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Tannous AM, Bastow BD. Cutaneous Tattoo Ink as a Mimicker of Endometriosis-Like Lesions on Diagnostic Laparoscopy. Cureus 2024; 16:e59212. [PMID: 38807789 PMCID: PMC11131970 DOI: 10.7759/cureus.59212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 05/30/2024] Open
Abstract
This paper presents the case of a 28-year-old with a history of chronic pelvic pain suspicious of endometriosis. She underwent a diagnostic laparoscopy and biopsy of lesions along the posterior cul-de-sac and right sidewall near the external iliac artery. Histopathological examination revealed no evidence of endometriosis but did comment on benign lymph node tissue with tattoo-like pigment. These findings correspond to the patient's tattoos located along the lower extremities. It is suspected there was cutaneous tattoo ink migration causing intra-abdominal lymphadenopathy, which visually mimicked endometriosis on diagnostic laparoscopy. Surgeons should become familiar with and recognize this phenomenon, as it can be misleading in the setting of endometriosis and diagnostic laparoscopy. Surgeons undertaking these cases must be able to identify and safely excise abnormal-appearing lesions in many different locations to prevent a missed or delayed diagnosis of endometriosis.
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Worrall AP, O'Leary BD, Salameh F. Obstetric anal sphincter injury (OASI) in the presence of an intact perineum. BMJ Case Rep 2023; 16:e253922. [PMID: 37848273 PMCID: PMC10583107 DOI: 10.1136/bcr-2022-253922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
Obstetric anal sphincter injury (OASI) in the absence of concurrent injury to the perineal skin is not a common diagnosis. A primiparous woman delivered a healthy male infant by spontaneous vertex delivery. At time of delivery, a compound presentation of the fetal hand with the head was noted. Initial examination revealed a presumed second-degree tear; however, a small laceration above the anal verge was noted, which on exploration revealed a perineal injury through the anal sphincter complex. In the operating theatre, the perineal skin was incised to reveal a 3c OASI, which was repaired appropriately. While atypical OASI has been reported previously, this specific injury has never been described in detail in the literature. Awareness of atypical perineal injuries is needed and while careful perineal examination is required in all cases, this is especially important where the perineal skin appears intact to ensure appropriate diagnosis of any concurrent OASI.
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Affiliation(s)
- Amy P Worrall
- Obstetrics and Gynaecology, Rotunda Hospital, Dublin 1, Ireland
| | - Bobby D O'Leary
- Obstetrics and Gynaecology, Rotunda Hospital, Dublin 1, Ireland
| | - Fadi Salameh
- Obstetrics and Gynaecology, Rotunda Hospital, Dublin 1, Ireland
- Department of Obstetrics and Gynaecology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Nguyen NH, Nguyen TH, Nguyen CL, Vu XV, Luong TH, Nguyen TK. Autologous blood for preoperative colorectal TUMOR’S localization: A Vietnamese preliminary experience. Ann Med Surg (Lond) 2022; 75:103345. [PMID: 35198186 PMCID: PMC8844862 DOI: 10.1016/j.amsu.2022.103345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Laparoscopic colorectal surgery (LCRS) is the optimal choice for cases of early cancer. However, due to their early stage, one of this procedure's challenges is tumoral localization. So that, there are many methods of locating tumors preoperatively that have been studied by authors. Recently, Korean authors have reported a method of injecting autologous blood to mark the tumor before surgery with high efficiency and safety. This article aims to evaluate the effectiveness by analyzing the section biopsy's results, as well as the safety of this procedure. Materials and method This study is descriptive cross-section study with analysis of retrospective occurrences of case series of colonoscopy with autologous blood before surgery from October 2020 to December 2021. Results 16 patients were recruited to the study. The average age was 62.9 ± 13.1 with male/female ratio was 8/8. 50% (8/16 patients) of all cases was early carcinomas, and by location, 62.5% of all cases was sigmoid colon tumors. All 16 patients (100%) found the tumor marking position. None of the patients had complications of marked endoscopy such as intestinal perforation, peritonitis, abdominal abscess, intestinal adhesions, etc. Conclusion The method of autologous blood injection to locate the tumor before laparoscopic colorectal surgery is a technique that can be performed effectively and safely. Laparoscopic colorectal surgery is the optimal choice for cases of early cancer. There are some methods of locating tumors preoperatively. Colonoscopy autologous blood injection can be performed effectively and safely. We can combine other methods to increase the certainty of tumor location.
