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A case of vesical endometriosis with unilateral renal agenesis is reported. A 13-year-old girl complained of difficulty in urination and lower abdominal pain during the menstruation. Detail urological examinations revealed left renal agenesis and intravesical cystic mass. The mass was located in the left vesical lateral wall, obstructing the vesical outlet and containing dark-brown-coloured fluid in it. She finally suffered from urinary retention following the menstruation and underwent a resection of the mass together with a part of the vesical wall. During the operation, the uterus was found to be a bicornate one. The resected mass was diagnosed as an endometriosis based on the histological findings. Eighteen months after the operation she is free from any symptoms during the menstruation and recurrence of endometriosis.
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PMID:[A case of juvenile vesical endometriosis with unilateral renal agenesis and bicornate uterus]. 195 38

The increasing use of laparoscopy as a therapeutic method mandates a reappraisal of the risks involved. Complications frequently described include injuries to the large and small bowels, bladder, and blood vessels. The world literature reports only eight cases of ureteral injury at laparoscopy. In this report, we present five additional cases of ureteral injury occurring at laparoscopy, in addition to a summary of those previously reported. Patients tend to present in the early postoperative period (48-72 hours) with low back pain, abdominal pain, leukocytosis, and peritonitis. The diagnosis should be made by intravenous pyelography; if possible, the injury should be stented by either the retrograde or percutaneous route. The injuries, except for one apparent trocar injury, involved the use of electrocoagulation, both unipolar and bipolar. The injuries occurred most commonly near the uterosacral ligaments. In 38% (five of 13) of the cases, the laparoscopy was performed for treatment of endometriosis. Three of the 13 patients eventually lost renal function of the affected side; two of these underwent a nephrectomy. Because visualization of the ureter near the cervix at the time of laparoscopy is difficult, especially in the presence of disease, laparoscopic procedures in this area must be carried out with caution.
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PMID:Ureteral injuries at laparoscopy: insights into diagnosis, management, and prevention. 214 32

To evaluate the efficacy, safety and tolerance of the GnRH-analogue Buserelin in the treatment of endometriosis, we started a non-comparative study of 52 patients with various stages of endometriosis. The dosage of 900 mcg/d was administered 3 times daily intranasally for 6 months. The degree of the disease was evaluated before and at the end of treatment by pelviscopy and biopsy. A regression of the implant score was found in 88% of patients. The mean AFS score was reduced from 17.4 +/- 1.9 before medication to 7.2 +/- 8.2 after therapy. Endometriosis related complaints were significantly improved during treatment. After 6 months 75% of the patients were without lower abdominal pain, 98% without dysmenorrhoea, and 85% without dyspareunia. As a result of the induced low level of oestrogen, 60% of the patients claimed hot flushes, 12% sweating, reduced libido, and dry vagina. Bleeding (spotting, break-through bleeding, menstruation) occurred in 40% during the first month, and was continuously reduced during the following period. Before, during and after therapy, venous blood samples were drawn to check laboratory tests for blood count, clotting parameters, clinical chemistry, serum electrolytes, as well as liver and lipid metabolism. All values stayed within the normal range without significant changes. In the follow-up period of at least 12 months, we achieved an uncorrected pregnancy rate of 41% in the group of 34 women with primary or secondary infertility.
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PMID:[Ovarian suppression by the GnRH analog buserelin in the treatment of endometriosis. Clinical, biochemical and pelviscopic studies]. 214 92

Cases of endometriosis of the colon were examined in a retrospective fashion to illustrate the problems in diagnosis and management of this disease entity. Nine patients were identified from 1956 to 1988; their average age was 41 years. Common presenting symptoms were abdominal pain, diarrhea, constipation, tenesmus, small caliber stools, abdominal distention, and blood per rectum. Bowel symptoms were cyclic in four of the nine patients, and seven had a history of gynecologic complaints. Barium enema was performed in six patients and endoscopy in five patients. All cases involved the sigmoid or rectosigmoid colon. In no case was the diagnosis established endoscopically. Surgical procedures included resection with primary anastomosis (6 patients), and resection with sigmoid endcolostomy and Hartmann's pouch (3 patients). In only one case was full-thickness colonic wall involvement noted. One patient had an adenocarcinoma of the colon adjacent to the area of endometriosis. Our data indicate that the diagnosis of endometriosis of the colon should be considered in women with colonic symptoms, especially with an associated history of dysmenorrhea or cyclic changes in bowel habits. Surgical resection offers the best chance for relief of symptoms.
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PMID:Endometriosis of the colon. Its diagnosis and management. 233 65

A postmenopausal woman on hormone replacement therapy presented with abdominal pain, a large pelvic mass and high-grade ureteral obstruction, with endometriosis found at exploration.
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PMID:Postmenopausal endometriosis associated with hormone replacement therapy. A case report. 252 89

