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ANZ Journal of Surgery Dec 2021
Topics: Colectomy; Humans; Internal Hernia; Ligaments; Mesentery; Omentum
PubMed: 33830580
DOI: 10.1111/ans.16851 -
Chinese Medical Journal Aug 2017
Topics: Adult; Endodermal Sinus Tumor; Endometrium; Female; Humans; Omentum; Peritoneal Neoplasms
PubMed: 28776560
DOI: 10.4103/0366-6999.211893 -
Journal of Pediatric and Adolescent... Jun 2019Adolescent endometriosis typically presents as stage I with superficial peritoneal disease and less commonly as stage III or IV with deeply infiltrative disease....
BACKGROUND
Adolescent endometriosis typically presents as stage I with superficial peritoneal disease and less commonly as stage III or IV with deeply infiltrative disease. Endometriosis lesions can be destroyed (cautery or laser), cutting out the discrete lesion with excision and destroyed, or radically excised with removal of the lesion and surrounding tissue. It has been shown to be beneficial to excise deeply infiltrative disease to improve pain. Radical excision has been promoted by a subset of surgeons and involves removal of large areas of peritoneum with the promise/proposal of a cure and suggestion of no need for medical suppression of endometriosis. The best technique to manage superficial peritoneal disease has not yet been defined.
CASE
A 15-year-old young woman with a history of 2 previous laparoscopies for pain and an ovarian cyst who underwent removal of a mucinous cystadenoma, presented to a local gynecologist with chronic pelvic pain. She underwent a third laparoscopy and was found to have superficial peritoneal endometriosis and filmy adhesions believed to be due to the previous ovarian surgery. The endometriosis was surgically destroyed with the use of cautery and the filmy adhesions were lysed. Months later she had a return of pain and was advised to have a fourth laparoscopy with radical excision by an "excisionalist" gynecologist. She was found to have superficial peritoneal disease with ASRM-defined stage I endometriosis and underwent radical excision of the peritoneum of the anterior cul de sac, posterior cul de sac, and both pelvic side walls. She was informed that she had been cured of her endometriosis and was thus not treated with postoperative hormonal suppression. Her pain did not improve and in fact worsened after the radical excisional surgery. She self-referred for care. She started menstrual suppression treatment with continuous estrogen/progestin therapy for medical treatment of endometriosis but after 6 months she was still having severe pain without bleeding. Eight months after the radical excisional surgery she elected to have a fifth laparoscopy to address potential adhesions. At that time she was found to have extensive pelvic adhesions with the uterus adherent to the anterior cul de sac, and adhesions in the posterior cul de sac. In addition, both ovaries were involved with adhesions and adherent to the pelvic side walls. She was found to have clear and red lesions of superficial peritoneal endometriosis. She underwent a lysis of adhesions, and excision of lesions, and destruction of endometriosis. Her pain improved postoperatively; menstrual suppression was continued and she has remained with a continued excellent quality of life with over 2 years of follow-up.
SUMMARY AND CONCLUSION
For this patient, radical excisional surgery resulted in increased pain and extensive adhesion formation. It was not curative because endometriosis was documented on follow-up surgery. In a previously published long-term follow-up report of adolescents with recurrent pain 2-10 years after destruction of superficial peritoneal disease, it was reported that there were no increased adhesions and no trend toward disease progression. Excisional gynecologists who perform this procedure should not suggest that radical excisional surgery is helpful and without increased risk, until studies have shown long-term benefit in the surgical management of superficial peritoneal endometriosis.
Topics: Adolescent; Endometriosis; Female; Humans; Laparoscopy; Pelvic Pain; Peritoneal Diseases; Peritoneum; Quality of Life; Tissue Adhesions
PubMed: 30708067
DOI: 10.1016/j.jpag.2019.01.005 -
Radiographics : a Review Publication of... 2015Ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Uncommon implantation sites of... (Review)
Review
Ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Uncommon implantation sites of ectopic pregnancy include the cervix, interstitial segment of the fallopian tube, scar from a prior cesarean delivery, uterine myometrium, ovary, and peritoneal cavity. Heterotopic and twin ectopic pregnancies are other rare manifestations. Ultrasonography (US) plays a central role in diagnosis of uncommon ectopic pregnancies. US features of an interstitial ectopic pregnancy include an echogenic interstitial line and abnormal bulging of the myometrial contour. A gestational sac that is located below the internal os of the cervix and that contains an embryo with a fetal heartbeat is indicative of a cervical ectopic pregnancy. In a cesarean scar ectopic pregnancy, the gestational sac is implanted in the anterior lower uterine segment at the site of the cesarean scar, with thinning of the myometrium seen anterior to the gestational sac. An intramural gestational sac implants in the uterine myometrium, separate from the uterine cavity and fallopian tubes. In an ovarian ectopic pregnancy, a gestational sac with a thick hyperechoic circumferential rim is located in or on the ovarian parenchyma. An intraperitoneal gestational sac is present in an abdominal ectopic pregnancy. Intra- and extrauterine gestational sacs are seen in a heterotopic pregnancy. Two adnexal heartbeats suggest a live twin ectopic pregnancy. Recognition of the specific US features will help radiologists diagnose these uncommon types of ectopic pregnancy.
