DOCSLIB.ORG

Uterine Fibroids

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Uterine Fibroids IMPERIAL COLLEGE LONDON Uterine Fibroids Response to novel treatment modalities Stephen Derek Quinn 1st November, 2013 Academic department of Obstetrics and Gynaecology St Mary’s Hospital London Imperial College London Praed Street, London W21NY A thesis submitted in partial fulfilment of the requirements for the degree of MD Res at Imperial College: 2013 I declare that work contained herein is my own and that work of others is appropriately acknowledged. The copyright of this thesis rests with the author and is made available under a Creative Commons Attribution Non-Commercial No Derivatives licence. Researchers are free to copy, distribute or transmit the thesis on the condition that they attribute it, that they do not use it for commercial purposes and that they do not alter, transform or build upon it. For any reuse or redistribution, researchers must make clear to others the licence terms of this work. 2 Acknowledgements I would like to express my appreciation and thanks to my MD supervisors- Professor Lesley Regan and Professor Wladyslaw Gedroyc. Without their guidance, immense patience and wisdom this thesis would not have been possible. I would also like to thank Mr Raj Rai for his support and advice during the writing of these chapters. Thanks to Dr Bernard North, Imperial College London Statistical Advisory service for his indispensable advice and assistance. I would like to thank Dr John Vedalago, whose enthusiasm, friendship and dedication has been an essential part of this process. Thank you to Dr Mohammad Hamady, Interventional Radiologist, who helped facilitate the cytokine and growth factor portions of this thesis; Miss Casey Murray and Miss Yvonne Bower from the MR-therapy unit at St Mary’s who were very supportive of my work and helped with patient recruitment; Miss Yvonne Clements for her advice and help with multi- plate assays. I also wish to thank Dr Patrick McCabe from the University of Surrey for his assistance with the statistical analysis. This thesis is dedicated to my parents Derek and Sheila, whose steadfast support and encouragement has been truly wonderful. Finally to my wife Annabel, whose understanding and love has made this thesis possible - thank you. 3 Abstract Introduction Magnetic resonance-guided focused ultrasound (MRgFUS) is a non-invasive, thermal ablation treatment for uterine fibroids. There is currently limited data regarding the long-term efficacy of this method and the effect of this treatment on circulating cytokine and growth factors. In this thesis I have: 1. Presented the most accurate method of measuring fibroid volumes, and propose a new classification system for describing fibroid uteri. 2. Reviewed the characteristics of a cohort of uterine fibroid subjects and perform a longitudinal analysis of MRgFUS results. 3. Assessed the fibroid volume treated, pain scores and cytokine levels and growth factor levels following MRgFUS and UAE. Results The Parallel Plannimetric method is an accurate and reliable method of measuring uterine, fibroid and non- perfused volumes. Classifying fibroid uteri by numbers of fibroids and the presence of dominant fibroids is useful for distinguishing between those cases to be treated by MRgFUS or UAE. Since the introduction of MRgFUS to our unit the percentage non-perfused volumes (NPV) achieved have increased from 41.22 to 50.49 (p=0.038), however the re-intervention rate at 5 years remains high at 50%. MRgFUS has an excellent safety record, and the introduction of the new ExAblate 2100 system also appears to be safe and well tolerated, with encouraging initial NPVs achieved. Following both MRgFUS and UAE circulating interleukin-6 (IL-6) is significantly raised, although this is not affected by the degree of pain experienced or the volume of fibroid treated. Following UAE there is rise in circulating vascular endothelial growth factor (VEGF) seen at one week, however no significant change in VEGF levels is seen following MRgFUS. These changes in VEGF are not related to fibroid volume. Discussion MRgFUS is a safe, well tolerated treatment for uterine fibroids, although re-intervention rate is high. Further developments in this treatment modality may continue to improve outcomes, however at present its routine use cannot be recommended. 4 Contents Abstract............................................................................................................................... 4 Abbreviations ....................................................................................................................... 10 List of figures ............................................................................................................................ 12 List of tables ............................................................................................................................. 14 1. Introduction and literature review ................................................................................... 16 Prevalence ............................................................................................................................ 16 Subgroups of uterine fibroids and classification .................................................................. 17 Sub-mucous (SM) fibroids ................................................................................................ 18 Intramural (IM) fibroids .................................................................................................... 20 Sub-serosal (SS) Fibroids ................................................................................................... 21 Cervical fibroids ................................................................................................................ 