Bilateral atresia of the proximal ampullary segment of the fallopian tubes

Bilateral interruption of mid-fallopian tubes and ovarian anomalies including ectopic ovary and cystic teratoma, a previously unreported combination

A 25-year-old infertile woman underwent laparoscopy because of a dermoid cyst of the left ovary and was found to have an ectopic ovary, to which an abnormal right fimbria was connected, with an isolated right ovary in the normal position and the bilateral segmental absence of the middle portion of the fallopian tubes. The complex of these anomalies is rare. A fundamental error might have existed in the mesenchyme of the gonadal ridges of the early embryo, rather than the epithelial origin of the müllerian and wolffian ducts.

[Results of modem tuboperitoneal infertility treatment]

BACKGROUND/AIM

A modem approach to surgical treatment of tuboperitoneal infertility is based on laporascopic techniques. The aim of this study was to compare results of tuboperitoneal infertility treatment by the use of laparoscopy and classical laparotomy.

METHODS

A retrospective-prospective study on 66 women treated operatively for tuboperitoneal infertility was performed. Data from patient's anemnesis and those related to the surgical treatment results, obtained by the use of an inquiry, were used in retrospective and prospective analysis, respectively. Chi-square test was used in statistical analysis. P value < 0.05 was considered significant.

RESULTS

Classical laparotomy was used on 34 women in a period from 1996 to 1997, while 32 women were operated laparoscopically in a period from 1999 to 2000. The results were as follows: a total number of conceived women was 16 (24%), seven in the group I (20.6%) and nine in the group II (28.1%); 13 women were with one pregnancy, six in the group I (17.6%) and seven in the group II (22%). Twice pregnant were three women, one in the group I (2.9%) and two in the group II (6.2%). The resulting pregnancies were: five women with abortion spontaneous, two in the group I (5.9%) and three in the group II (9.40/%); two women with extrauterine pregnancy in the group I (5.9%); three with pretemporal birth, one in the group I (2.9%) and two in the group II (6.2%), while six women were with the temporal birth, two in the group I (5.9%) and four in the group II (12.5%). Statistical analysis showed that there was no significant difference in the results between these two groups.

CONCLUSION

Surgical treatment of tubeperitoneal infertility, regardless of the used methods (classical laparotomy or laparoscopy) was successful in a great number of women. These methods have a great advantage over in vitro fertilization, and they should not be ignored.

Torsion causing interruption of the ampullary portion of the fallopian tube

OBJECTIVE

To present a description of a young girl who presented acutely with symptoms and findings that are consistent with acute adnexal torsion, where resultant outcome would have led to perception of a congenital anomaly.

DESIGN

Case report.

SETTING

Tertiary pediatric hospital.

PATIENT(S)

A young girl who presented acutely with symptoms consistent with adnexal torsion but who was found to have a torsion affecting a paratubal cyst and the midsegment of her fallopian tube.

INTERVENTION(S)

A salpingectomy was performed because of damage involving the ischemic paratubal cyst and tubal segment that left too little residual tube to allow for a future anastomosis of the residual unaffected components.

MAIN OUTCOME MEASURE(S)

Operative findings, which give an explanation for midsegmental tubal absence.

RESULT(S)

This case challenges previous reports that absent midsegment of a tube is a rare congenital anomaly.

CONCLUSION(S)

Absent midsegment of a tube can be explained as an acquired anomaly, rather than proposing an unusual congenital anomaly.

Congenital partial atresia of the Fallopian tube

Partial tubal atresia is a rare anomaly of unknown pathogenesis. It can occur unilaterally or bilaterally, mainly including the proximal isthmic portion or the proximal ampullary segment ('mid-portion'), and is especially associated with uterine anomalies. Any more extensive pelvic surgery, including preoperative diagnosis of associated urological anomalies, must be well planned in such patients. Salpingostomy and fimbrial approximation is a realistic option in patients with congenital ampullary atresia who wish to have a child. A MEDLINE search was performed and 18 patients found with partial atresia of different tubal portions. This report describes a further patient and reviews the available literature.

Fertility potential of women with congenital ampullary atresia of the fallopian tube

OBJECTIVE

To determine the fertility potential of women with congenital ampullary atresia of the fallopian tube.

DESIGN

Case report and review of literature.

SETTING

University-affiliated tertiary care infertility clinic.

PATIENT(S)

Six infertile women with congenital ampullary atresia of the oviduct.

INTERVENTION(S)

Salpingostomy and fimbrial approximation.

MAIN OUTCOME MEASURE(S)

Pregnancy.

RESULT(S)

Of six reported cases of congenital ampullary atresia of the fallopian tube who underwent surgery, four women conceived intrauterine pregnancies (IUP) and another, a pregnancy of undetermined site.

CONCLUSION(S)

Salpingostomy and fimbrial approximation is a therapeutic option for infertile women with congenital ampullary atresia of the fallopian tube.