstitial pregnancy has already been reported but remains understudied. Case presentation A 39-year-old woman was diagnosed asymptomatic uterine rupture at 22 weeks gestation by a routine second-trimester ultrasound scan. She had a history of laparoscopic salpingectomy with cornual wedge resection for interstitial pregnancy 10 months before this pregnancy. Refusing doctor’s twice advice of terminating the pregnancy, the patient insisted carrying on the pregnancy, and followed up by ultrasound and magnetic resonance imaging. Fetal growth was appropriate, fetal movements were good and the patient had no symptoms, without uterine contraction or amniotic fluid loss throughout follow-up period. Caesarean section was carried out at 34 + 1 weeks with a good maternal and neonatal outcome. Conclusions A previous history of laparoscopic salpingectomy with cornual wedge resection could be a risk factor for uterine rupture in pregnant women. Sonographers should be alert to this potential risk in pregnant women with a history of laparoscopic salpingectomy with cornual wedge resection even in asymptomatic patients.

Prospective study on ectopic pregnancy in a tertiary care hospital

Background: Pregnancy of unknown location was frequently missed and increasing incidence of ectopic pregnancy needs awareness about common risk factors, mortality and morbidity. Aim of this study is identify the incidence, clinical presentation, risk factors, treatment, mortality and morbidity associated with ectopic pregnancies.Methods: Prospective analysis of ectopic was done in Chengalpattu Government Medical College and Hospital from December 2018 to December 2019. Parameters included in this study was age, parity, gestational age, risk factors, clinical presentation, site of ectopic, need of blood transfusion, mode of management, mortality and morbidity were identified.Results: Out of 10900 deliveries, 53 were ectopic pregnancies (0.48%). Women with age 20-25 years had highest incidence (54.71%) and with least below 20yrs and above 40 years (1.88%). Ectopic pregnancies were common in multiparous women (70.68%) than primigravida (28.30%). Common symptoms: amennorhea (98.11%), pain abdomen (96.22%), bleeding per vaginum (47.16%) patients. Urine pregnancy test positive in 98.11%. Etiology was pelvic infection (18.88%), surgeries including LSCS and tubal surgeries (15.09%), previous dilatation and curettage was done in (15.09%) cases, previous ectopic (5.66%), intrauterine contraception usage seen in (1.88%). Right sided ectopic was more common. Site of ectopic: common in fallopian tube- ampullary region (54.71%)), fimbria (22.64%), isthumus (11.32%), followed by ovarian ectopic (5.66%) cornual (3.77%), caesarean scar (1.88%) tubal abortion (1.88%). About 94.33% of ectopic was ruptured, 3/4th of these patients presented with shock at the time of presentation. Most of cases being ruptured ectopic pregnancies, unilateral salpingectomy in 75.47% and unilateral salpingoopherectomy in 3.77%. Salpingectomy with contralateral tubal ligation done in 15.09%, laparoscopic salpingectomy done in 3.77%, hysterectomy done for 1.88%. Blood transfusion was done in (96.22%), without single mortality.Conclusions: Immediate prompt diagnosis, identifying the high-risk factors and early intervention by conservative or surgical management will help in reducing the mortality and morbidity associated with ectopic pregnancted.