21 Vaginal fibroids ................................................................................................................. 21 Fibroid symptoms ................................................................................................................. 22 Menstrual symptoms ........................................................................................................ 23 Pressure symptoms .......................................................................................................... 24 Pain ................................................................................................................................... 24 Sub-Fertility ...................................................................................................................... 25 Pregnancy Complications ................................................................................................. 27 Psychological aspects of a diagnosis of uterine fibroids .................................................. 29 Fibroid Aetiology .................................................................................................................. 30 Obesity .............................................................................................................................. 30 Race .................................................................................................................................. 31 Parity ................................................................................................................................. 31 Diet ................................................................................................................................... 31 Smoking and Alcohol ........................................................................................................ 32 5 Hypertension .................................................................................................................... 32 Mechanisms of fibroid growth ......................................................................................... 33 The role of Oestrogen ....................................................................................................... 34 Genetics of uterine fibroids .............................................................................................. 35 Epigenetic factors ............................................................................................................. 37 The Role of the Extracellular Matrix ................................................................................. 37 Vasculature of the fibroid ................................................................................................. 38 Fibroid Histology ............................................................................................................... 39 Fibroid diagnosis .................................................................................................................. 40 History of uterine fibroids and their management .............................................................. 46 Fibroid management ............................................................................................................ 47 Surgical Treatments .......................................................................................................... 50 Hysterectomy ................................................................................................................... 50 Myomectomy.................................................................................................................... 51 Trans-cervical resection of fibroid (TCRF) ........................................................................ 52 Uterine artery embolism (UAE) or uterine fibroid embolization
Load more

Recommended publications
  • Sexual Assault Cover
    Sexual Assault Victimization Across the Life Span A Clinical Guide G.W. Medical Publishing, Inc. St. Louis Sexual Assault Victimization Across the Life Span A Clinical Guide Angelo P. Giardino, MD, PhD Associate Chair – Pediatrics Associate Physician-in-Chief St. Christopher’s Hospital for Children Associate Professor in Pediatrics Drexel University College of Medicine Philadelphia, Pennsylvania Elizabeth M. Datner, MD Assistant Professor University of Pennsylvania School of Medicine Department of Emergency Medicine Assistant Professor of Emergency Medicine in Pediatrics Children’s Hospital of Philadelphia Philadelphia, Pennsylvania Janice B. Asher, MD Assistant Clinical Professor Obstetrics and Gynecology University of Pennsylvania Medical Center Director Women’s Health Division of Student Health Service University of Pennsylvania Philadelphia, Pennsylvania G.W. Medical Publishing, Inc. St. Louis FOREWORD Sexual assault is broadly defined as unwanted sexual contact of any kind. Among the acts included are rape, incest, molestation, fondling or grabbing, and forced viewing of or involvement in pornography. Drug-facilitated behavior was recently added in response to the recognition that pharmacologic agents can be used to make the victim more malleable. When sexual activity occurs between a significantly older person and a child, it is referred to as molestation or child sexual abuse rather than sexual assault. In children, there is often a "grooming" period where the perpetrator gradually escalates the type of sexual contact with the child and often does not use the force implied in the term sexual assault. But it is assault, both physically and emotionally, whether the victim is a child, an adolescent, or an adult. The reported statistics are only an estimate of the problem’s scope, with the actual reporting rate a mere fraction of the true incidence.
