Cases Of Uterine Perforation Research Articles

Endometrial ablation by means of photodynamic therapy with photofrin II

OBJECTIVE: Photodynamic therapy is a technique in which tissue is irradiated with light after the use of a photosensitizing drug that produces singlet oxygen, which has a cytotoxic effect. The feasibility of using photodynamic therapy with photofrin II for endometrial ablation was studied.STUDY DESIGN: Fifty-eight rabbits were studied. Preferential uptake of photofrin II by endometrial tissue, compared with the myometrium, was established by drug extraction and fluorescence microscopy after administration of photofrin II intravenously. Dosimetry for endometrial ablation was established by administering photofrin II in 1, 2, 5, and 10 mg/kg doses and laser light (630 nm) at radiant exposures of 100 and 200 J/cm2. Histologic examination was performed at 24 hours, 5 days, and 10 days after treatment. There were two control groups. One group received laser light but no photofrin II, and the other received photofrin II without laser light.RESULTS: The concentration of photofrin II was three times higher in the endometrium than in the myometrium at doses of 1 and 2 mg/kg. Fluorescence microscopy of frozen sections of endometrium and myometrium showed a predominantly perivascular fluorescence from photofrin II. A dose of 1 and 2 mglkg and a flow of 100 J/cm2 was adequate for endometrial ablation in rabbits. At 24 hours after treatment there was extensive hemorrhage and evidence of cell death in the entire endometrium and mild hemorrhage in 10% to 50% of the inner circular layer of the myometrium. At 5 days after treatment necrosis of the entire endometrium and the inner half of the myometrium was seen, but the outer half of the myometrium and the serosa were normal. There were no cases of uterine perforation. Similar results were seen at 10 days after treatment, except for the additional presence of inflammatory cells. Neither control group (drug without light, light without drug) showed any injury to the endometrium at 24 hours.CONCLUSION: We conclude that endometrial ablation can be effectively achieved in rabbits by means of photodynamic therapy with photofrin II without significant complications. (AM J OBSTET GYNECOL 1992;167:1856-63.)

Resectoscopic myomectomy

To evaluate safety and efficacy of resectoscopic myomectomy for control of menorrhagia, dysmenorrhea, and/or reproductive wastage. Retrospective consecutive patient follow-up. Private practice, outpatient, hospital. All patients (92) having resectoscopic myomectomy between September 1, 1986 and December 31, 1989. Resectoscopic myomectomy with or without concomitant procedures such as endometrial ablation. Assessment of dysmenorrhea, menorrhagia, and reproductive outcome after surgery. Elimination of dysmenorrhea in 24 of 28, absence of menorrhagia in 65 of 80, and pregnancy in 10 of 13 with two abortions in a total of 11 gestations. One patient was admitted and treated with one unit of autologous blood and mechanical tamponade with an intrauterine balloon. Three cases of uterine perforation had no sequelae. One patient had mild endometritis responding to outpatient antibiotics. Two cases of leiomyosarcoma were diagnosed histologically and accounted for two of the three hysterectomies noted during follow-up. Resectoscopic myomectomy is a safe, effective, and relatively simple outpatient surgical procedure.

The frequency and management of uterine perforations during first-trimester abortions

The frequency and management of uterine perforation during first-trimester abortions remain a matter of continuing debate among gynecologists. The rate of uterine perforations was 1.3/1000 procedures (eight cases) in 6408 women undergoing first-trimester abortions at our clinic. We also performed 706 first-trimester abortions at the time of laparoscopic sterilization. Two perforations (2.8/1000 procedures) were reported before laparoscopy. Twelve (15.6/1000 procedures) unsuspected perforations were discovered during direct laparoscopic visualization. This represents a 19.8/1000 procedure rate of perforation (14 cases). All 22 patients with perforations were managed conservatively, and no immediate or late complications were noted. Our data suggest that the true incidence of uterine perforations is significantly underestimated and serious complications caused by perforations are rare. Conservative therapy is recommended rather than early surgical intervention.

Uterine perforation and embedding by intrauterine device: evaluation by US and hysterography.

Uterine perforation and deep embedding by an intrauterine device (IUD) require exact determination of its location as a necessary step to safe and effective retrieval. Six cases of uterine perforation and four of embedding by an IUD were studied with ultrasonography (US) and hysterography. While US findings suggested the correct diagnosis of perforation in five of the six cases, hysterography yielded more exact diagnostic information. Deep embedding could only be diagnosed with hysterography. A classification of the types of perforation and an algorithm for diagnosing ectopic IUD are presented. Undue reliance on the sonographic appearance of an IUD in the center of the uterine image may lead to hazardous attempts at transvaginal removal of a device that is partly intramural. In this study, hysterography offered the most precise diagnostic information.

Uterine perforation during intracavitary application. Prognostic significance in carcinoma of the cervix.

All cases of uterine perforation occurring during intracavitary application for carcinoma of the cervix over a 13-year period (1968-1981) were reviewed. There were 14 perforations out of 799 applications in 622 patients, for an incidence of 2.25% of patients and 1.75% of applications. In most cases, it is sufficient to halt the application and carefully monitor the patient, as supported by the uneventful post-perforation course in 12 cases. Nine patients (64%) underwent subsequent intracavitary application without further complications; of these, 8 are still living or died without evidence of tumor. In the other 5, it was impossible to locate the cervical canal on subsequent applications. Alternative treatments, results of therapy, and analysis of failures are presented. The authors conclude that there is no direct evidence that uterine perforation alters the prognosis following radiation therapy for carcinoma of the cervix.

A comparative study of the safety and efficacy of postabortal intrauterine contraceptive device insertion

At a hospital in Pusan, Korea, 1,104 Lippes Loop∗∗Ortho Pharm. Corp., Route 202, Raritan, New Jersey 08869. intrauterine contraceptive devices (IUD's) were inserted immediately after abortion. Acceptors experienced side effects no more often than did a nearly equal number of ordinary abortion patients at the same hospital. The incidence of leukorrhea was higher for postabortal IUD acceptors than for ordinary abortion patients, while the incidence of infection was actually somewhat less for the IUD acceptors. There were no cases of uterine perforation. These data and those from similar studies suggest that immediate postabortal IUD insertion is a medically safe and recommendable procedure. In addition, higher IUD continuation rates are likely to be observed.

Laparoscopic removal of a perforated copper T IUD: A case report

A case of uterine perforation by a copper T intrauterine device is described, in which the device was removed through a laparoscope, using the one-hole technique. The patient noted pain at the time of IUD insertion, three months postpartum, and complained of post-insertion. The diagnosis of perforation was confirmed by hysterography and the device was removed six months after insertion. At the time of laparoscopy, dense adhesions were noted between the copper portion of the device and the omentum, making the removal relatively difficult. It is recommended that extrauterine copper bearing devices be removed as early as possible after diagnosis to minimize the risk of adhesion formation.

RADIOGRAPHIC ASPECTS OF PERFORATED INTRAUTERINE CONTRACEPTIVE DEVICES

Small intestinal obstruction secondary to a perforated intrauterine contraceptive device (IUD) has been rarely reported and was not considered in many earlier reviews on the complications of these devices, although uterine perforation is a well recognized though infrequent complication. Some radiographic features of IUD perforation have only recently been considered (8). In Hall's analysis (12) of 19 proved cases of IUD perforation at the Sloane Hospital for Women he listed 2 associated with intestinal obstruction. Since his report, 3 additional cases of uncomplicated perforation have been diagnosed. The purpose of this paper is to assess the radiographic features of the 22 cases of uterine perforation and to present this entity as a possible cause of intestinal obstruction. Case Reports Case I: A 34-year-old Caucasian female, gravida VII, Para VI, had a Birnberg bow inserted in 1964, five weeks postpartum. With no history of its expulsion, she subsequently delivered a normal full-term infant in September...

Traumatic perforation of the uterus following attempted self-induced abortion with a rubber catheter

1. Four cases are herein reported in which a rubber catheter was introduced by the patient into the uterine cavity for the purpose of abortion. At laparotomy, in three of the cases, the major portion of the catheter was found in the peritoneal cavity, having perforated the uterine wall. In one case, the catheter was found in the uterine cavity.2. In the three cases of uterine perforation, the catheter was removed and the uterine rent was repaired. In the case of pregnancy and the catheter within the uterus, a hysterotomy was performed with removal of the uterine contents.3. Three of the patients aborted; the fourth, with the intact uterus, had a hysterotomy and evacuation of the uterine contents.4. All of the patients had an uneventful postoperative course following laparotomy.5. In all four cases the rubber catheter was visualized on x-ray.

Treatment of uterine perforation

The treatment of 34 cases of uterine perforation caused by curettage for post-abortion bleeding and commenced abortion yielded the following results: conservative treatment 3 sl -, O death, laparotomy, drainage 1 sl -1 death, laparotomy, uterine suture 3 cases-0 death, abdominal uterine extirpation 22 sl -2 deaths. The total mortality rate was 9% (3 : 34).