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Pedersen R, Chen J, Kho KA. Peritoneal and Intestinal Ink Stains from Endoscopic Tattooing Encountered during Gynecologic Surgery. J Minim Invasive Gynecol 2021; 28:1669-1670. [PMID: 34010695 DOI: 10.1016/j.jmig.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Rebecca Pedersen
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas (all authors)
| | - Joseph Chen
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas (all authors)
| | - Kimberly A Kho
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas (all authors)..
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Tejedor P, Bodega-Quiroga I, Plaza J, Ortega López M, Gutierrez C, García Olmo D, Pastor C. Quality of life and 3D-EUS assessment for anal incontinence after childbirth. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:453-459. [PMID: 31021166 DOI: 10.17235/reed.2019.6040/2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND the incidence of obstetric sphincter tears has risen to 15-30% and the prevalence of anal incontinence (AI) symptoms after childbirth may be as high as 40%. The present study evaluates the correlation between obstetric injuries detected by endoanal ultrasound (3D-EUS) and AI symptoms, as well as their impact on the quality of life (QOL) of women after childbirth. METHODS a prospective observational study was performed of pregnant women evaluated before (baseline) and three months after childbirth to ensure the integrity of the anal sphincters and to evaluate possible injuries. The Fecal Incontinence Quality of Life (FIQL) questionnaire and the Cleveland Clinic Score of Incontinence (Wexner) were completed before and after childbirth. The questionnaire results were correlated with an assessment of sphincter defects performed by 3D-EUS. RESULTS a total of 56 females were included in the study. Overall, 48% developed symptoms of AI after childbirth, with a significant decrease in their FIQL compared to the initial evaluation, 3.9 (0.05) vs 3.4 (0.8), respectively (p = 0.000). In addition, 42% of the cohort presented with some kind of obstetric sphincter defect on the 3D-EUS. Instrumental assisted delivery and the sphincter defects were the only two significant factors identified via multivariate analysis that were associated with a decrease in QOL (0.4, 95% CI, 0.07-0.8). CONCLUSIONS AI after childbirth was associated with a huge impact on QOL, especially in patients with sphincter injuries. A complete clinical evaluation, including 3D-EUS, is recommended to prevent, manage or treat AI in primiparous females.
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Affiliation(s)
- Patricia Tejedor
- Department of Colorectal Surgery, Hospital Universitario Fundación Jiménez Díaz, Spain
| | | | - Javier Plaza
- Department of Gynaecology and Obstetrics, Hospital Universitario Fundación Jiménez Díaz, Spain
| | - Mario Ortega López
- Colorectal Surgery, Hospital Universitario Fundación Jiménez Díaz, Spain
| | | | - Damian García Olmo
- Cirugía General y Digestivo, Hospital Universitario Fundación Jiménez Díaz, Spain
| | - Carlos Pastor
- Colorectal Surgery, Hospital Universitario Fundación Jiménez Díaz, Spain
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Sideris M, McCaughey T, Hanrahan JG, Arroyo-Manzano D, Zamora J, Jha S, Knowles CH, Thakar R, Chaliha C, Thangaratinam S. Risk of obstetric anal sphincter injuries (OASIS) and anal incontinence: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 252:303-312. [PMID: 32653603 DOI: 10.1016/j.ejogrb.2020.06.048] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Obstetric anal sphincter injuries (OASIS) are the commonest cause of anal incontinence in women of reproductive age. We determined the risk of anal sphincter defects diagnosed by ultrasound, and the risk of anal incontinence in (i) all women who deliver vaginally, (ii) in women without clinical suspicion of OASIS, and (iii) after primary repair of sphincter injury, by systematic review. METHODS We searched major databases until June 2018, without language restrictions. Random effects meta-analysis was used to obtain pooled estimates of ultrasound diagnosed OASIS and risk of anal incontinence symptoms at various time points after delivery, and of persistent sphincter defects after primary repair. We reported the association between ultrasound diagnosed OASIS and anal incontinence symptoms using relative risk (RR) with 95 % CI. RESULTS We included 103 studies involving 16,110 women. Of all women who delivered vaginally, OASIS were diagnosed on ultrasound in 26 % (95 %CI, 21-30, I2 = 91 %), and 19 % experienced anal incontinence (95 %CI, 14-25, I2 = 92 %). In women without clinical suspicion of OASIS (n = 3688), sphincter defects were observed in 13 % (10-17, I2 = 89 %) and anal incontinence experienced by 14 % (95 % CI: 6-24, I2 = 95 %). Following primary repair of OASIS, 55 % (46-63, I2 = 98 %) of 7549 women had persistent sphincter defect with 38 % experiencing anal incontinence (33-43, I2 = 92 %). There was a significant association between ultrasound diagnosed OASIS and anal incontinence (RR 3.74, 2.17-6.45, I2 = 98 %). INTERPRETATION Women and clinicians should be aware of the high risk for sphincter defects following vaginal delivery even when clinically unsuspected. This underlines the need of careful and systematic perineal assessment after birth to mitigate the risk of missing OASIS. We also noted a high rate of persistent defects and symptoms following primary repair of OASIS. This dictates the need for provision of robust training for clinicians to achieve proficiency and sustain competency in repairing OASIS.