    [Show full text]
  • Multidetector CT of Expected Findings and Complications After Hysterectomy
    Insights into Imaging (2018) 9:369–383 https://doi.org/10.1007/s13244-018-0610-9 PICTORIAL REVIEW Multidetector CT of expected findings and complications after hysterectomy Massimo Tonolini1 Received: 19 December 2017 /Revised: 12 February 2018 /Accepted: 12 February 2018 /Published online: 6 April 2018 # The Author(s) 2018. This article is an open access publication Abstract Indicated to manage a variety of disorders affecting the female genital tract, hysterectomy represents the second most common gynaecological operation after caesarean section. Performed via an open, laparoscopic or vaginal approach, hysterectomy is associated with non-negligible morbidity and occasional mortality. Iatrogenic complications represent a growing concern for gynaecologists and may result in prolonged hospitalisation, need for interventional procedures or repeated surgery, renal im- pairment and malpractice claims. As a result, radiologists are increasingly requested to investigate patients with suspected complications after hysterectomy. In the vast majority of early postoperative situations, multidetector CT represents the ideal modality to comprehensively visualise the surgically altered pelvic anatomy and to consistently triage the varied spectrum of possible injuries. This pictorial review provides an overview of current indications and surgical techniques, illustrates the expected CT appearances after recent hysterectomy, the clinical and imaging features of specific complications such as lymphoceles, surgical site infections, haemorrhages, urinary tract lesions and fistulas, bowel injury and obstruction. Our aim is to increase radiologists’ familiarity with normal post-hysterectomy findings and with post-surgical complications, which is crucial for an appropriate choice between conservative, interventional and surgical management. Teaching points • Hysterectomy via open, laparoscopic or vaginal route is associated with non-negligible morbidity.
    [Show full text]
  • Surgical Techniques
    SURGICAL TECHNIQUES ■ BY MARCO A. PELOSI II, MD, and MARCO A. PELOSI III, MD Pelosi minilaparotomy hysterectomy: Effective alternative to laparoscopy and laparotomy This new modality—useful for normal, large, and fibroid-ridden uteri—combines the technical benefits of standard laparotomy with the convalescent advantages of laparoscopic surgery. lthough laparoscopic hysterectomy Position, incision, and retraction offers a minimally invasive alternative are crucial to success Ato laparotomy when vaginal hysterec- ur minilaparotomy hysterectomy is a sys- tomy is contraindicated, it has its drawbacks. Otemized approach with elements derived Among them: the cost of expensive equip- from both open and laparoscopic surgery. ment, the long learning curve, and prolonged Three preparatory components are involved: operating time. • position We describe another alternative to open • incision surgery that is comparable to laparoscopic • retraction hysterectomy in postoperative pain, cosmetic All are critical to a successful hysterectomy, results, and time to return to normal activi- ensuring that the procedure never becomes a ties. Our procedure—a redesigned minila- haphazard struggle through an improvised, parotomy hysterectomy—relies on tradition- scaled-down, conventional Pfannenstiel or al open techniques and inexpensive novel vertical incision. Our approach also avoids instrumentation, making it significantly cumbersome traditional laparotomy exposure faster than laparoscopy and easy to perform maneuvers and positioning. and teach. Position: Modified lithotomy. After For patients who cannot undergo vaginal regional or general anesthesia is given, posi- hysterectomy, this new modality offers tion the patient in a modified lithotomy with an expeditious, minimal-access option. both arms tucked as for laparoscopic surgery. Gynecologists reluctant to relinquish the rou- Place the legs in boot-type stirrups, with no tine use of standard laparotomy may hip flexion and sufficient thigh abduction to find this approach an appealing, less-invasive expose the vagina.
    [Show full text]
  • Imperforate Anus and Cloacal Malformations Marc A
    C H A P T E R 3 5 Imperforate Anus and Cloacal Malformations Marc A. Levitt • Alberto Peña ‘Imperforate anus’ has been a well-known condition since component but were left with a persistent urogenital antiquity.1–3 For many centuries, physicians, as well as sinus.21,23 Additionally, most rectovestibular fistulas were individuals who practiced medicine, have tried to help erroneously called ‘rectovaginal fistula’.21 A rectoblad- these children by creating an orifice in the perineum. derneck fistula in males is the only true supralevator Many patients survived, most likely because they suffered malformation and occurs in about 10%.18 As it is the only from a type of defect that is now recognized as ‘low.’ malformation in males in which the rectum is unreach- Those with a ‘high’ defect did not survive. In 1835, able through a posterior sagittal incision, it requires an Amussat was the first to suture the rectal wall to the skin abdominal approach (via laparoscopy or a laparotomy) in edges which was the first actual anoplasty.2 Stephens addition to the perineal approach. made a significant contribution by performing the first Anorectal malformations represent a wide spectrum of anatomic studies in human specimens. In 1953, he pro- defects. The terms ‘low,’ ‘intermediate,’ and ‘high’ are arbi- posed an initial sacral approach followed by an abdomi- trary and not useful in current therapeutic or prognostic noperineal operation, if needed.4 The purpose of the terminology. A therapeutic and prognostically oriented sacral stage of this procedure was to preserve the pub- classification is depicted in Box 35-1.24 orectalis sling, considered a key factor in maintaining fecal incontinence.
