著者
水田 馨 三好 潤也 黒田 くみ子 井手上 隆史 田中 義弘 松岡 智史 吉松 かなえ 荒金 太
出版者
日本産科婦人科内視鏡学会
雑誌
日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)
巻号頁・発行日
vol.34, no.1, pp.123-127, 2018 (Released:2018-07-21)
参考文献数
19

Ectopic pregnancy is considered as a possible diagnosis in cases in which women experience acute abdominal pain and a urinary human chorionic gonadotropin (hCG) test produces a positive result. However, we present a case of ruptured ectopic pregnancy involving a negative urinary pregnancy test result. A 34-year-old nulliparous woman was admitted to the emergency room of our hospital due to the sudden onset of lower abdominal pain. Rebound pain in the lower abdomen was detected during a physical examination. Since transabdominal ultrasonography showed massive ascites, and a urinary pregnancy test produced a negative result, we performed a contrast-enhanced computed tomography scan and found a 5-cm right-sided ovarian cyst and extravasation around the left adnexa. We diagnosed the patient with left ovarian hemorrhaging and a right ovarian hemorrhagic luteal cyst. Two hours later, hemorrhagic shock occurred, and an emergency laparoscopic operation was carried out. We detected a swollen left fallopian tube, which had ruptured and was bleeding. We performed left salpingectomy. After the operation, the patient's preoperative serum sample was re-examined to re-assess her hCG level. As a result, her serum hCG level was found to be 23.3 mIU/ml. Pathological examinations showed a very small number of chorionic villi. The final diagnosis was ectopic pregnancy. The patient's postoperative course was uneventful. This case report illustrates the difficulty of diagnosing ectopic pregnancy. Clinicians should include ectopic pregnancy in the differential diagnoses for cases of acute abdominal pain involving women of reproductive age, regardless of the results of urinary pregnancy tests.
著者
安藤 有里子 大西 賢人 緒方 佑莉 郷田 朋子 諸宇 ヒブン 中西 美紗緒 定月 みゆき 大石 元
出版者
日本産科婦人科内視鏡学会
雑誌
日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)
巻号頁・発行日
vol.35, no.2, pp.377-382, 2019

<p> Omental pregnancy is a subtype of abdominal pregnancy, which accounts for <1% of all ectopic pregnancies. Definitive diagnosis is challenging due to its rarity and difficulty in localizing its implantation site. Here, we describe the case of a 20-year-old nulliparous woman with omental pregnancy, referred to our hospital due to acute abdominal pain and high serum human chorionic gonadotropin levels. The gestational sac was not detected on a pelvic ultrasound examination. Abdominal contrast enhanced computerized tomography (CT) revealed an intra-abdominal hemorrhage and a 3-cm mass in the omentum. Diagnostic laparoscopy confirmed the omentum as the implantation site, following which complete resection of the lesion was performed. Histopathological analysis confirmed the diagnosis of omental pregnancy. Her postoperative course was uneventful. Our findings suggest that CT and laparoscopy are useful when the implantation site could not be visualized via ultrasonography in ectopic pregnancy. In addition, we discuss the association between emergency contraception and ectopic pregnancies.</p><p></p>
著者
今井 宗 舟本 寛 山口 彩華 吉越 信一 南 里恵 飴谷 由佳 谷村 悟
出版者
日本産科婦人科内視鏡学会
雑誌
日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)
巻号頁・発行日
vol.35, no.1, pp.238-242, 2019 (Released:2019-06-08)
参考文献数
11