A consecutive series of 49 women (50 procedures), whose conditions were haemodynamically stable, presenting with acute lower abdominal pain, pelvic tenderness, and either a urine concentration of greater than 50 U/l beta human chorionic gonadotrophin or a pelvic mass shown by ultrasonography were treated with operative laparoscopy under video monitoring (videopelviscopy) as an alternative to laparotomy. Ectopic pregnancy, ovarian and non-ovarian cysts, pelvic adhesions, endometriosis, and fibroids were found, for which salpingotomy, salpingectomy and salpingo-oophorectomy, cystectomy, adhesiolysis, thermocoagulation, and myomectomy were carried out by laparoscopy. In one patient pelviscopy was repeated because of persistent tubal pregnancy after the fimbria was expressed. Laparotomies were carried out on three patients because treatment was not possible by laparoscopy and on a further patient two days after adhesiolysis had been attempted. These were the only serious complications. For the 46 cases (45 patients) in which operative laparoscopy was successful the mean stay in hospital was 1.9 days after operation, and this group of patients returned to normal activities and to work after an average of 2.3 and 2.6 weeks respectively. Most gynaecological emergencies that are managed by laparotomy can be treated by laparoscopy and benefit both patients and the health service.
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PMID:Managing gynaecological emergencies with laparoscopy. 252 9

Complete or incomplete transverse vaginal septum is a rare malformation of the female genital tract. Usually the complete congenital type occurs at puberty because of the collection of menstrual blood above the septum with amenorrhea and cyclic lower abdominal pain as presenting symptoms. On the contrary, in the case shown by the authors, the subacute epilogue occurred in the perimenopausal phase: a very large colpohematometra is reported in a 49 years old woman, with an incomplete vaginal septum resulting in progressive obstruction. The association between this malformation and the presence of endometriotic localizations in the genital tract, as reported by other authors, is interesting. In this case, endometriosis can be secondary to the presence of the septum or could have determined the impairment of the obstruction in consequence of the associated status of chronic flogosis.
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PMID:[Large colpohematometra with bilateral hematosalpinx resulting from progressive obstruction caused by incomplete vaginal septum]. 266 23

The clinical and pathologic features of four new and eight previously reported primary carcinomas of the broad ligament have been reviewed. The patients' ages ranged from 29 to 70 years (average, 46) and the most common clinical presentations were vague lower abdominal pain, a palpable pelvic mass, and an associated disorder such as pelvic endometriosis. The tumors ranged from 4.5 to 13 cm in greatest dimension and were solid, cystic, or mixed. All of them were unilateral. Review of the pathologic descriptions and illustrations of the cases in the literature and microscopic review of one reported case revealed that four of the tumors were endometrioid carcinomas, four were clear cell carcinomas, one was probably a mucinous adenocarcinoma, two were papillary adenocarcinomas of undetermined cell type, and one was a serous papillary cystadenoma of borderline malignancy with microinvasion. Three patients were treated by excision of the tumor alone. Seven of them were treated by total abdominal hysterectomy and salpingo-oophorectomy; three patients received postoperative radiation therapy, and one of them also received chemotherapy. Eight patients were free of disease 6 months to 7 years postoperatively, and one patient with distant metastasis (rib) at the time of operation lived for 27 months. In three cases no follow-up data were available. Three of the four patients in current series were found to have pelvic endometriosis at the time of operation. Three of their carcinomas were endometrioid and one was of clear cell type, suggesting the possibility of an origin from endometriotic tissue in the broad ligament.
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PMID:Primary carcinoma of the broad ligament. Report of four cases and review of the literature. 267 5

Endometriosis is a disease characterized by the occurrence of ectopic endometrium, most frequently in the pouch of Douglas and the ovaries. The disease is diagnosed at operation and occurs practically exclusively in women of fertile age. The symptoms are, in particular, diffuse low abdominal pain, dyspareunia, infertility and dysmenorrhoea. The prevalence of the disease is unknown but has been estimated as about 1-2%. The etiology is still unknown. The classical theories about 1) retrograde implantation of endometrium from menstruation and 2) metaplasia of the coelom epithelium are still current. A series of recent observations of increased macrophage activity, reduced cellular immunity and deviations in the complement system suggest, however, that special immunological factors also play a causal role. Endometriotic tissue has great morphological and biochemical similarities with endometrium and contains, similarly, receptors for steroid sex hormones but in lower concentrations and with an increased relationship between progesterone and oestrogen receptors. The pathophysiological basis for the infertility correlated with the disease is only partially understood. Apart from obvious anatomical causes, the occurrence of the luteinized unruptured follicle syndrome and alterations in the content of steroid hormones and prostaglandins in the peritoneal fluid are possible causes.
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PMID:[Endometriosis--new perspectives. 1. Pathology and physiopathology]. 267 28

Endometriosis affects 8%-15% of all women, and of these 3%-37% have intestinal involvement. Affected women are typically of childbearing age and of low parity, with a history of cyclic abdominal pain and progressive dysmenorrhea. Endometriosis may involve the rectum and sigmoid, ileum, cecum, and appendix, generating symptoms suggestive of acute obstruction, appendicitis, ileitis, diverticulitis, or colonic carcinoma. Thus, this entity should be included in the differential diagnosis of recurrent abdominal pain and other episodic bowel symptoms in women of childbearing age.
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PMID:Intestinal endometriosis and its complications: case report and review. 267 1


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