[Pneumoperitoneum is not always caused by bowel perforation: a case report of vaginal cuff dehiscence].

Postcoital vaginal cuff dehiscence is a rare but well documented complication of hysterectomy. Common symptoms are vaginal bleeding and abdominopelvic pain with or without evisceration of the intraperitoneal contents through the separated vaginal cuff, which can lead to bowel injury, necrosis and sepsis. This potentially life-threatening condition usually occurs during the first postoperative act of intercourse or within the first few months of surgery. This case report presents the unusual case of vaginal cuff dehiscence in a 59-year-old woman 14 years after a total abdominal hysterectomy.

Body mass index influences the risk of reoperation after first-time surgery for pelvic organ prolapse. A Danish cohort study, 2010-2016.

INTRODUCTION AND HYPOTHESIS: The aims of this study were to evaluate the impact of body mass index (BMI) on the risk of reoperation for pelvic organ prolapse (POP) up to 5 years after first-time surgery. MATERIALS AND METHODS: This nationwide register-based study includes first-time POP surgery in 2010 through 2016. The cumulative incidence proportions of reoperation were analyzed in a Cox regression model and described using Kaplan-Meier plots stratified in BMI categories. RESULTS: A total of 28,533 first-time procedures were performed in 22,624 women; 76.6% had single-compartment repair. The 1- and 5-year reoperation rate within the same compartment was 2.6% and 6.1% respectively for women with BMI < 25, and for women with BMI > 35 it was 3.7% and 11.2 respectively. In the anterior compartment there was a significantly increased adjusted hazard ratio for reoperation in the same compartment with increasing BMI (reference group BMI < 25), BMI 30-34.9 with an aHR = 1.34 (CI 95% 1.04-1.71) and BMI ≥ 35 aHR = 1.77 (CI 95% 1.17-2.67). The 1- and 5-year reoperation rate in an adjacent compartment was 0.6% and 1.6% respectively for women with BMI < 25, and for women with BMI > 35 it was 1.0% and 4.4 respectively. For reoperation in an adjacent compartment the adjusted results were BMI 30-34.9 aHR = 1.64 (95% CI 1.05-2.56) and BMI > 35 aHR = 2.64 (95% CI 1.36-5.14) when the first-time operation was in the anterior compartment. CONCLUSIONS: If the woman had BMI > 35 and first-time surgery was in the anterior compartment, she had an almost doubled risk of reoperation within 5 years both in the same compartment and in an adjacent compartment compared to women with BMI < 35. In the apical and posterior compartment there was a trend towards increasing risk of reoperation with increasing BMI, although with a broad confidence interval.

Influence of body mass index on short-term subjective improvement and risk of reoperation after mid-urethral sling surgery.

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate the impact of body mass index (BMI) on the subjective improvement and risk of reoperation after first-time mid-urethral sling surgery. METHODS: Data were retrieved from the national Danish Urogynaecological Database, including women with first-time surgery with mid-urethral polypropylene slings from 2011 to 2016. The subjective improvement was assessed by the difference in symptoms based on the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) completed pre- and 3 months postoperatively. A reoperation was defined as any new surgical procedure for stress urinary incontinence performed within the study period. RESULTS: During the study period, 6,414 mid-urethral sling procedures were performed; 80.0% of these women filled out both pre- and post-surgical International Consultation on Incontinence Questionnaire (ICI-Q) forms. 42.4% had a BMI < 25, 34.6% had BMI 25-30, 16.9% had BMI 30-35, and 6.0% BMI >35. The subjective improvement after surgery was high in all BMI categories and there were no differences between the categories. The overall cumulative hazard proportion at 2 years of follow-up was 1.9% (CI 95%: 1.6-2.3) and after 5 years 2.4% (CI 95%: 2.0-2.9). Adjusted for age, smoking, and use of alcohol, the cumulative hazard proportion after 2 years of follow-up was 3.2% (CI 95%: 1.6-6.2) for women with BMI >35 and after 5 years 4.0% (CI 95%: 2.0-7.7), which was the highest proportion of reoperation in the study. The crude hazard ratio was 1.84 (CI 95%: 0.89-3.83) women with BMI >35 and the adjusted hazard ratio was 1.94 (CI 95%: 0.92-4.09). CONCLUSIONS: We found high subjective improvement after the first-time surgery unrelated to BMI. Women with a BMI over 35 had the highest proportion of reoperations, although this was not statistically significant.

[Spontaneous rupture of uteroovarian veins in 3rd trimester]. / Spontan bristning af varicøs parametrievene i tredje trimester.

Spontaneous rupture of uteroovarian veins in pregnancy is rare and is a serious complication with a high mortality for both mother and infant. The condition is rarely recognized preoperatively. Patients often present themselves with sudden intense abdominal pain and hypovolemic shock and when fetal distress an abnormal CTG is seen. The acute treatment should consist of maintaining circulating intravascular volume and rapid surgical intervention.