    [Show full text]
  • Outcome of Abdominal Sacrocolpopexy for Post Hysterectomy Vaginal Vault Prolapse BRIG
    Bangladesh J Obstet Gynaecol, 2016; Vol. 31(2): 90-93 Outcome of Abdominal Sacrocolpopexy for Post Hysterectomy Vaginal Vault Prolapse BRIG. GEN. LIZA CHOWDHURY1, NURUN NAHAR KHANAM2, MAJ. JUNNU RAYEN JANNA3 Abstract: Objective (s): The aim of this study was to explore the outcome of abdominal sacrocolpopexy for the correction of post hysterectomy vaginal vault prolapse. Materials and Methods: This prospective study was done over the period of five years from 2011 to 2015 where twenty patients of vault prolapse were subjected to abdominal sacrocolpopexy. Procedure was completed by securing the vaginal apex to the anterior longitudinal ligament of sacrum using synthetic mesh. Intra and postoperative complications and patients’ satisfaction was assessed. Results: No post-operative serious complications were reported during follow up period. The vaginal vault was well supported in all patients with no recurrent vault prolapse. One patient had mild asymptomatic rectocele. No mesh complication was found during the follow up period. Conclusion: The abdominal sacrocolpopexy achieves excellent correction of post hysterectomy vaginal vault prolapse with minimal morbidity. Keywords: Abdominal sacrocolpopexy, vaginal vault prolapse, anterior longitudinal ligament. Introduction: and something coming down. There may be vaginal Where the top of the vagina gradually falls toward the discomfort, dyspareunia and impaired vaginal vaginal opening and eventually may protrude out of intercourse because of something is in the way. The the body through vaginal opening is known as vaginal patient’s sexual partner may also complain that the vault prolapse. The vaginal vault prolapse can be vagina is too large. If the vaginal skin is ulcerated, there 4,5 encountered in patients who had abdominal or vaginal may be troublesome discharge and bleeding.
    [Show full text]
  • OBGYN Outpatient Surgery Coding
    OBGYN Outpatient Surgery Coding Anatomy Anatomy • Hyster/o – uterus, womb • Uter/o – uterus, womb • Metr/o – uterus, womb • Salping/o – tube, usually fallopian tube • Oophor/o – ovary • Ovari/o - ovary Terminology • Colpo – vagina • Cervic/o – cervix, lower part of the uterus, the “neck” • Episi/o – vulva • Vulv/o – vulva • Perine/o – the space between the anus and vulva Hysterectomy • A hysterectomy is an operation to remove a woman's uterus. • A woman may have a hysterectomy for different reasons, including: • Uterine fibroids that cause pain • bleeding, or other problems. • Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal. Hysterectomy • There are around 30 hysterectomy CPT codes. • To find the correct code you have to first check: • the surgical approach and • extent of the procedure. Surgical Approaches • Abdominal – the uterus is removed via an incision in the lower abdomen • Vaginal – the uterus is removed via an incision in the vagina • Laparoscopic – the procedure is performed using a laparoscope , inserted via several small incisions in the body. • Their are also CPT codes for laparoscopic-assisted vaginal approach. In this procedure ,the scope is inserted via a small incisions in the vagina. Extent of Procedure • Total hysterectomy: It includes laparoscopically detaching the entire uterine cervix and body from the surrounding supporting structures and suturing the vaginal cuff. It includes bivalving, coring, or morcellating the excised tissues, as required. The uterus is then removed through the vagina or abdomen. • Subtotal, partial or supracervical hysterectomy: It is the removal of the fundus or op portion of the uterus only, leaving the cervix in place.
