Unification and orificing of two functional noncommunicating uterine horns through the created neovagina using peritoneum.

OBJECTIVE: To demonstrate the surgical approach for Müllerian agenesis with bilateral uterine remnants containing functional endometrium. DESIGN: Stepwise demonstration of the technique with narrated video footage. SETTING: Reproductive surgery unit of a tertiary university hospital. PATIENT: An 18-year-old adolescent was admitted to a tertiary university hospital with complaints of primary amenorrhea and cyclic pelvic pain. Physical examination and magnetic resonance imaging scans suggested a complex Müllerian abnormality. The patient had uterine remnants with bilateral functional endometrium and cervicovaginal agenesis. INTERVENTION: An operation was planned to reconstruct her anatomy by providing a neovagina and anastomosing the uterine remnants. Gonadotropin-releasing hormone analogs were prescribed to suppress her menstruation until the procedure. The operation was performed in the third month after the initial diagnosis. A laparoscopy was conducted, revealing approximately 5 × 6-cm bilateral uterine horns with healthy adnexa. As the first step, a neovagina was created using a modified peritoneal pull-down technique, a standard approach in our clinic. A vaginal incision was made, and a blind vaginal dissection was performed to reach the peritoneum vaginally. Subsequently, an acrylic vaginal mold was inserted. The vaginal orifice was laparoscopically incised using ultrasonic energy with guidance from the inserted vaginal acrylic mold. The orifice was gradually dilated with larger molds. The entire pelvic peritoneum was dissected circularly, and the distal part of the dissected peritoneum was pulled down using four 2.0 Vicryl sutures at 0°, 90°, 180°, and 270° from the opened vaginal orifice. The uterine cavities of both remnants were incised, and two separate Foley catheters were placed in both cavities. A mold with a hole was used to insert the catheters through the vagina. Both catheters were secured in the cavities with Prolene sutures pulled up from the anterior abdominal wall. The next step involved uterine anastomosis. The uterine remnants were unified through continuous suturing, resulting in the formation of a normally shaped uterus. In the final step, the created uterus and neovagina were anastomosed. The patient received instructions on how to perform mold exercises and follow-up care. MAIN OUTCOME MEASURE: Description of laparoscopic management of a rare Müllerian abnormality. RESULTS: The postoperative magnetic resonance imaging scan at 1 month revealed healed unified uterine cavities and vagina. The patient experienced spontaneous menstruation in the second month after surgery and now maintains regular menses with an approximately 9-10 cm functional vagina. Within 3 months after surgery, the visual analogue scale scores for chronic pelvic pain and dysmenorrhea decreased from 9 to 2-3. CONCLUSIONS: Müllerian abnormalities are exceptionally rare, and their spectrum is broad, making it challenging to identify an exact surgical method to restore functional anatomy. Therefore, a customized surgical approach should be designed for each patient on the basis of their unique condition.

Persistencia del conducto peritoneo vaginal: revisión conceptual a propósito de un caso clínico / Persistence of the conduit vaginal peritoneum: conceptual review about a clinical case

La persistencia del conducto peritoneo-vaginal escrotal se debe a una falta de cierre del trayecto que, durante las etapas de desarrollo fetal, separan la cavidad peritoneal del escroto. Factores como la prematuridad o el bajo peso al nacer predisponen a esta alteración. Se presenta de diversas maneras: persistencia completa, parcial en forma de quiste de cordón e hidrocele con conducto cerrado. Es posible la asociación a hernia inguinal. Se puede producir su cierre espontánea en los 2 primeros años de vida. El tratamiento es quirúrgico, generalmente vía inguinal. Presentamos un caso clínico y una revisión sobre los aspectos básicos de esta entidad (AU)

The persistence e of the scrotum peritoneal-vaginal duct due to a lack of closure of the journey, during fetal development stages, separating the peritoneal cavity of the scrotum. Factors such as prematurity or low birth weight predispose to this disorder. It comes in different ways: full persistence, partly in the form of hydrocele and cord cyst with duct closed. Possible association with inguinal hernia is possible. Closure can occur spontaneously in the first 2 years of life. Treatment is surgical, usually transinguinal We present a case report and a review on the basic aspects of this entity (AU)

