Iliopsoas abscess: an unexpected sequela of dilation and evacuation.

OBJECTIVE: This study aimed to report the case of a patient who developed an iliopsoas abscess after a dilation and evacuation for a midtrimester fetal demise. MATERIALS AND METHODS: This is a case report of a 35-year-old woman who underwent a dilation and evacuation at 17 weeks' gestation because of a preterm premature rupture of membranes and fetal demise. Four days later, she presented with fevers, chills, malaise, and right lower back, hip, and thigh pain. Magnetic resonance imaging of the abdomen and pelvis revealed a 2.3 × 1.6-cm right iliopsoas abscess. RESULTS: The patient underwent computed tomography-guided drainage of the abscess and made an uneventful recovery after completion of an antibiotic course and physical therapy. CONCLUSIONS: An iliopsoas abscess should be considered in the differential diagnosis of any woman presenting with fevers, chills, and unilateral lower back, hip, and thigh pain in a radicular pattern after a recent dilation and evacuation.

Retained viable single intrauterine pregnancy after vacuum aspiration for a dichorionic-diamniotic twin pregnancy.

BACKGROUND: Retained viable intrauterine pregnancy is an infrequent complication of vacuum aspiration. We report a case of a retained single intrauterine pregnancy after an elective vacuum aspiration of a dichorionic-diamniotic twin gestation. CASE: A patient presented to the emergency department reporting vaginal spotting, breast engorgement, and lower abdominal cramping for the previous 2 weeks. The patient had had an elective abortion 2 months previously. Transvaginal ultrasonography revealed an apparent twin gestational sac within the uterus. The presenting gestational sac contained a mixture of blood clot and tissue with no discernible fetal parts. The second sac contained a live fetus of approximately 15 weeks of gestation. CONCLUSION: An underreported complication of vacuum aspiration is a retained viable intrauterine pregnancy. There is a role for postoperative ultrasonography in complicated cases such as twin gestations or in very early pregnancies to avoid retained products of conception or the infrequent case of retained viable intrauterine pregnancy.

Hysteroscopic tubal occlusion: sterilization after failed laparoscopic or abdominal approaches.

BACKGROUND: When tubal ligations cannot be performed because of dense postoperative adhesions, options for female sterilization are very limited. As the incidence of cesarean delivery rises and the occurrence of peritubal adhesions increases, tubal ligation using abdominal or laparoscopic surgery may become increasingly technically difficult. Hysteroscopic tubal occlusion provides a method of permanent sterilization when an abdominal or laparoscopic approach is unsuccessful. CASES: Three patients with failed tubal ligations by abdominal or laparoscopic approaches were referred to our institution. Their cases were complicated by technically difficult surgeries with dense intraabdominal adhesions. Hysteroscopic tubal occlusion was successfully performed in each patient. CONCLUSION: Hysteroscopic tubal occlusion can be used for permanent sterilization when abdominal or laparoscopic approaches are not possible.