    [Show full text]
  • Outcomes After Female Urinary Incontinence and Pelvic Organ Prolapse Surgery
    D 1258 OULU 2014 D 1258 UNIVERSITY OF OULU P.O.BR[ 00 FI-90014 UNIVERSITY OF OULU FINLAND ACTA UNIVERSITATIS OULUENSIS ACTA UNIVERSITATIS OULUENSIS ACTA SERIES EDITORS DMEDICA Virva Nyyssönen ASCIENTIAE RERUM NATURALIUM Virva Nyyssönen Professor Esa Hohtola TRANSVAGINAL MESH- BHUMANIORA AUGMENTED PROCEDURES University Lecturer Santeri Palviainen CTECHNICA IN GYNECOLOGY Postdoctoral research fellow Sanna Taskila OUTCOMES AFTER FEMALE URINARY DMEDICA INCONTINENCE AND PELVIC ORGAN PROLAPSE Professor Olli Vuolteenaho SURGERY ESCIENTIAE RERUM SOCIALIUM University Lecturer Veli-Matti Ulvinen FSCRIPTA ACADEMICA Director Sinikka Eskelinen GOECONOMICA Professor Jari Juga EDITOR IN CHIEF Professor Olli Vuolteenaho PUBLICATIONS EDITOR Publications Editor Kirsti Nurkkala UNIVERSITY OF OULU GRADUATE SCHOOL; UNIVERSITY OF OULU, FACULTY OF MEDICINE, INSTITUTE OF CLINICAL MEDICINE, ISBN 978-952-62-0562-5 (Paperback) DEPARTMENT OF OBSTETRICS AND GYNECOLOGY; ISBN 978-952-62-0563-2 (PDF) OULU UNIVERSITY HOSPITAL ISSN 0355-3221 (Print) ISSN 1796-2234 (Online) ACTA UNIVERSITATIS OULUENSIS D Medica 1258 VIRVA NYYSSÖNEN TRANSVAGINAL MESH-AUGMENTED PROCEDURES IN GYNECOLOGY Outcomes after female urinary incontinence and pelvic organ prolapse surgery Academic dissertation to be presented with the assent of the Doctoral Training Committee of Health and Biosciences of the University of Oulu for public defence in auditorium L4 of Oulu University Hospital, on 10 October 2014, at 12 noon UNIVERSITY OF OULU, OULU 2014 Copyright © 2014 Acta Univ. Oul. D 1258, 2014 Supervised by Docent Markku Santala Docent Anne Talvensaari-Mattila Reviewed by Professor Seppo Heinonen Doctor Kari Nieminen Opponent Docent Pentti Kiilholma ISBN 978-952-62-0562-5 (Paperback) ISBN 978-952-62-0563-2 (PDF) ISSN 0355-3221 (Printed) ISSN 1796-2234 (Online) Cover Design Raimo Ahonen JUVENES PRINT TAMPERE 2014 Nyyssönen, Virva, Transvaginal mesh-augmented procedures in gynecology.
    [Show full text]
  • Evisceration After Vaginal Cuff Dehiscence: a Case Report and Review
    www.jcimcr.org Journal of Clinical Images and Medical Case Reports ISSN 2766-7820 Case Report Open Access, Volume 2 Evisceration after vaginal cuff dehiscence: A case report and review Sonia De-Miguel-Manso1,2*; Dakota Viruega-Cuaresma1; Elena García-García1; Carmen E Badillo-Bercebal1; Victoria Pascual- Escudero1; María López-País1 1Department of Obstetrics and Gynecology, Hospital Clínico Universitario de Valladolid, Regional Health Management of Castilla y León (SACYL), Spain. 2Department of Pediatrics and Immunology, Obstetrics and Gynecology, Nutrition and Bromatology, Psychiatry and History of Science, Faculty of Medicine, University of Valladolid, Spain. Abstract *Corresponding Author: Sonia De-Miguel-Manso Department of Obstetrics and Gynecology, Hospital Introduction:Intestinal loop Evisceration (VE) complicates the 35- 67% Of Vaginal Cuff Dehiscence (VCD), constituting a medical emer- Clínico Universitario de Valladolid, Regional Health gency. In most cases, it is associated with genital prolapse in post- Management of Castilla y León (SACYL), Avenida menopausal women with previous hysterectomy. Ramón y Cajal 3, 47005 Valladolid, Spain. Clinical case: 94-year-old patient with VE after VCD, associated Tel: +34-617061826; with prolonged use of pessary as a treatment for vaginal cuff pro- Email: [email protected] lapse and enterocele, after laparotomic hysterectomy. Results: Vaginal repair was performed abdominally, due to the size and condition of the eviscerated loops, requiring intestinal resection. Received: Mar 04, 2021 An omentum flap was attached to the vaginal cuff to improve healing Accepted: Apr 14, 2021 and to try to occlude the Douglas space. Published: Apr 16, 2021 Conclusions: VE requires vaginal, abdominal or mixed repair, gen- Archived: www.jcimcr.org erally deferring the definitive treatment of the prolapse to a second stage.