Relevance of herniography for accurate diagnosis of patent processus vaginalis in cryptorchidism

OBJECTIVE: To clarify the role of peritoneography in assessing the patency of processus vaginalis (PV) in pediatric patients diagnosed with cryptorchidism. MATERIALS AND METHODS: We designed a prospective clinical trial to evaluate the patency of PV in boys presenting cryptorchidism. Herniography was performed in 310 prepubertal boys. Data about the morphology of PV was compared with operative findings in those surgically treated patients. Retractile and ectopic testes were excluded from the study. RESULTS: Of the 376 undescended testes (310 patients), 281 cases were associated with an obliterated PV. Herniography revealed 95 cases of open PV in cryptorchid boys. The 244 normally descended testes had associated patent processus vaginalis in only 31 cases. CONCLUSIONS: Herniography is the most relevant procedure for accurate diagnosis of persistent PV. The persistence of PV was significantly more frequent when the position of the testes is more cranial. The incidence of an open PV decreases with age.

Bazo accesorio en el retroperitoneo simulando un tumor suprarrenal / Accesory spleen in retroperitonei simulating an adrenal tumor

Se reporta el caso de un hombre de 51 años de edad que se presentó a consulta médica por dolor abdominal bajo, detectándose una masa por encima del riñón izquierdo por ultrasonido. Fue operado con el diagnóstico de tumor suprarrenal, encontrándose una heterotopia esplénica

Linfangiomiomatosis pulmonar y Linfangiomiomas: presentación de 8 casos y revisión de la literatura / Lymphangiomyomatosis and lymphangiomyomas: a study of 8 cases and review of the literature

Se presenta un estiduo clinicopatológico de 3 casos de linfangiomiomatosis pulmonar y mediastinal y de 5 linfangiomiomas de mediastino, retroperitoneo, mesenterio (2) y hombro. Seis pacientes fueron del sexo femenino y 2 del masculino, sus edades variaron de 19 meses a 47 años. Todos los pacientes presentaron grandes tumores por períodos que variaron de meses a muchos años, los cuales no afectaron su estado general. Cinco linfangiomiomas y un pulmón con linfangiomiomatosis se extirparon quirúrgicamente, a dos pacientes con linfangiomiomatosis solamente se les pudo biopsiar. Las lesiones midieron entre 12 y 32 cm de eje mayor, frecuentemente eran de aspecto multiquístico con pequeñas áreas sólidas. Microscópicamente, se observaron innumerables espacios quísticos, separados por septos tapizados con revestimiento endotelial y/o epitelial y dotados de músculo liso en haces. Un estudio inmunohistoquímico demostró que los quistes de la linfangiomiomatosis pulmonar tiene su orígen principalmente en conductos aéreos, mientras que los de los linfangiomiomas son exclusivamente de naturaleza vascular. Se informan 3 casos excepcionales en edad pediátrica (1 7/12, 9 y 11 años ) 2 localizaciones no descritas antes (mesenterio y hombro). Se presenta una revisión de las características clinicopatológicas de las dos formas de la enfermedad y su probale asociación con esclerosis tuberosa. Se discuten algunas ideas sobre la histogénesis y la etiopatogenia en estas lesiones de probable naturaleza hamartomatosa o corsistomatosa.

Mesotelioma peritoneal

Se presenta el caso de un hombre de 49 años con cuadro de dolor abdominal, ascitis y masa en hipocondrio derecho. Habia trabajado durante 31 años con asbesto. Al examen se palpó masa nodular, dolorosa, de 10 cm por debajo del reborde costal derecho. Los exámenes de función y biopsia hepática fueron normales. La ecografía no fue de ayuda y la gammagrafía mostró lesion nodular hipocaptante de 3 cm con una gran masa extrahepática. La citología peritoneal correspondió a un PAP II con células mesoteliales que se obtuvieron también en una biopsia con aguja fina. Por laparotomía se hizo el diagnóstico de mesotelioma peritoneal maligno del tipo mixto que se confirmó mediante el uso de marcadores tumorales de inmunohistoquímica