Introduction: Uterine cystic adenomyosis is a rare proliferative disease in which the endometrial tissue focally repeats hemorrhage in the myometrium and forms cystic lesions. We report a case of uterine cervical cystic adenomyosis for which we performed total laparoscopic hysterectomy (TLH) with two techniques to avoid urinary tract injury.Case: The patient was a 45-year-old woman with G0 who had two times of surgery for endometriosis. A local doctor diagnosed uterine cervical cystic adenomyosis about 30 mm in diameter and followed her up. Due to the worsening dysmenorrhea and the enlarging cystic lesion, she was referred to our hospital for treatment. Pelvic MRI showed uterine cervical adenomyosis about 35 mm in diameter and diffuse adenomyosis of the uterine body. TLH was performed because of the worsening dysmenorrhea due to uterine adenomyosis. Anatomical change due to a cervical tumor and severe adhesions because of endometriosis were expected; hence, we carried out two techniques. Firstly, urinary catheters were preoperatively placed, secondary, we injected air into the bladder when the uterus and the bladder were detached, then, TLH was safely completed while monitoring the bladder wall. Histopathology showed endometrial glands in the cervical myometrium, and uterine cervical cystic adenomyosis was diagnosed. Her symptoms have improved, and no recurrence after surgery has been observed. Discussion: Cystic adenomyosis is rarer in the cervix than in the uterine body. There is no report about TLH for uterine cervical cystic adenomyosis. A difficult surgery was expected due to a cervical tumor and endometriosis, but the urinary tract injury was avoided using two techniques, and the surgery was safely completed.
著者
山中 章義 安藤 正明 小玉 敬亮 白根 晃 柳井 しおり 中島 紗織 福田 美香 黒土 升蔵 海老沢 桂子 羽田 智則 太田 啓明
出版者
日本産科婦人科内視鏡学会
雑誌
日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)
巻号頁・発行日
vol.31, no.1, pp.257-263, 2015 (Released:2015-12-23)
参考文献数
13

Deeply infiltrating endometriosis (DIE) is defined as subperitoneal invasion by endometriotic lesions. These lesions are considered very active and are strongly associated with pelvic pain. The incidence of DIE is reportedly 20 % in all cases of endometriosis, with uterosacral ligaments representing the most frequent location. Therefore, the resection of uterosacral ligaments is effective in reducing the pelvic pain and dyspareunia that is experienced by patients with endometriosis. However, the operation is associated with a risk of injury to the ureter and rectum; a laparoscopic resection is more useful and safer than open surgery, particularly in patients with adhesion in the pouch of Douglas. Thus, in our study, we initially identified and isolated the ureter and open spaces around the uterosacral ligaments. From June 2012 to December 2013, 262 patients underwent laparoscopic resection of the uterosacral ligaments. Of these, 10 (3.8 %) patients had mild dysuria after the operation, but all cases improved within 2 months. One (0.38 %) patient required clean intermittent catheterization after the operation, which was discontinued 14 months later. Bilateral hydronephrosis occurred in one (0.38 %) patient, which required ureteral dilatation. No ureteral or rectal injury occurred in any patient. Therefore, if the operation is carefully performed, it is possible to safely resect the uterosacral ligaments in patients with endometriosis.
著者
石山 美由紀 渡辺 正 黒澤 大樹 氷室 裕美 鈴木 久也 宇賀神 智久 中西 透 渡部 洋
出版者
日本産科婦人科内視鏡学会
雑誌
日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)
巻号頁・発行日
vol.35, no.2, pp.345-351, 2019

<p><b>Objective:</b> To report our experience with the management of two cases of chronic tubal pregnancy by laparoscopic surgery.</p><p><b>Case 1:</b> A 37-year-old woman presented to our hospital with a small amount of genital bleeding at 10 weeks and 3 days of gestation, calculated from the date of her last menstrual period. Serum human chorionic gonadotropin level was elevated to 108.5 mIU/mL and transvaginal sonography (TVS) revealed a 52-mm diameter of irregularly shaped left periovarian mass. Magnetic resonance imaging (MRI) also showed a periovarian cystic mass with suspicion of an old hemorrhage. We performed laparoscopic left salpingectomy after the diagnosis of chronic left tubal pregnancy.</p><p><b>Case 2:</b> A 31-year-old woman was referred to our hospital with suspected left tubal abortion at 16 weeks and 1 day of gestation. Both TVS and MRI revealed a left periovarian mass with a diameter of 40 mm. After the mass was diagnosed as chronic left tubal pregnancy under laparoscopic vision, left fallopian tube was preserved by salpingotomy. She achieved twin pregnancy by ovulation induction with clomiphene 7 months after laparoscopic surgery.</p><p><b>Conclusion:</b> Although preoperative diagnosis of chronic tubal pregnancy is difficult, laparoscopic approach would be feasible, especially when salpingotomy would be performed for future fertility preservation.</p><p></p>
著者
大橋 和明 小寺 宏平 伊藤 信一郎 原口 正史 入江 準二
出版者
日本産科婦人科内視鏡学会
雑誌
日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)
巻号頁・発行日
vol.32, no.1, pp.260-264, 2016 (Released:2017-01-21)
参考文献数
8