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Affiliation(s)
- Michail Sideris
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK.
| | - Tristan McCaughey
- Department of Surgery, School of Clinical Science at Monash Health, Monash University, 3800, VIC, Australia
| | | | - David Arroyo-Manzano
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK; Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS, CIBERESP), Madrid, Spain
| | - Javier Zamora
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK; Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS, CIBERESP), Madrid, Spain
| | - Swati Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Charles H Knowles
- National Bowel Research Centre, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ranee Thakar
- Department of Obstetrics and Gynaecology, Croydon University Hospital, Croydon, UK
| | - Charlotte Chaliha
- Department of Obstetrics and Gynaecology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Shakila Thangaratinam
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK; Multidisciplinary Evidence Synthesis Hub (MEsH), Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
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Pihl S, Blomberg M, Uustal E. Internal anal sphincter injury in the immediate postpartum period; Prevalence, risk factors and diagnostic methods in the Swedish perineal laceration registry. Eur J Obstet Gynecol Reprod Biol 2019; 245:1-6. [PMID: 31825790 DOI: 10.1016/j.ejogrb.2019.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/19/2019] [Accepted: 11/27/2019] [Indexed: 11/17/2022]
Abstract
Risk factors for obstetric external anal sphincter injury are well known. Maternal and obstetric risk factors for internal anal sphincter injury are not extensively studied. The rationale of this study was to evaluate the proportion of internal anal sphincter injury in women with external anal sphincter injury, diagnosed immediately after delivery. This study will assess whether there are additional risks for obstetric internal anal sphincter injury. OBJECTIVES The primary aim was to assess the proportion of internal anal sphincter injury immediately in women with an external sphincter injury and to evaluate maternal and obstetric risk factors for internal anal sphincter injury in women with an external anal sphincter injury only. A secondary aim was to relate the diagnostic methods used for obstetric perineal lacerations to the presence of an internal anal sphincter injury. STUDY DESIGN A registry study with data from the Swedish Perineal Laceration Registry 2014-2018. From the registry, the maternal and obstetric characteristics of 3,333 primiparous women with isolated external (N = 2,236) versus both external and internal (N = 1,097) anal sphincter injuries were studied, as were the methods used for examining the obstetric anal sphincter injuries. RESULTS In 32.9 % (1,097/3,333) of primiparous women with an external anal sphincter injury, an internal anal sphincter injury was diagnosed immediately after delivery. A perineal palpatory thickness of less than 10 mm was a diagnostic sign for internal sphincter injury. Well-known risk factors associated with obstetric anal sphincter injuries could not be confirmed as independent risk factors for internal sphincter injury. When the infant is born with an arm beside the head, there is an almost two-fold increased risk for internal sphincter injury. CONCLUSIONS Our main finding is that 32.9 % of women with external anal sphincter injury also have an internal anal sphincter injury. A palpable perineal thickness of less than 10 mm, a degree 4-laceration and an infant born with a hand by the head increases the risk of internal sphincter injury and should be a clinical warning sign.
