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Dipak LIMBACHIYA

Eva Women's Hospital & Endoscopy Centre
Ahmedabad , Индия
MDDGO
239 лайков
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Laparoscopic management of extrauterine leiomyomas
Uterine leiomyomas affect 20 to 30% of women older than 35 years. Extrauterine leiomyomas are rarer, and they present a greater diagnostic challenge. These histologically benign leiomyomas occasionally occur with unusual growth patterns or in unusual locations which make their identification more challenging both clinically and radiologically. Unusual growth patterns may be seen, including benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. Diffuse peritoneal leiomyomatosis manifests as innumerable peritoneal nodules resembling those in peritoneal carcinomatosis. Parasitic leiomyoma and retroperitoneal leiomyomatosis usually manifest as single or multiple pelvic or retroperitoneal masses. Retroperitoneal growth is yet another unusual growth pattern of leiomyomas. Multiple leiomyomatous masses are usually seen in the pelvic retroperitoneum in women with a concurrent uterine leiomyoma or a history of uterine leiomyoma. Rarely, the extrauterine masses may extend to the upper retroperitoneum, as high as the level of the renal hilum. Occasionally, leiomyomas become adherent to surrounding structures (e.g., broad ligament, omentum, or retroperitoneal connective tissue), develop an auxiliary blood supply, and lose their original attachment to the uterus, hence becoming “parasitic.” We are presenting a case of extrauterine leiomyoma, which was operated for laparoscopic myomectomy for huge cervical leiomyoma 4 years back but was converted to an abdominal myomectomy.
Хирургические операции
3 года назад
2898 просмотров
174 лайка
0 комментариев
09:11
Laparoscopic management of extrauterine leiomyomas
Uterine leiomyomas affect 20 to 30% of women older than 35 years. Extrauterine leiomyomas are rarer, and they present a greater diagnostic challenge. These histologically benign leiomyomas occasionally occur with unusual growth patterns or in unusual locations which make their identification more challenging both clinically and radiologically. Unusual growth patterns may be seen, including benign metastasizing leiomyoma, disseminated peritoneal leiomyomatosis, intravenous leiomyomatosis, parasitic leiomyoma, and retroperitoneal growth. Diffuse peritoneal leiomyomatosis manifests as innumerable peritoneal nodules resembling those in peritoneal carcinomatosis. Parasitic leiomyoma and retroperitoneal leiomyomatosis usually manifest as single or multiple pelvic or retroperitoneal masses. Retroperitoneal growth is yet another unusual growth pattern of leiomyomas. Multiple leiomyomatous masses are usually seen in the pelvic retroperitoneum in women with a concurrent uterine leiomyoma or a history of uterine leiomyoma. Rarely, the extrauterine masses may extend to the upper retroperitoneum, as high as the level of the renal hilum. Occasionally, leiomyomas become adherent to surrounding structures (e.g., broad ligament, omentum, or retroperitoneal connective tissue), develop an auxiliary blood supply, and lose their original attachment to the uterus, hence becoming “parasitic.” We are presenting a case of extrauterine leiomyoma, which was operated for laparoscopic myomectomy for huge cervical leiomyoma 4 years back but was converted to an abdominal myomectomy.
Laparoscopic management of bladder endometriosis
Endometriosis is an enigmatic disorder, which affects women in their reproductive age. Failure of recent clinical trials on non-surgical management of endometriosis confirms the role of surgery as a viable treatment of choice. However, recurrence after surgery is common. Recurrence rate varies according to the surgeon’s skills, instrumentation, surgical techniques, and to the postoperative intervention outcome. In patients with severe endometriosis, lesions usually involve the posterior cul-de-sac, anterior rectum, one or both pelvic sidewalls, involving the ureters, the rectosigmoid, and less commonly the anterior bladder, the appendix, and the small bowel. Ureteral retroperitoneal dissection becomes mandatory in extensive endometriosis due to pelvic anatomical distortion. It also leaves the bowel intact without injuring it as the pseudo-peritoneum is lifted along with the inflamed bowel. Consequently, in the surgical practice of benign pathologies, a proper knowledge of the retroperitoneal anatomy ensures complete clearance in cases of advanced endometriosis and frozen pelvis. Here, we present a very interesting case of bladder endometriosis associated with hematuria during menstruation. Partial cystectomy is the treatment of choice for patients with bladder endometriosis in most cases. Provided surgeons are skilled and lesions require no ureteral reimplantation, operative laparoscopy is a valid alternative to laparotomy for partial cystectomy.
Хирургические операции
4 года назад
2166 просмотров
65 лайков
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06:56
Laparoscopic management of bladder endometriosis
Endometriosis is an enigmatic disorder, which affects women in their reproductive age. Failure of recent clinical trials on non-surgical management of endometriosis confirms the role of surgery as a viable treatment of choice. However, recurrence after surgery is common. Recurrence rate varies according to the surgeon’s skills, instrumentation, surgical techniques, and to the postoperative intervention outcome. In patients with severe endometriosis, lesions usually involve the posterior cul-de-sac, anterior rectum, one or both pelvic sidewalls, involving the ureters, the rectosigmoid, and less commonly the anterior bladder, the appendix, and the small bowel. Ureteral retroperitoneal dissection becomes mandatory in extensive endometriosis due to pelvic anatomical distortion. It also leaves the bowel intact without injuring it as the pseudo-peritoneum is lifted along with the inflamed bowel. Consequently, in the surgical practice of benign pathologies, a proper knowledge of the retroperitoneal anatomy ensures complete clearance in cases of advanced endometriosis and frozen pelvis. Here, we present a very interesting case of bladder endometriosis associated with hematuria during menstruation. Partial cystectomy is the treatment of choice for patients with bladder endometriosis in most cases. Provided surgeons are skilled and lesions require no ureteral reimplantation, operative laparoscopy is a valid alternative to laparotomy for partial cystectomy.