A 36-year-old woman presented with a palpable tender mass at the left lower quadrant of the abdomen. She had suffered from constipation for five years and had a previous history of intrauterine device-use for one year. Preoperative barium enema and abdominopelvic CT showed a compatible finding of rectosigmoid colon cancer or left ovary cancer. She underwent segmental resection of the sigmoid colon along with the removal of left distal ureter, left ovary and salpinx. Pathologic examination revealed actinomycotic abscesses containing sulfur granules. Thereafter, she took parenteral ampicillin (50mg/kg/day) for one month and oral amoxicillin (250mg, tid) for 2 months consecutively. The patient has no specific problems for 6 months after surgical resection and long-term antibiotic therapy. This report may be the first of intrauterine device-associated pelvic actinomycosis involving both sigmoid colon and rectum extensively.
Actinomycosis/*complications ; Adult ; Case Report ; Colonic Diseases/*etiology/microbiology ; Female ; Human ; Intestinal Obstruction/*etiology/microbiology ; Pelvic Inflammatory Disease/*complications

Adult ; Female ; Humans ; Laparoscopy ; Pelvic Inflammatory Disease ; etiology ; microbiology ; Pneumococcal Infections ; etiology ; Postoperative Complications ; Salpingostomy ; Smoking ; adverse effects ; Streptococcus pneumoniae

Objectives: We performed this study to review the clinical availability of the classical intrafascial SEMM hysterectomy (CISH), and report our experience for 2 years restrospectively. METHODS: From March 1999 to February 2001, 100 cases of CISH were performed at the Department of Obstetrics and Gynecology, College of Medicine, Kangdong Sacred Heart Hospital, Hallym university. We performed this procedure by 3 steps. The dissection of uterus was done by classical suture methods (including extracorporeal and intracorporeal suture techniques) to uterine isthmic portion. And then transvaginal cylindrical coring out of the cervical tissue was done using a cervix corer, the Calibrated Uterine Resection Tools (CURT) for resection of cervical tissue especially transformation zone. Finally, the dissected uterus was extracted by using a Serrated Edged Macro-Morcellator (SEMM) without colpotomy. We reviewed the patient's data retrospectively and made phone calls to each patients. RESULTS: The indications for CISH, based on the pre-and intraoperative diagnosis, were leiomyoma, adenomyosis, endometrial hyperplasia and chronic pelvic inflammatory disease or pelvic pain, in order of frequency. The mean operative time was 126 minutes and the mean hemoglobin change was 1.27 gm/dL. The mean hospital days were 5.7 days and the mean age of the patients was 44.6 years old. There were no definite intra- and postoperative complications except for 3 cases of CO2 retentions and 2 cases of delayed bleeding on cervical stump. The mean days to first sexual contact after surgery were 34.5 days. In view of sexual feeling, 86% of the patients didn't feel any difference and only 13% felt worse than before. During postoperative follow-up, the cervical cytologic study were found no endocervical cells at all of 44 checked patients. CONCLUSION: The CISH procedures can be safely performed by well-trained laparoscopists, and this technique minimally alters the anatomy and integrity of the pelvic floor and vagina. Therefore the reductions of surgical morbidity, blood loss, hospitalization and postoperatve discomfort were obtained. Through the preservation of the anatomical relations of the pelvic floor and the function of female sexuality, this technique is the new proposal in gynecologic surgery.
Adenomyosis ; Cervix Uteri ; Colpotomy ; Diagnosis ; Endometrial Hyperplasia ; Female ; Follow-Up Studies ; Gynecologic Surgical Procedures ; Gynecology ; Heart ; Hemorrhage ; Hospitalization ; Humans ; Hysterectomy* ; Leiomyoma ; Obstetrics ; Operative Time ; Pelvic Floor ; Pelvic Inflammatory Disease ; Pelvic Pain ; Postoperative Complications ; Retrospective Studies ; Sexuality ; Sutures ; Uterus ; Vagina

A review of cases of ectopic pregnancy operated upon at Vila Central Hospital during 1992 with an analysis of clinical presenting features and diagnostic factors is presented. Comparison is made between hospital, regional and national figures and possible explanations for the differences are given. Recommendations are made to ensure that ectopic pregnancy is always at the forefront of differential diagnosis in women presenting with abdominal pain.
Diagnosis, Differential ; Female ; Hospitals, District - statistics & ; numerical data ; Hospitals, District - trends ; Medical Audit ; Pelvic Inflammatory Disease - complications ; Pregnancy ; Pregnancy, Ectopic - surgery ; Referral and Consultation - statistics & ; numerical data ; Vanuatu