    [Show full text]
  • Manual of Diagnostic Ultrasound Iagnostic U Vol
    Vol. 2 0.1 Manual of d Manual of diagnostic ultrasound iagnostic vol. 2 During the last decades , use of ultrasonography became increasingly common in medical practice and hospitals around u the world, and a large number of scientific publications reported ltrasound the benefit and even the superiority of ultrasonography over commonly used X-ray techniques, resulting in significant changes in diagnostic imaging procedures. With increasing use of ultrasonography in medical settings, the need for education and training became essential. WHO took Manual of up this challenge and in 1995 published its first training manual in ultrasonography. Soon, however, rapid developments and improvements in equipment and indications for the extension of diagnostic ultrasound medical ultrasonography into therapy indicated the need for a totally new ultrasonography manual. volume2 The manual (consisting of two volumes) has been written by an international group of experts of the World Federation for Ultrasound in Medicine and Biology (WFUMB), well-known for their publications regarding the clinical use of ultrasound and with substantial experience in the teaching of ultrasonography in both developed and developing countries. The contributors (more than fifty for the two volumes) belong to five different continents, to guarantee that manual content represents all clinical, cultural and epidemiological contexts This new publication, which covers modern diagnostic and therapeutic ultrasonography extensively, will certainly benefit Second edition and inspire medical professionals in improving ‘health for all’ in both developed and emerging countries. cm/s 60 [TIB 1.3] 7.5L40/4.0 40 SCHILDDR. 100% 48dB ZD4 20 4.0cm 11B/s 0 Z ISBN 978 92 4 154854 0 THI CF5.1MHz -20 PRF1102Hz F-Mittel 70dB ZD6 DF5.5MHz PRF5208Hz 62dB FT25 FG1.0 DIM Cover_Final Proof.indd 1 7/1/13 6:47 AM 0.1 Manual of diagnostic ultrasound volume2 Second edition cm/s 60 [TIB 1.3] 7.5L40/4.0 40 SCHILDDR.
    [Show full text]
  • Small Bowel Evisceration in a Perforated Uterine Prolapse Eric Y
    Case Report Small bowel evisceration in a perforated uterine prolapse Eric Y. Amakpa1, Gertrudis A. Hernandez-Gonzalez2 and Edith Camejo-Rodriguez2 Ghana Med J 2021; 55(2): 156-159 doi: http://dx.doi.org/10.4314/gmj.v55i2.10 1Ho Teaching Hospital, Department of Obstetrics and Gynecology, Ho. Volta Region, Ghana. 2University of Health and Allied Sciences, School of Medicine, Department of Internal Medicine and Therapeutics, Ho. Volta Region, Ghana. Corresponding author: Edith Camejo-Rodriguez E-mail: ecamejouhas.edu.gh Conflict of interest: None declared SUMMARY The evisceration of the bowel through the vaginal vault is an extremely rare condition and a surgical emergency with a high-reported mortality rate. Vaginal evisceration most commonly affects menopausal women with a hysterectomy or those with previous vaginal surgery. The most common risk factors include the triad of post-menopausal atrophy, previous vaginal surgery and enterocele. Estrogen deficiency in post-menopausal women leads to weaker pelvic sup- port structures and a thin, atrophic vagina, making it more prone to rupture. Previous vaginal surgery leaves scar tissue with diminished vascularity in the vaginal wall and apex, predisposing it to dehiscence. Post hysterectomy, the axis of the vagina may be changed, making it more vertical or shortened and resulting in the vagina losing its valve-like mechanism. We present a 70-year-old female brought to the emergency department with a vaginal prolapse compli- cated by bowel evisceration, without any history of vaginal surgery, hysterectomy or trauma. The bowel was inspected and irrigated copiously, then reduced into the abdominal cavity as it was still viable.