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Affiliation(s)
- Sofia Pihl
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Marie Blomberg
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Eva Uustal
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Tejedor P, Plaza J, Bodega-Quiroga I, Ortega-López M, García-Olmo D, Pastor C. The Role of Three-Dimensional Endoanal Ultrasound on Diagnosis and Classification of Sphincter Defects After Childbirth. J Surg Res 2019; 244:382-388. [PMID: 31325659 DOI: 10.1016/j.jss.2019.06.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/21/2019] [Accepted: 06/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diagnostic tests for fecal incontinence have been improved over time. This study aims to evaluate the role of Three-dimensional endoanal ultrasound (3D-EUS) and the Starck's score in the assessment and treatment of obstetric sphincter injuries. METHODS A prospective observational study was performed including primiparous women who were evaluated at 20 wk of pregnancy and 3 mo after childbirth. Sphincter defects were classified according to the Starck's and Obstetrical Anal Sphincter Injuries classifications. Patients also completed the Fecal Incontinence Quality of Life and the Wexner questionnaires before and after childbirth. RESULTS Sphincter defects were detected in 45% of the 56 women included, although 85% had an uneventful delivery. Most defects were found isolated to the external anal sphincter except for two cases, classified by a Starck's score >8. Fecal Incontinence Quality of Life and Wexner questionnaires showed a rate of symptomatic patients of around 46%. We observed that 30% of patients with sphincter injuries remained asymptomatic. CONCLUSIONS The 3D-EUS is a useful test in assessing sphincter defects after childbirth. This method makes it possible to detect small sphincter defects that otherwise would have gone unnoticed, as 30% of patients with sphincter injuries were asymptomatic. In addition, both the 3D-EUS and the Starck's score were valuable in establishing an algorithm for the treatment of obstetric sphincter injuries.
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Affiliation(s)
- Patricia Tejedor
- Division of Colorectal Surgery, Department of General Surgery, University Hospital Fundacion Jimenez Diaz, Madrid, Spain.
| | - Javier Plaza
- Department of Gynaecology and Obstetrics, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | | | - Mario Ortega-López
- Division of Colorectal Surgery, Department of General Surgery, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | - Damián García-Olmo
- Division of Colorectal Surgery, Department of General Surgery, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | - Carlos Pastor
- Division of Colorectal Surgery, Department of General Surgery, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
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[Anal incontinence and obstetrical anal sphincter injuries, epidemiology and prevention]. ACTA ACUST UNITED AC 2018; 46:419-426. [PMID: 29500142 DOI: 10.1016/j.gofs.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Indexed: 12/11/2022]
Abstract
Our main objectives were to identify risk factors, methods for early diagnosis, and prevention of obstetric anal sphincter injuries (OASIs), using a literature review. The main risk factors for OASIs are nulliparity, instrumental delivery, posterior presentation, median episiotomy, prolonged second phase of labor and fetal macrosomia. Asian origin, short ano-vulvar distance, ligamentous hyperlaxity, lack of expulsion control, non-visualization of the perineum or maneuvers for shoulder dystocia also appear to be risk factors. There is a risk of under-diagnosis of OASIs in the labor ward. Experience of the accoucheur is a protective factor. Secondary prevention is based on the training of birth professionals in recognition and repair of OASIs. Primary prevention of OASIs is based on training in the maneuvers of the second phase of labor; if possible, instrumental extractions should be avoided. Mediolateral episiotomy may have a preventive role in high-risk OASIs deliveries. A robust predictive model is still lacking to allow a selective use of episiotomy.
