Images in Gynecologic Surgery
Intraperitoneal Endocervical Eversion Hugo D. Ribot Jr., MD* From the Georgia Advanced Surgery Center for Women, Cartersville, Georgia.
DISCUSS
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A 37-year-old woman, para 3003, status post laparoscopic supracervical hysterectomy approximately 5 years earlier, came to the emergency department because of acute onset of pelvic and right adnexal pain. Examination revealed free fluid in the pelvis and a substantially enlarged right adnexa. Doppler studies suggested ischemia due to absence of pulsatile flow. The patient was counseled about the likely diagnosis of adnexal torsion, and informed consent was obtained for laparoscopy with possible salpingo-oophorectomy. At surgery, the preoperative diagnosis was confirmed, and the right tube and ovary were found to be diffusely ecchymotic, edematous, and friable, with areas of ischemic necrosis. There were no adhesions to either adnexa or to the cervical stump or pelvic peritoneum, although the omentum was adherent to the anterior parietoperitoneum near the bladder at the anterior pelvic brim. Adhesiolysis was easily performed usingmonopolar cautery to restore normal anatomy. An uncomplicated right adnexectomy was performed using endoloop ligation of the right infundibulopelvic pedicle. After irrigation and aspiration of all intraperitoneal blood and fluid was completed, the findings documented photographically (Fig. 1)were noted. The endocervical epithelium, which was substantially everted intraperitoneally,
The author has no commercial, proprietary, or financial interest in the products or companies described in this article. Corresponding author: Hugo D. Ribot, Jr., MD, Cartersville Ob/Gyn Associates, 958-A Joe Frank Harris Pkwy, Ste 102, Cartersville, GA 30121. E-mail: [email protected] Submitted April 6, 2013. Accepted for publication May 5, 2013. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2014 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2013.05.014
Fig. 1 (A–C) Cervical stump seen at laparoscopy. Note prominence of the upper endocervical epithelial eversion on the peritoneal side of the cervix.
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was excised using monopolar instrumentation, and fulguration of the upper cervical canal was also performed. Of interest, the patient had no history of cyclic bleeding or intraperitoneal irritation to suggest residual endometrium of the upper cervical canal/lower uterine segment.
Journal of Minimally Invasive Gynecology, Vol 21, No 1, January/February 2014
Histologic analysis of the excised ‘‘rosebud’’ of everted tissue was consistent with endocervical epithelium with no atypical or inflammatory changes. The patient was managed as an outpatient, and had an uneventful recovery.
Intraperitoneal Endocervical Eversion Hugo D. Ribot Jr., MD* From the Georgia Advanced Surgery Center for Women, Cartersville, Georgia.
DISCUSS
You can discuss this article with its authors and with other AAGL members at http://www.AAGL.org/jmig-21-1-JMIG-D-13-00213R1
Use your Smartphone to scan this QR code and connect to the discussion forum for this article now* * Download a free QR Code scanner by searching for ‘‘QR scanner’’ in your smartphone’s app store or app marketplace.
A 37-year-old woman, para 3003, status post laparoscopic supracervical hysterectomy approximately 5 years earlier, came to the emergency department because of acute onset of pelvic and right adnexal pain. Examination revealed free fluid in the pelvis and a substantially enlarged right adnexa. Doppler studies suggested ischemia due to absence of pulsatile flow. The patient was counseled about the likely diagnosis of adnexal torsion, and informed consent was obtained for laparoscopy with possible salpingo-oophorectomy. At surgery, the preoperative diagnosis was confirmed, and the right tube and ovary were found to be diffusely ecchymotic, edematous, and friable, with areas of ischemic necrosis. There were no adhesions to either adnexa or to the cervical stump or pelvic peritoneum, although the omentum was adherent to the anterior parietoperitoneum near the bladder at the anterior pelvic brim. Adhesiolysis was easily performed usingmonopolar cautery to restore normal anatomy. An uncomplicated right adnexectomy was performed using endoloop ligation of the right infundibulopelvic pedicle. After irrigation and aspiration of all intraperitoneal blood and fluid was completed, the findings documented photographically (Fig. 1)were noted. The endocervical epithelium, which was substantially everted intraperitoneally,
The author has no commercial, proprietary, or financial interest in the products or companies described in this article. Corresponding author: Hugo D. Ribot, Jr., MD, Cartersville Ob/Gyn Associates, 958-A Joe Frank Harris Pkwy, Ste 102, Cartersville, GA 30121. E-mail: [email protected] Submitted April 6, 2013. Accepted for publication May 5, 2013. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ - see front matter Ó 2014 AAGL. All rights reserved. http://dx.doi.org/10.1016/j.jmig.2013.05.014
Fig. 1 (A–C) Cervical stump seen at laparoscopy. Note prominence of the upper endocervical epithelial eversion on the peritoneal side of the cervix.
26
was excised using monopolar instrumentation, and fulguration of the upper cervical canal was also performed. Of interest, the patient had no history of cyclic bleeding or intraperitoneal irritation to suggest residual endometrium of the upper cervical canal/lower uterine segment.
Journal of Minimally Invasive Gynecology, Vol 21, No 1, January/February 2014
Histologic analysis of the excised ‘‘rosebud’’ of everted tissue was consistent with endocervical epithelium with no atypical or inflammatory changes. The patient was managed as an outpatient, and had an uneventful recovery.