Topics: Adnexal Diseases; Adult; Cervix Uteri; Fallopian Tubes; Female; Humans; Myometrium; Ovary; Peritoneum; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Ultrasonography, Prenatal
PubMed: 25860721
DOI: 10.1148/rg.2015140202 -
Morphologie : Bulletin de L'Association... Jun 2017Hernia is described as the protrusion of an organ into the wall of its normal containing cavity. Internal hernia (IH) involves protrusion of viscera through: a...
Hernia is described as the protrusion of an organ into the wall of its normal containing cavity. Internal hernia (IH) involves protrusion of viscera through: a peritoneal or mesentery defect, a normal or abnormal compartment of the peritoneal cavity. Hernias occurring in the pelvis cavity are usually classified according to the fascial margins breached and include sciatic, obturator and those through the rectouterin pouch: elytrocele and enterocele. Those hernias are defined by the protrusion of a viscus through the wall of the pelvis due to weakness of the pelvic fascia and/or muscles. Pelvic hernia through the pouch of Douglas (PD) involves the genital tract in female (elytrocele and enterocele). Sometimes described in the literature as Douglas hernia, this type of hernia must be distinguished from the conventional IH. As defined before, the borders to be considered for IH is the peritoneal membrane, which is not a real solid wall but delimitates the peritoneal cavity; and there is no peritoneal defect in elytrocele or enterocele. A PubMed search for IH through a defect in the peritoneal PD revealed only five female cases, making this an extremely rare condition. To our knowledge, we have presented here the only published case in a male. This probably congenital and morphologic anomaly (defect) of pouch of Sir Douglas must be distinguished as the real "Douglas IH". Authors discuss the concept of a new and more detailed classification of IH.
Topics: Abdominal Pain; Anastomosis, Surgical; Bandages; Constipation; Digestive System Surgical Procedures; Douglas' Pouch; Hernia; Humans; Ileal Diseases; Ileum; Intestinal Obstruction; Male; Middle Aged; Peritoneal Diseases; Surgical Wound Infection; Sutures; Tomography, X-Ray Computed; Vomiting
PubMed: 28528186
DOI: 10.1016/j.morpho.2017.04.002 -
Journal of Minimally Invasive Gynecology 2020To determine if intraoperative outcomes for patients undergoing laparoscopic hysterectomy with endometriosis and an obliterated cul-de-sac are different than patients... (Comparative Study)
Comparative Study
STUDY OBJECTIVE
To determine if intraoperative outcomes for patients undergoing laparoscopic hysterectomy with endometriosis and an obliterated cul-de-sac are different than patients with endometriosis and no obliteration of the cul-de-sac.
DESIGN
A retrospective cohort study.
SETTING
An academic tertiary care hospital.
PATIENTS
Patients undergoing total laparoscopic hysterectomy with endometriosis between 2012 and 2016.
INTERVENTIONS
Total laparoscopic hysterectomy, laparoscopic modified radical hysterectomy, and other procedures as indicated.
MEASUREMENTS AND MAIN RESULTS
A total of 333 patients undergoing hysterectomy were found to have endometriosis at the time of surgery. Ninety-six (29%) patients were found to have stage IV endometriosis as defined by the American Society for Reproductive Medicine staging criteria. Of those, 55 (57%) had an obliterated cul-de-sac, and 41 (43%) did not. The remaining 237 (71%) patients had stage I, II, or III endometriosis. Fifty-one (93%) patients with an obliterated cul-de-sac required laparoscopic modified radical hysterectomy compared with 12 (29%) patients with stage IV endometriosis without obliteration and 60 (25%) patients with stages I through III endometriosis (p < .0001). The median total surgical time in minutes differed among the 3 groups as follows: obliterated cul-de-sac = 159 minutes, stage IV endometriosis without obliteration = 108 minutes, and stages I through III endometriosis = 116 minutes (p <.0001). Additional procedures at the time of hysterectomy were more frequently performed for patients with an obliterated cul-de-sac and included salpingectomy (p = .02), ureterolysis (p <.0001), enterolysis (p <.0001), cystoscopy (p = .0006), ureteral stenting (p <.0001), proctoscopy (p <.0001), oversewing of the bowel (p <.0001), and anterior resection and anastomosis (p = .006).
CONCLUSION
Patients with stage IV endometriosis and an obliterated cul-de-sac required laparoscopic modified radical hysterectomy and various other intraoperative procedures more than patients with stage IV endometriosis without obliteration and stages I through III. Patients with obliterated cul-de-sacs who are identified intraoperatively should be referred to minimally invasive gynecologic specialists because of the difficult nature of these procedures and extra training required to perform them safely with limited morbidity.
Topics: Adult; Cohort Studies; Douglas' Pouch; Endometriosis; Female; Humans; Hysterectomy; Intraoperative Complications; Laparoscopy; Middle Aged; Operative Time; Peritoneal Diseases; Postoperative Complications; Retrospective Studies; Severity of Illness Index; Treatment Outcome
PubMed: 31279776
DOI: 10.1016/j.jmig.2019.07.001 -
American Journal of Obstetrics and... Aug 2023Dense adhesions because of severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterate the cul-de-sac and distort normal...
Dense adhesions because of severe endometriosis between the posterior cervical peritoneum and the anterior sigmoid or rectum obliterate the cul-de-sac and distort normal anatomic landmarks. Surgery for endometriosis is associated with severe complications, including ureteral and rectal injuries and voiding dysfunction. Surgeons should recognize the importance of not only avoiding ureteral and rectal injuries but also focusing on the preservation of the hypogastric nerves. Herein, we reported the anatomic highlights and surgical steps of laparoscopic hysterectomy for posterior cul-de-sac obliteration with the nerve-sparing technique.
Topics: Female; Humans; Endometriosis; Douglas' Pouch; Hysterectomy; Peritoneum; Laparoscopy
PubMed: 36972894
DOI: 10.1016/j.ajog.2023.03.033 -
Seminars in Cell & Developmental Biology Aug 2019The vertebrate intestine has a continuous dorsal mesentery between pharynx and anus that facilitates intestinal mobility. Based on width and fate the dorsal mesentery... (Review)
Review
The vertebrate intestine has a continuous dorsal mesentery between pharynx and anus that facilitates intestinal mobility. Based on width and fate the dorsal mesentery can be subdivided into that of the caudal foregut, midgut, and hindgut. The dorsal mesentery of stomach and duodenum is wide and topographically complex due to strong and asymmetric growth of the stomach. The associated formation of the lesser sac partitions the dorsal mesentery into the right-sided "caval fold" that serves as conduit for the inferior caval vein and the left-sided mesogastrium. The thin dorsal mesentery of the midgut originates between the base of the superior and inferior mesenteric arteries, and follows the transient increase in intestinal growth that results in small-intestinal looping, intestinal herniation and, subsequently, return. The following fixation of a large portion of the abdominal dorsal mesentery to the dorsal peritoneal wall by adhesion and fusion is only seen in primates and is often incomplete. Adhesion and fusion of mesothelial surfaces in the lesser pelvis results in the formation of the "mesorectum". Whether Toldt's and Denonvilliers' "fasciae of fusion" identify the location of the original mesothelial surfaces or, alternatively, represent the effects of postnatal wear and tear due to intestinal motility and intra-abdominal pressure changes, remains to be shown. "Malrotations" are characterized by growth defects of the intestinal loops with an ischemic origin and a narrow mesenteric root due to insufficient adhesion and fusion.
Topics: Embryo, Mammalian; Fetus; Humans; Mesentery
PubMed: 30142441
DOI: 10.1016/j.semcdb.2018.08.009 -
The American Surgeon Aug 1980The peritoneum exists as a closed sac within a second closed sac, the fascial layer derived from and continuous with transversalis fascia. Extraperitoneal abscess may...
The peritoneum exists as a closed sac within a second closed sac, the fascial layer derived from and continuous with transversalis fascia. Extraperitoneal abscess may occur between the peritoneum and the deep fascia anteriorly, posteriorly, or in the pelvis. Extrafascial abscess is a form of extraperitoneal abscess that develops outside the transversalis layer and may occur anteriorly a well as posteriorly. A classification of extraperitoneal infection is proposed, which is both clinically applicable yet reflects the anatomic relationship of the peritoneum and transversalis fascia.
Topics: Abdomen; Abscess; Adult; Fascia; Humans; Male; Pelvis; Peritoneal Diseases; Peritoneum; Retroperitoneal Space
PubMed: 7406354
DOI: No ID Found -
The Journal of Urology Jan 1997We reviewed the conflicting theories concerning the anatomy and embryological derivation of Denonvilliers' fascia since its first description in 1836. (Review)
Review
PURPOSE
We reviewed the conflicting theories concerning the anatomy and embryological derivation of Denonvilliers' fascia since its first description in 1836.
MATERIALS AND METHODS
An extensive review of the literature for the last 160 years was done.
RESULTS
Various studies contributed to the debate on the anatomy and origins of Denonvilliers' fascia. We chose to review these studies because of their sound methodology, large numbers of cases and results, and the high quality of the macroscopic and/or microscopic evidence.
CONCLUSIONS
Denonvilliers' fascia consists of a single layer arising from fusion of the 2 walls of the embryological peritoneal cul-de-sac. Histologically, it has a double-layered quality. The fascia of Denonvilliers extends from the deepest point of the interprostatorectal peritoneal pouch to the pelvic floor. A so-called posterior layer is in reality the rectal fascia propria.
Topics: Anatomy; Eponyms; Fascia; France; History, 19th Century; Humans; Peritoneum
PubMed: 8976203
DOI: 10.1097/00005392-199701000-00003