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Evaluation of long-term pelvic floor symptoms after an obstetric anal sphincter injury (OASI) at least one year after delivery: A retrospective cohort study of 159 cases. ACTA ACUST UNITED AC 2016; 44:385-90. [DOI: 10.1016/j.gyobfe.2016.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/24/2016] [Indexed: 11/19/2022]
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Shek KL, Zazzera VD, Atan IK, Rojas RG, Langer S, Dietz HP. The evolution of transperineal ultrasound findings of the external anal sphincter during the first years after childbirth. Int Urogynecol J 2016; 27:1899-1903. [DOI: 10.1007/s00192-016-3055-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/12/2016] [Indexed: 12/31/2022]
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Early pelvic floor muscle training after obstetrical anal sphincter injuries for the reduction of anal incontinence. Eur J Obstet Gynecol Reprod Biol 2016; 199:201-6. [PMID: 26963793 DOI: 10.1016/j.ejogrb.2016.01.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/11/2016] [Accepted: 01/29/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Between 0.5 and 5% of vaginal deliveries involve obstetrical anal sphincter injuries (OASIS). Thirty to forty percent of patients with OASIS will suffer from anal incontinence in the subacute postpartum period. The aim of the present study was to assess the effectiveness of early pelvic floor muscle training (PFMT) combined with standard rehabilitation on anal incontinence after vaginal deliveries complicated by OASIS. STUDY DESIGN The present work was a retrospective quantitative study performed in a tertiary-level maternity hospital. Women with 3rd or 4th degree obstetric tears were included. Women who gave birth between January 1st, 2011 and December 31st, 2012 underwent standard pelvic-perineal rehabilitation within 6-8 weeks postpartum. Women who gave birth between January 1st, 2013 and July 1st, 2014 had early rehabilitation (within 30 days after delivery) followed by the same standard rehabilitation received by the other group. Rehabilitation was performed by physiotherapists specialized in perineology. No electrostimulation was done in early rehabilitation. An in-house-validated modification of the Jorge and Wexner questionnaire was sent by mail to the patients to assess symptoms. The main judgment criterion was anal incontinence to gas, loose stools and/or solid stool. RESULTS Two hundred and thirty patients were diagnosed with OASIS. Nineteen women (8.3%) were lost to follow-up. The intention-to-treat analysis included 211 patients, 109 of whom underwent standard rehabilitation and 102 early rehabilitation plus standard rehabilitation. The two groups were comparable in terms of parity, birth weight, assisted delivery, epidural anesthesia and rates of mediolateral episiotomy. Multivariate analyses adjusted for type of perineal lesion were performed. Early rehabilitation significantly reduced gas leakage: OR 0.51 [0.29-0.90] (p=0.02), liquid stool leakage: OR 0.22 [0.08-0.58] (p=0.02) and urinary stress incontinence: OR 0.43 [0.24-0.77] (p=0.004). CONCLUSIONS We recommend early (during the first month postpartum) PFMT after vaginal deliveries associated with OASIS. Rehabilitation should be carried out by a physiotherapist specialized in perineology in order to prevent medium-term functional consequences. A longer follow-up may be necessary to confirm the stability of results.
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Villot A, Deffieux X, Demoulin G, Rivain AL, Trichot C, Thubert T. [Management of third and fourth degree perineal tears: A systematic review]. ACTA ACUST UNITED AC 2015; 44:802-11. [PMID: 26143094 DOI: 10.1016/j.jgyn.2015.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
This was a comprehensive literature review using Pubmed, Medline, Embase and Cochrane, whose aim was to analyse the prevalence of anal sphincter injuries, their risk factors, their management and their functional prognosis. The prevalence of 3rd and 4th degree perineal tears varies between studies from 2.95% regardless the parity to 25% in nulliparous women. Twenty-eight percent to 48% of these lacerations were clinically occult. Perineal tears were associated with (multivariate analysis) forceps (6.021 [IC 95% 1.23-19.45]), nulliparity (OR 9.8 [IC 95% 3.6-26.2]), gestational age over 42 SA (OR 2.5 [IC 95% 1-6.2]), fundal pressure (OR 4.6 [IC 95% 2.3-7.9]), midline episiotomy (OR 5.5 [IC 95% 1.4-18.7]) or fetal weight in interval of 250g (OR 1.3 [IC 95% 1.1-1.6]). There was no difference between the sphincter repair techniques. Post-partum laxative use showed less painful bowel motion and earlier postnatal discharge. Data concerning rehabilitation were contradictory. The rate of anal incontinence 6 months after vaginal delivery were 3.6% following third degree of perineal tear and 30.8% in case of fourth degree of perineal tear. Thirty years after anal sphincter disruption, the prevalence of fecal incontinence reached 6.9%.
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Affiliation(s)
- A Villot
- Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN (Group of clinical research in neuro-urology, university Pierre and Marie Curie), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - X Deffieux
- Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN (Group of clinical research in neuro-urology, university Pierre and Marie Curie), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Demoulin
- Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - A-L Rivain
- Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - C Trichot
- Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - T Thubert
- Service de gynécologie obstétrique et biologie de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; GMC-UPMC 01, GREEN (Group of clinical research in neuro-urology, university Pierre and Marie Curie), hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
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Albuquerque A. