Adnexal torsion in third trimester of pregnancy.

The authors report an unusual case of adnexal torsion in a patient in the third trimester of pregnancy. A 32-year-old woman, gravida 1, para 0, in the 32nd week of gestation initially presented with clinical signs of acute appendicitis. On laparotomy, it was identified that a necrotic mass of the right adnexa and performed a unilateral salpingo-oophorectomy. The postoperative period was uneventful. In the 37th week of gestation, the labour was induced by fetal intrauterine growth restriction. She delivered vaginally, a healthy baby, with 2085 g and an Apgar score of 9 and 10 at the first and fifth minute, respectively.

Laparoscopia na decisão da estratégia terapêutica para o casal infértil / Laparoscopy in the decision of treatment strategy for the infertile couple

OBJETIVO: avaliar a contribuição da laparoscopia diagnóstica na abordagem do casal infértil. MÉTODOS: estudo retrospectivo com análise dos 86 casos consecutivos de pacientes acompanhadas em consulta de esterilidade que foram submetidas à laparoscopia entre Janeiro de 2004 e Dezembro de 2006. Oitenta e duas pacientes tinham realizado histerossalpingografia (HSG) previamente à laparoscopia. Avaliaram-se os achados laparoscópicos bem como os procedimentos acessórios efetuados, e correlacionaram-se os achados histerossalpingográficos com os da laparoscopia. A análise estatística foi efetuada com o Statistical Package for the Social Sciences 15. A sensibilidade e a especificidade da HSG foram determinadas e os intervalos de confiança calculados assumindo-se um erro alfa de 0,05 (IC95 por cento). RESULTADOS: na laparoscopia foram identificadas alterações compatíveis com endometriose em 21 casos (24,4 por cento), salpinge uni/bilateral em 14 casos (16,3 por cento) e doença inflamatória pélvica em 16 casos (18,6 por cento). Procedeu-se à adesiólise e à fulguração dos focos de endometriose em oito pacientes. Foram feitas duas salpingostomias, duas quistectomias do paraovário, duas quistectomias do ovário e três drillings do ovário. A prova de permeabilidade tubar foi normal em 44 casos (53 por cento), revelou obstrução unilateral em 21 (25,3 por cento) e obstrução bilateral em 17 (20,5 por cento). Os resultados da histerossalpingografia foram concordantes com os da laparoscopia em 44 dos 82 casos (53,7 por cento). Quando definimos doença como qualquer forma de obstrução tubar presente na laparoscopia, a sensibilidade da HSG foi 0,79 (IC95 por cento=0,62-0,9) e a especificidade 0,58 (IC95 por cento=0,42-0,73). Quando limitamos a definição de doença à presença de obstrução tubar bilateral na laparoscopia, a sensibilidade e a especificidade da HSG foram 0,47 (IC95 por cento=0,24-0,71) e 0,77 (IC95 por cento=0,64-0,86), respectivamente. Em nove casos (15,3 por cento) em que a HSG havia sido normal ou revelado apenas obstrução unilateral, a laparoscopia revelou obstrução bilateral. Em 15 casos (65,2 por cento) em que a HSG havia demonstrado obstrução bilateral, a laparoscopia foi normal ou revelou apenas obstrução unilateral. CONCLUSÕES: a laparoscopia demonstrou sua relevância diagnóstica e terapêutica revelando-se fundamental na clarificação do status tubo-peritoneal. Permitiu a realização concomitante de atos terapêuticos, possibilitando a definição da melhor estratégia terapêutica no casal infértil.