Lipiodized oil has been widely used for hysterosalpingography because it has superior imaging capability. We report a case of prolonged retention of lipiodized oil suspicious for foreign material in the abdomen. A 34-year-old woman who had undergone hysterosalpingography for evaluation of primary infertility visited our hospital with complaints of lower abdominal pain. She was found to have a metal-like shadow in the right side of the pelvis that was present on abdominal radiography performed at another facility. Computed tomography showed a high absorption range with halation in the right side of the pelvis. We suspected retention of metallic material because she had a history of cesarean section in our hospital several years prior, but we did not consider the likelihood of prolonged retention of lipiodized oil. Laparoscopic surgery was performed for diagnosis. During the operation we did not find any metallic material in the pelvis; we confirmed the position of the mass by using X-ray imaging and resected a cystic mass from the right side of the pelvis. The cyst showed high absorption on radiography and contained a yellowish oily fluid. We carried out a combustion experiment and it was found that the oily fluid included iodine; we therefore concluded that the cystic mass was due to prolonged retention of lipiodized oil rather than metallic material. It is necessary to consider the possibility of prolonged retention of lipiodized oil in patients with a history of hysterosalpingography.
著者
永井 智之 島田 宗昭 湊 敬道 田中 恵子 土岐 麻実 工藤 敬 橋本 千明 星合 哲郎 徳永 英樹 八重樫 伸生
出版者
日本産科婦人科内視鏡学会
雑誌
日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)
巻号頁・発行日
vol.35, no.1, pp.92-97, 2019 (Released:2019-06-08)
参考文献数
11

Objective: To evaluate the usefulness of diagnostic laparoscopy in patients with advanced ovarian cancer.Methods: We retrospectively analyzed nine patients for whom primary debulking surgery was considered unfeasible. We evaluated whether laparoscopic procedure was adequate in making pathological diagnosis and intraabdominal assessment.Results: Median age was 63 years (range, 47-79 years), and median operation time was 59 minutes (range, 43-103 minutes). All nine patients were pathologically diagnosed with high-grade serous carcinoma and were considered unfit to undergo primary debulking surgery. All patients received chemotherapy. Six patients underwent interval debulking surgery. Only one patient showed mild adhesions between the omentum and the abdominal wall. Conclusion: Diagnostic laparoscopy is safe and feasible in advanced ovarian cancer patients.
著者
上地 秀昭 野原 理
出版者
日本産科婦人科内視鏡学会
雑誌
日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)
巻号頁・発行日
vol.33, no.2, pp.197-201, 2017

<p>  Interstitial pregnancy is a rare and life-threatening condition. The most important facet of caring for women with interstitial pregnancy is early diagnosis. We report a case of interstitial pregnancy that was indistinguishable from normal intrauterine pregnancy. A 38-year-old woman, gravida 4 para 3, with a history of laparoscopic salpingectomy for ectopic pregnancy, felt a strong lower abdominal pain and visited our emergency department. The pregnancy test result was positive, and transvaginal ultrasonography revealed intrauterine pregnancy of 11 weeks with intrapelvic hemorrhage but without an adnexal mass. Two hours later, she felt severe upper abdominal pain. Urgent ultrasonography revealed increased intra-abdominal hemorrhage. Emergency laparoscopy was performed. We collected 1400 ml of blood in the abdominopelvic cavity and found that she had a left interstitial pregnancy with bleeding. We removed all gestational tissue and performed a cornuostomy. After the surgery, 4 blood units were transfused. Interstitial pregnancy was difficult to diagnose at 11 weeks of pregnancy. However, ultrasonography revealed intrauterine pregnancy with intrapelvic hemorrhage. Concomitant intrauterine and extrauterine pregnancies or interstitial pregnancy should be considered.</p>
著者
長尾 有佳里 鈴木 一弘 新保 暁子 坂堂 美央子 齋藤 愛 廣村 勝彦 安藤 智子
出版者
日本産科婦人科内視鏡学会
雑誌
日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)
巻号頁・発行日
vol.31, no.2, pp.399-405, 2016 (Released:2016-05-17)
参考文献数
10

Anti-N-methyl-D-aspartate (NMDA)-receptor encephalitis is a paraneoplastic encephalitide that causes various symptoms. It occurs especially in young women, with about 60% of cases being associated with ovarian teratoma.   We report two cases of emergency laparoscopic surgeries for anti-NMDA-receptor encephalitis associated with ovarian teratoma.Case 1: A 17-year-old woman had headache, fever and vomiting. A week later, she also had abnormal behavior and hallucination and entered hospital. CT scan detected left ovarian teratoma. As anti-NMDA-receptor encephalitis was suspected, she underwent laparoscopic left ovarian cystectomy. She needed post-operative respirator management for 2.5 months. Although discharged after 4.5 months, she was sent to a psychiatrist after 7 months because of domestic violence. The pathological diagnosis was an immature teratoma, but there is no sign of recurrence.Case 2: A 26-year-old woman had fever, headache and fatigue. A few days later, she also had memory disorder and entered hospital. CT scan detected right ovarian teratoma. As anti-NMDA-receptor encephalitis was suspected, she underwent single incision laparoscopic right salpingo-oophorectomy. She needed post-operative respirator management for 9 months and left hospital after 1 year. The pathological diagnosis was a mature teratoma.  Antibodies against NMDA-receptor were positive in both cerebrospinal fluids.  Early diagnosis and surgery are important for quick recovery of anti-NMDA-receptor encephalitis associated with ovarian teratoma. Even so, patients don't necessarily recover quickly without aftereffects. We should review operative methods, because the patient is young and cannot agree and immature teratoma prevalence is high. Whether a tumor is benign or malignant, it is important to prevent leakage of tumor contents whenever possible.
著者
奥田 知宏 吉岡 崇 秋山 誠 山下 貞雄
出版者
Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy
雑誌
日本産科婦人科内視鏡学会雑誌 (ISSN:18849938)
巻号頁・発行日
vol.26, no.2, pp.429-434, 2010 (Released:2011-06-02)
参考文献数
17

Laparoscopic surgery is a valuable tool in the definitive diagnosis and treatment of benign uterine tumors. Here we report two cases diagnosed as benign uterine tumors by laparoscopic surgery: the first is an adenomatoid tumor that was suspected preoperatively as a uterine leiomyoma; the second is a uterine leiomyoma that was suspected preoperatively as an adenomatoid tumor.Cases:   Case 1: A 63 year-old woman presented to our hospital complaining of lumbago. Uterine myoma was suspected and ultrasound and MRI were performed. A cystic uterine tumor suggesting benign uterine leiomyoma was discovered. However, malignancy could not be ruled out, therefore, the patient consented to LAVH (laparoscopic assisted vaginal hysterectomy). Upon removal of the patient's uterus, macroscopic examination of the tumor was strongly suggestive of uterine leiomyoma. The specimen was sent to pathology; microscopic examination and immunohistological testing provided the definitive diagnosis of benign adenomatoid tumor.   Case 2: A 44 year-old woman presented to our hospital for periodic examination of a uterine myoma that she had been diagnosed with several years ago. MRI was performed and myoma nodule was found. To rule out malignancy, a diagnostic and therapeutic laparoscopic assisted myomectomy (LAM) was recommended. LAM was chosen because the tumor surface appeared as a usual myoma nodule. Final pathology findings on immunohistochemical study of the surgical specimen confirmed the diagnosis of uterine leiomyoma.Conclusion:   Laparoscopic surgery provides many advantages in clinical gynecological practice. We stress the importance of laparoscopic surgery in preventing misdiagnosis, and in providing definitive diagnosis and treatment in cases of benign gynecologic tumors, including the rare uterine adenomatoid tumor presented herein. We recommend laparoscopic surgical intervention particularly in cases where various imaging studies including MRI, CT, and sonogram, are incompatible with or unable to confirm benign tumor origin.