Spontaneous Ruptured Uterus in an Adolescent With Polycystic Ovarian Syndrome and Endometrial Hyperplasia.

Uterine diverticula and rudimentary horns are rare forms of uterine anomalies that occur during embryogenesis. They can communicate with the endometrial cavity and may have the potential to develop pathology. This case report presents an obese, anovulatory adolescent with polycystic ovarian syndrome who was admitted with acute abdominal pain and found to have radiological findings that were concerning for a ruptured mass contiguous with the uterine cavity, which was likely a uterine horn or diverticulum. Further evaluation revealed simple hyperplasia without atypia on endometrial sampling, supporting the surgical resection and subsequent medical management of this young patient.

Management of severe anemia secondary to menorrhagia in a Jehovah's Witness: a case report and treatment algorithm.

We report a 44 year old nulligravida Jehovah's Witness with a known fibroid uterus who presented with menorrhagia and life-threatening anemia. Adamant in her refusal of blood products and deemed too unstable for surgical management, the patient was managed conservatively by a multidisciplinary team.

Developing a visual aid to improve women's knowledge of hysterectomy.

BACKGROUND: Female reproductive anatomy and physiology, compounded by low health literacy, can result in limited patient understanding of gynecologic procedures, complicating the already challenging patient decision-making process. OBJECTIVE: Describe a process of developing an effective visual aid that accurately communicates the risks, benefits, and possible outcomes of hysterectomy surgical approaches. PATIENT INVOLVEMENT: None. METHODS: This qualitative study was performed in a private practice and an academic institution with a total of 8 female non-clinical employees in the English-speaking group and 9 non-employees in the Spanish-speaking group. A 5-minute video focusing on the hysterectomy procedure was developed and shown to focus group participants. A discussion led by a sociologist obtained feedback regarding understanding and perceptions of video content to validate the tool, which was analyzed to extract themes that could guide refinements. RESULTS: Focus group participants wanted more information on post-hysterectomy quality of life and desired a longer video that included more general information about hysterectomies. All participants felt the video would be a valuable aid if watched prior to undergoing a hysterectomy and would be an effective tool for improving patient communication. DISCUSSION: While there was strong support for the video-based patient education program, participants found some elements confusing (e.g., type and magnitude of risk, scope of aftercare) and expressed interest in more in-depth information. Our development process would have been enhanced by involving patients before the initial version of the video was created, holding more and more diverse focus groups and ensuring that translation was both accurate and culturally appropriate. PRACTICAL VALUE: This study offers lessons learned in the process of developing a video-based visual aid for improving women's knowledge of hysterectomy and may inform other efforts to help patients understand complex medical pathology and procedures.

The role of hand assist laparoscopic surgery (HALS) in pelvic surgery for nonmalignant disease.

OBJECTIVE: Hand assist laparoscopic surgery (HALS) is a surgical modality rarely used in benign gynecology. We analyzed nonmalignant pelvic disorders that utilized HALS to see whether there is any benefit over standard laparotomy. METHODS: A case control chart review identified patients who underwent HALS for a variety of benign gynecological conditions from 2004 through 2007. Cases were then compared with a control group of all the patients who underwent similar procedures for the same diagnosis via laparotomy (ELAP) in our center within the same time period. The groups were comparable with respect to age, BMI, and surgical indication. RESULTS: Twenty-nine patients were analyzed: 12 cases (HALS) and 17 controls (ELAP). Each group was broken up into 2 subsets: Group A, older patients who underwent surgery for pelvic organ prolapse or diverticulitis with adnexectomy and Group B, younger patients who underwent surgery for pelvic pain, endometriosis, or both. Hospital stay in Group B was statistically lower in the HALS cases vs. the ELAP controls, (2.9 vs. 5.4 days, P=0.04). All HALS and ELAP patients were then analyzed for overall trends. HALS cases had shorter hospitalization than ELAP controls had (3.3 vs 4.5 days, P=0.035). Estimated blood loss was also less overall in the HALS cases vs. the ELAP controls (175 vs 355.9 mL, P=0.021). There were 2 adverse outcomes reported in Group A of the HALS cases. These 2 patients experienced postoperative hernias though the hand-assist port-site incision. CONCLUSION: Compared with laparotomy, overall, HALS offers the advantage of decreased hospitalization and decreased intraoperative blood loss. Postoperative hernias through the HA port site may be a potential problem with this technique.

Patient Understanding of Uterine Fibroids and the Different Surgical Approaches to Hysterectomy.

Objective: The purpose of this study was to assess understanding of the hysterectomy procedure and uterine fibroids among women in a general gynecology clinic. Materials and Methods: This was an anonymous cross-sectional survey. We adapted and pilot tested a survey instrument designed to assess understanding of the hysterectomy procedure and of uterine fibroids. The final version of the survey consisted of basic demographic questions, followed by 28 knowledge questions (Canadian Task Force Classification II-2). The survey was disseminated to women in the waiting room of one of our gynecology clinics. The patient population included women 18 years and older. Results: The mean age of respondents was 33.5 years old. In total, 69.5% of the respondents had at least some college education. In the group of questions related to different types of hysterectomies, the most poorly answered question was "Which type of hysterectomy has the highest risk of damage to the bladder?" Less than 40% of the respondents were able to identify a laparoscopic and robotic hysterectomy based on a written description. Of questions about uterine fibroids, the most poorly answered question was whether cancer that looks like fibroids is common, with >90% of the respondents incorrectly thinking that cancer that resembled fibroids is common. More than half of respondents did not know what a fibroid is. Conclusions: In this analysis of the understanding of the hysterectomy procedure and fibroids among an educated population, overall understanding was poor. Specific areas where knowledge was particularly poor were the different ways of doing a hysterectomy and uterine fibroids.

Hand-assist laparoscopic surgery for the gynecologic surgeon.

BACKGROUND: Hand assist laparoscopy (HALS) is a minimally invasive technique which allows for the placement of the surgeon's non-dominant hand through a hand-port device while maintaining pneumoperitoneum. There is no standardization of this procedure and it is rarely used in gynecology. METHODS: The multidisciplinary team of authors, with experience in minimally invasive pelvic surgery, has developed a practical approach performing HALS over several years. Here we present our technique. CONCLUSIONS: There are several roles for HALS in the world of gynecology and pelvic surgery. Further experience will help improve upon a standard technique.

Surgical Planning and Counseling in Adolescence: A Case Report of a 16-Year-Old with an Aborting Pelvic Mass.

This case illustrates a rare finding and successful treatment of an aborting fibroid in a virginal adolescent. Careful consideration for the exam process, specific counseling, surgical planning and approach in this case are presented.

Resection of a vulvar arteriovenous malformation in a premenarchal patient.

BACKGROUND: Arteriovenous malformation of the vulva is described in only a few case reports in the literature. Given the complex anatomy of the vulva, arteriovenous malformations in this location present a particularly challenging treatment dilemma. CASE: An 11-year-old premenarchal girl with a large vulvar arteriovenous malformation was monitored for several years. After three episodes of bleeding, despite conservative management with embolization, she was taken urgently to the operating room for resection of the lesion. A multidisciplinary team participated in the 12-hour procedure. Several months after the initial surgery, the patient is without complaints and adjusting well. Labial reduction will be required once she is fully grown. CONCLUSION: Arteriovenous malformations of the vulva require treatment before the onset of menarche because of the potential for massive hemorrhage. If first-line conservative treatment with embolization fails, a multidisciplinary team should be assembled for surgical treatment.