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Laparoscopic Treatment of Intrauterine Fallopian Tube Incarceration

DOI: 10.1155/2013/205957

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Herniation of the pelvic structures into the uterine cavity (appendix vermiformis, small bowel, omentum, or fallopian tube) may occur after uterine perforation. In this paper, we describe one case of intrauterine fallopian tube incarceration treated by means of laparoscopic surgery. 1. Introduction Uterine perforation during curettage is a potentially dangerous complication but may go unrecognized on many occasions [1]. Herniation of the pelvic structures into the uterine cavity, such as the appendix vermiformis, small bowel, omentum or fallopian tube, occurring after uterine perforation has been described in the medical literature but is very rare [1–5]. In this paper, we describe one case of intrauterine fallopian tube incarceration treated by means of laparoscopic surgery. 2. A Case Presentation A 22-year-old woman, gravida 2 para 2, came to our office complaining about pelvic pain and amenorrhea since her vaginal delivery. The symptoms of pain were intermittent, but they worsened in the last 3 days before she came to our service including persistent, cramping abdominal pain, and mild abdominal distension. Eleven months ago, she had her second vaginal delivery complicated by retained placenta. The placenta was delivered in multiple fragments followed by sharp curettage. Then, she presented postpartum hemorrhage requiring another curettage of the uterus. On physical examination, the abdominal examination was unremarkable. Gynecologic examination revealed a tender uterus with no adnexal abnormalities. Transvaginal ultrasound (Figure 1(a)) revealed a hypoechoic, irregular tissue within the endometrial cavity. The ovaries were normal. Pelvic MRI (Figure 1(b)) demonstrated a right hydrosalpinx that “infiltrated” the uterine fundus, extending to the endometrial cavity. A diagnostic laparoscopy (Figure 1(c)) was indicated, and during the procedure, the right fallopian tube was found to be adhered to the uterine fundus. The right ovary and the left adnexae were normal. The tube was progressively freed from the uterine wall. A right salpingectomy was conducted because the patient did not want to have any more pregnancies. The uterine wall defect was repaired in multiple layers using caprofyl (poliglecaprone 25) zero (Figure 1(d)). The patient was discharged 12 hours after the procedure. Figure 1: (a) Transvaginal ultrasound showing a hypoechoic structure (blue arrows) within the uterus (U). (b) Pelvic MRI demonstrating a herniation (blue arrow) of the right hydrosalpinx (H) through the uterine wall (U) going up to the endometrial cavity (EC). Both the right

References

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