    [Show full text]
  • Pelvic Organ Prolapse Or Vaginal Cuff Dehiscence and Evisceration? a Case Report
    Rowan University Rowan Digital Works Stratford Campus Research Day 23rd Annual Research Day May 2nd, 12:00 AM Something has Fallen: Pelvic Organ Prolapse or Vaginal Cuff Dehiscence and Evisceration? A Case Report. Alexandra Nutaitis Rowan University Laurie Kane M.D. Southern Ocean Medical Center, Manahawkin, NJ Follow this and additional works at: https://rdw.rowan.edu/stratford_research_day Part of the Female Urogenital Diseases and Pregnancy Complications Commons, Obstetrics and Gynecology Commons, Surgery Commons, and the Urogenital System Commons Let us know how access to this document benefits ouy - share your thoughts on our feedback form. Nutaitis, Alexandra and Kane, Laurie M.D., "Something has Fallen: Pelvic Organ Prolapse or Vaginal Cuff Dehiscence and Evisceration? A Case Report." (2019). Stratford Campus Research Day. 44. https://rdw.rowan.edu/stratford_research_day/2019/may2/44 This Poster is brought to you for free and open access by the Conferences, Events, and Symposia at Rowan Digital Works. It has been accepted for inclusion in Stratford Campus Research Day by an authorized administrator of Rowan Digital Works. Something has Fallen: Pelvic Organ Prolapse or Vaginal Cuff Dehiscence and Evisceration? A Case Report Alexandra Nutaitis, BS, Laurie Kane, MD, FACOG Department of Urogynecology, Southern Ocean Medical Center, Manahawkin, NJ LEARNING OBJECTIVES RADIOGRAPHIC IMAGING CONCLUSIONS and SUMMARY 1. Recognize a late presenting complication of hysterectomy • VCDE refers to the separation of the anterior and posterior edges of 2. Include vaginal cuff dehiscence with evisceration (VCDE) in the vaginal cuff followed by expulsion of intraperitoneal contents the differential diagnosis of acute pelvic organ prolapse through the separated incision.
    [Show full text]
  • Pelvic Surgery
    International Journal of Surgical Oncology Pelvic Surgery Guest Editors: Constantine P. Karakousis and Harold Wanebo Pelvic Surgery International Journal of Surgical Oncology Pelvic Surgery Guest Editors: Constantine P.Karakousis and Harold Wanebo Copyright © 2012 Hindawi Publishing Corporation. All rights reserved. This is a special issue published in “International Journal of Surgical Oncology.” All articles are open access articles distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Editorial Board Rajendra A. Badwe, India Michael Hunerbein,¨ Germany George H. Sakorafas, Greece William Carson, USA Vijay P. Khatri, USA Roderich E. Schwarz, USA Anees B. Chagpar, USA Wai Lun Law, Hong Kong Perry Shen, USA Pankaj Chaturvedi, India Theodore D. Liakakos, Greece Elin R. Sigurdson, USA S. Curley, USA R. Martin, USA Atilla Soran, USA T. K. Das Gupta, USA E. W. Martin, USA Masahiko Tosaka, Japan A. K. D’cruz, India Sanjeev Misra, India Todd M. Tuttle, USA Rolando Del Maestro, Canada Kefah Mokbel, UK Georges Vlastos, Switzerland Philip J. Drew, UK Masaki Mori, Japan Toshiaki Watanabe, Japan AndreM.Eckardt,Germany´ Giuseppe Nigri, Italy William Ignace Wei, Hong Kong Alfio Ferlito, Italy Vahit Ozmen, Turkey Desmond C. Winter, Ireland Frank A. Frizelle, New Zealand Kumar A. Pathak, Canada C. H. Yip, Malaysia John F. Gibbs, USA Timothy M. Pawlik, USA Kazuhiro Yoshida, Japan Steven Heys, UK Malcolm Reed, UK Jan Zaloudˇ ´ık, Czech Republic Steven N. Hochwald, USA Douglas Reintgen, USA Contents Pelvic Surgery, Constantine P. Karakousis and Harold Wanebo Volume 2012, Article ID 287096, 2 pages The Role of Secondary Surgery in Recurrent Ovarian Cancer, D.
    [Show full text]