Necrosis Of Uterus Research Articles

Vaginal omentum prolapse due to uterine anterior wall necrosis after prophylactic compression suture for postpartum hemorrhage: case report and review of the literature

Abstract Introduction Postpartum or peripartum hemorrhage (PPH) is a major cause of maternal death in Western industrialized countries. Fertility preserving second stage interventions following uterotonic drugs include embolization or ligation of relevant arteries, uterine tamponade or compression sutures. Little is known about the complications due to uterine compression sutures. We describe a case report in association with uterine compression sutures and provide a systematic review on necrosis due to compression sutures (CSU). Data sources A PubMed database search was done up to October 1, 2016 without any restrictions of publication date or journal, using the following key words: “compression suture” and “postpartum hemorrhage” or “peripartum hemorrhage”. Reported cases were considered eligible when reason for postpartum hemorrhage (PPH), type of compression suture, suture material and type of complication were described. Results Among 199 publications a total of 11 reported on uterus necrosis after CSU applied for PPH. B-Lynch and modifications were applied in seven cases, Cho compression sutures in three cases and in one case B-Lynch and Cho techniques were combined. In six cases no additional measures were applied, in two cases vessel ligation, in one case embolization and in one case intrauterine balloon application were applied. In one case of partial necrosis it is not reported if additional measures were applied. Discussion and conclusion Uterine compression sutures are a useful method for fertility preserving management of postpartum hemorrhage. The risk of serious complications demands the careful consideration of its use. More research is necessary to improve the technique.

Uterusnekrose nach Radiochemotherapie lokal fortgeschrittener Zervixkarzinome

Simultaneous platinum-based radiochemotherapy is the standard of care for patients with advanced or node-positive cancer of the uterine cervix. A large body of literature concerning therapy-related acute and late morbidity is available. Chemoradiation-associated necrosis of the uterus has not been described so far. Two patients are reported who were treated by combined chemoradiation between 2004 and 2005 for histologically confirmed cervical cancer following laparoscopic staging. Both patients were diagnosed with squamous cell cancer of the cervix FIGO stage IIB (T2b pN1 pM1 LYM G2) and FIGO IIIA (T3a pN1 M0 G2), respectively. External-beam radiotherapy was applied in a 3-D-planned four-field technique, covering pelvic lymph nodes and primary tumor. Patient #1 received additional paraaortic irradiation. Patient #2 underwent 5 x 5 Gy brachytherapy covering the tumor. Simultaneously, cisplatin was given to both patients. Following chemoradiation, both patients developed pelvic pain and an elevation of C-reactive protein (CRP) in the presence of a normal leukocyte count. Both patients underwent relaparoscopy, and necrosis of the uterus combined with partial necrosis of the bladder was diagnosed in patient #1. Patient #1 underwent total supralevatoric exenteration and patient #2 laparoscopically assisted hysterectomy with bilateral salpingo-oophorectomy. In patients with persisting or incident pelvic pain, questionable findings in imaging techniques and/or elevated inflammation parameters following completion of chemoradiation for cervical cancer, differential diagnosis should include radiogenic necrosis of the uterus and other pelvic organs. Laparoscopy is an ideal technique to exclude or confirm this diagnosis.

Uterus Necrosis after Radiochemotherapy for Locally Advanced Cervical Cancer - A Case Report

Hintergrund: Die simultane platinbasierte Radiochemotherapie ist die Standardbehandlung für lokal fortgeschrittene und/oder nodalpositive Karzinome der Cervix uteri. Umfangreiche Literatur zur therapiebedingten Akut- und Spättoxizität ist verfügbar. Eine radiochemotherapiebedingte Nekrose des Uterus wurde bisher nicht beschrieben. Material, Methoden und Ergebnisse: Wir berichten über eine Patientin, die 2004 aufgrund eines Zervixkarzinoms nach laparoskopischem paraaortalen und pelvinen Staging kombiniert radiochemotherapiert wurde. Es handelte sich um ein Plattenepithelkarzinom der Zervix uteri im Stadium FIGO IIIA (T3a pN1 M0 G2). Die perkutane Strahlentherapie wurde in 3D-geplanter Mehrfeldertechnik bis 54 Gy durchgeführt. Die Patientin erhielt eine Afterloading-Therapie mit 5 × 5 Gy Einzeldosis tumorumschließend sowie eine simultane Chemotherapie mit Cisplatin. Vier Monate nach Therapieende entwickelte die Patientin pelvine Schmerzen, verbunden mit einer CRP-Erhöhung bei normalen Leukozytenwerten. MRT-morphologisch wurde ein Rezidiv vermutet. Zum Ausschluss bzw. Nachweis eines Rezidivs wurde eine erneute Laparoskopie durchgeführt, die eine Uterusnekrose ergab. Aufgrund des intraoperativen Befundes wurde bei der Patientin eine laparoskopisch assistierte Hysterektomie durchgeführt. Schlussfolgerung: Bei Patientinnen nach abgeschlossener Radiochemotherapie eines Zervixkarzinoms mit persistierenden oder neu aufgetretenen Schmerzen im Becken, unklaren Befunden in der bildgebenden Diagnostik und bei erhöhten Entzündungsparametern sollte eine radiogene Nekrose differenzialdiagnostisch in Erwägung gezogen werden. Die Diagnosestellung ist mittels Laparoskopie sicher möglich.

Fetal death with retention of fetus in utero and necrosis of uterus: Dr. Albert B. Davis presented a case of

Fetal death with retention of fetus in utero and necrosis of uterus: Dr. Albert B. Davis presented a case of