BACKGROUND/AIMS: Fitz-Hugh-Curtis syndrome is defined as perihepatitis associated with pelvic inflammatory disease (PID). We retrospectively analyzed clinical and laboratory manifestations as well as the therapeutic response in patients with clinically diagnosed Fitz-Hugh-Curtis syndrome. METHODS: A cohort of 25 patients with PID and perihepatitis (as diagnosed by dynamic abdominal computed tomography (CT)) was enrolled. The prognosis, clinical manifestations, and physical examination, laboratory, and CT findings were analyzed. RESULTS: The mean (+/-SD) age of the patients was 32(+/-8) years, and all of them were sexually active, premenopausal women, and presented with abdominal pain. Of these, 52% complained of vaginal discharge. On physical examination, right upper-quadrant tenderness was the most common finding (84%), with lower-abdominal tenderness being present in 20% of patients. On laboratory examination, erythrocyte sedimentation rate and C-reactive protein were increased in 76% and 92% of the patients, respectively. The white blood cell count was increased in 60% of them. Most patients had a normal liver function test. Using a specimen of the cervical discharge, the polymerase chain reaction to test for Chlamydia trachomatis were positive in 87% (13/15) of the patients, and Chlamydia antigen was found in 75% (9/12) of them. Dynamic abdominal CT revealed subcapsular enhancement of the liver in the arterial phase. All of the patients improved with antibiotic therapy. CONCLUSIONS: Symptoms and physical findings suggestive of PID are not present in many patients with Fitz-Hugh-Curtis syndrome. When a premenopausal woman complains of upper abdominal pain and shows CT findings compatible with perihepatitis, examination of cervical discharge would be recommended to assess the possibility of Fitz-Hugh-Curtis syndrome.
Adult ; Anti-Bacterial Agents/therapeutic use ; Chlamydia Infections/diagnosis/microbiology ; Chlamydia trachomatis/isolation & purification ; Cohort Studies ; Diagnosis, Differential ; Drug Therapy, Combination ; Female ; Gonorrhea/complications/*diagnosis/radiography ; Hepatitis/complications/*diagnosis/radiography ; Humans ; Pelvic Inflammatory Disease/complications/*diagnosis/radiography ; Retrospective Studies ; Syndrome ; Tomography, X-Ray Computed

BACKGROUND: Fitz-Hugh-Curtis (FHC) syndrome is inflammation of the liver capsule associated with pelvic inflammatory disease. We measured Chlamydia trachomatis antibodies in 30 female patients with acute abdominal pain for diagnosis of FHC-syndrome, and the results were compared with other tests. METHODS: A dual-polymerase chain reaction was used for the detection of C. trachomatis in the cervix, and a micro-immunofluorescence test was performed to measure the antibody to C. trachomatis in serum. Cervical specimens were stained with Gram stain and cultured on chocolate agar for detection of Neisseria gonorrhoeae, and abdominal computed tomography (CT) and pelvic examinations were performed. RESULTS: Of the 30 patients examined, 19 were diagnosed as having FHC-syndromes and 11 abdominal pains without FHC-syndrome. C. trachomatis was detected from one of the five patients studied, and no N. gonorrhoeae was isolated from the patients with FHC-syndrome. High titers of IgG antibody (1:512-1:1,024) to C. trachomatis were demonstrated in all patients with FHC-syndrome. The CT scan revealed perihepatitis in 14 patients with FHC-syndrome. CONCLUSIONS: All patients with FHC-syndrome are associated with C. trachomatis infections, and a high titer of C. trachomatis antibody (IgG) is a very useful marker for FHC-syndrome.
Adolescent ; Adult ; Aged ; Antibodies, Bacterial/*analysis ; Cervix Uteri/chemistry ; Chlamydia Infections/*diagnosis/microbiology ; Chlamydia trachomatis/*immunology/isolation & purification ; Female ; Hepatitis/diagnosis ; Humans ; Immunoglobulin G/analysis ; Immunoglobulin M/analysis ; Middle Aged ; Pelvic Inflammatory Disease/complications/*diagnosis ; Syndrome ; Tomography Scanners, X-Ray Computed ; Young Adult