Coincidental finding of pelvic splenosis during gynecological surgery.

OBJECTIVE: To describe a case of coincidental finding of splenosis during gynecological laparoscopic surgery. DESIGN: Case report. SETTING: Department of gynecology and obstetrics, Hospital of Frýdek-Místek. CASE REPORT: We describe the case of coincidental perioperative finding of pelvic tumorous mass that was later histologicaly verified as accsessory spleen or splenosis. CONCLUSION: Ectopic spleen is mostly random finding with no symptoms observed. Rarely it can cause pelvic pain or mimick adnexal malignity or endometriosis. It is neccesery to keep this rare diagnosis in mind, mainly at patients with splenic trauma or splenectomy in their medical history to preserve immunological function of this splenic tissue.

Anatomy and biomechanic of the musculus levator ani.

OBJECTIVE: The aim of the rewiew is to provide complex new informations about anatomy and biomechanics features of the musculus levator ani. Described are risk factors leading to it´s injury and options of imaging the muscle complex (ultrasound, magnetic imaging resonance and 3D modeling). DESIGN: Review. SETTINGS: Departement of Obstetrics and Gynaecology, Hospital in Frýdek-Místek, GONA Co. Ltd , Institute for Mother and Child Prague. RESULTS: Musculus levator ani (MLA) has a complex structure composed mainly of striated muscles. Minority of smooth muscle fibres are also found. Particular parts of the MLA hold together different angles. Inervation is provided through somatic and visceral nerve fibres. During delivery, more there three times stretching of the muscle was observed. Less strenght is needed do the same stretching of the muscle in repeating stress situations. In the MRI studies, two types of injury of the MLA, were found. Predisponed to the injury is medial part of the MLA known as pubovisceral muscle (PVM). PVM has three insertions. The most fragile is it´s medial insertion to the pubic bone described as enthesis. During experimental delivery studies was found, that the pressure in this part of the muscle reach almost 36MPa. CONCLUSION: MLA is a difficult muscle. Because of the ethical reasons we don´t have, and probably never will have informations, how structuraly and elasticaly differs muscle, that was damaged during the delivery, compared to muscle without any damage. Promising are computer delivery simulations. In future, they would give us an answer, how risky is vaginal delivery in concrete expectant mother.

[MRI analysis of the musculo-fascial component of pelvic floor in woman before planned vaginal reconstruction procedur for symptomatic pelvic organ prolapse]. / Analýza stavu muskulo-fasciální slozky pánevního dna pomocí MRI u pacientek pred plánovaným vaginálním rekonstrukcním výkonem pro symptomatický sestup pánevního dna.

OBJECTIVE: The aim of the study is to analyse the musculo-fascial component of the pelvic floor in symptomatic group of woman with pelvic organ prolapse before planned vaginal reconstruction using synthetic vaginal mesh. DESIGN: Observational cohort study. SETTING: Department of Obstetrics and Gynaecology, Hospital in Frýdek-Místek; GONA Ltd, Prague; Institute for Care of Mother and Child, Prague; 3rd Faculty of Medicine CHU Prague. METHODOLOGY: The study involved 285 female volunteers (6 nulliparous, all other patients gave birth vaginally at least once) that in the period 2008-2015 before the planned reconstructive vaginal operations have undergone a comprehensive urogynaecology examination supplemented by magnetic resonance imaging (MRI) of the pelvic floor. Assessed was musculofascial component of the pelvic floor containing -musculus levator ani (MLA), endopelvic fascia (EF) and sacrouterine ligaments (SUL). MLA and EF were evaluated at two levels. The first level corresponds to the puborectalis muscle (evaluation of MRI trauma stage and avulsion), the second level correspondes to the iliococcygeus muscule (evaluation only avulsion injury to the muscle). RESULTS: Normal appereance of musculus puborectalis (level 1) was captured only in 25 (8.8) women. In 117 (41.1%) of women were present MRI minor trauma, 143 (50,2%) women were present with MRI major trauma. Avulsion of the muscle was captured in 85 cases (29.8%) at level 1 and in 165 cases (57.9%) in level 2. Preserved architecture of the EF was caught only 99 (34.7%) of the cases in level 1 and in 47 cases (16.5%) in level 2. Sacrouterine ligaments showed normal morphology in 100 cases (35.1%).Conslusion: Defects of musculofascial component of the pelvic floor is found frequently in women with symptomatic pelvic organ prolapse. Often a combination of defects MLA, EF and SUL are found. These comprehensive pelvic floor defects require careful urogynecological examination and planing operating methods with a view to minimizing the likelihood of recurrence of the descent. In indicated cases the use of the synthetic vaginal mesh is as a method of first choice.