PURPOSE: to evaluate the contribution of diagnostic laparoscopy to approach the infertile couple. METHODS: retrospective analysis of 86 consecutive cases of patients who were accompanied in the infertility appointments and were submitted to diagnostic laparoscopy from January 2004 to December 2006. Eighty-two of these patients had been submitted to hysterosalpingography (HSG) prior to laparoscopy. The laparoscopic findings were analyzed, as well as the accessory procedures, and the results of the hysterosalpingography and of the laparoscopy were correlated. Statistical analysis was performed by the use of the Statistical Package for the Social Sciences 15. The sensitivity and the specificity of HSG were determined and the confidence intervals were calculated with an alpha error of 0.05 (95 percentCI). RESULTS: the laparoscopy revealed 21 cases of endometriosis (24.4 percent), 14 cases of uni/bilateral inflammatory disease of the salpinx (16.3 percent), and 16 cases of pelvic inflammatory disease (18.6 percent). Adhesiolysis and ablation of endometrial lesions were performed in eight patients. There were also other accessory procedures: two salpingostomies, two paraovarian cystectomies, two ovarian cystectomies and three ovarian drillings. The tubal patency test during laparoscopy was normal in 44 cases (53 percent), revealed unilateral obstruction in 21 cases (25.3 percent) and bilateral obstruction in 17 cases (20.5 percent). The results of the hysterosalpingography were similar to those of the laparoscopy in 44 out of the 82 cases (53.7 percent). HSG sensitivity was 0.79 (95 percentCI=0.62-0.9) and its specificity was 0.58 (95 percentCI=0.42-0.73) when the disease was defined as any form of tubal occlusion detected with the laparoscopy, wheter this occlusion was one-sided or two-sided. HSG sensitivity and specificity were 0.47 (95 percentCI=0.24-0.71) and 0.77 (95 percentCI=0.64-0.86), respectively, when the definition of the disease was limited to two-sided tubal occlusion. In nine cases (15.3 percent) in which HSG had shown normal findings or only a unilateral occlusion, laparoscopy revealed a two-sided occlusion. And in 15 cases (65.2 percent) in which HSG had shown a two-sided occlusion, laparoscopy revealed normal findings or one-sided occlusion. CONCLUSIONS: the laparoscopy demonstrated its diagnostic and therapeutic relevance, proving to have fundamental importance for the clarification of the tuboperitoneal status. It has permitted the development of concomitant accessory therapeutic procedures, thus defining the best treatment strategy for the infertile couples.

[Laparoscopy in the decision of treatment strategy for the infertile couple]. / Laparoscopia na decisão da estratégia terapêutica para o casal infértil.

PURPOSE: to evaluate the contribution of diagnostic laparoscopy to approach the infertile couple. METHODS: retrospective analysis of 86 consecutive cases of patients who were accompanied in the infertility appointments and were submitted to diagnostic laparoscopy from January 2004 to December 2006. Eighty-two of these patients had been submitted to hysterosalpingography (HSG) prior to laparoscopy. The laparoscopic findings were analyzed, as well as the accessory procedures, and the results of the hysterosalpingography and of the laparoscopy were correlated. Statistical analysis was performed by the use of the Statistical Package for the Social Sciences 15. The sensitivity and the specificity of HSG were determined and the confidence intervals were calculated with an alpha error of 0.05 (95%CI). RESULTS: the laparoscopy revealed 21 cases of endometriosis (24.4%), 14 cases of uni/bilateral inflammatory disease of the salpinx (16.3%), and 16 cases of pelvic inflammatory disease (18.6%). Adhesiolysis and ablation of endometrial lesions were performed in eight patients. There were also other accessory procedures: two salpingostomies, two paraovarian cystectomies, two ovarian cystectomies and three ovarian drillings. The tubal patency test during laparoscopy was normal in 44 cases (53%), revealed unilateral obstruction in 21 cases (25.3%) and bilateral obstruction in 17 cases (20.5%). The results of the hysterosalpingography were similar to those of the laparoscopy in 44 out of the 82 cases (53.7%). HSG sensitivity was 0.79 (95%CI=0.62-0.9) and its specificity was 0.58 (95%CI=0.42-0.73) when the disease was defined as any form of tubal occlusion detected with the laparoscopy, whether this occlusion was one-sided or two-sided. HSG sensitivity and specificity were 0.47 (95%CI=0.24-0.71) and 0.77 (95%CI=0.64-0.86), respectively, when the definition of the disease was limited to two-sided tubal occlusion. In nine cases (15.3%) in which HSG had shown normal findings or only a unilateral occlusion, laparoscopy revealed a two-sided occlusion. And in 15 cases (65.2%) in which HSG had shown a two-sided occlusion, laparoscopy revealed normal findings or one-sided occlusion. CONCLUSIONS: the laparoscopy demonstrated its diagnostic and therapeutic relevance, proving to have fundamental importance for the clarification of the tuboperitoneal status. It has permitted the development of concomitant accessory therapeutic procedures, thus defining the best treatment strategy for the infertile couples.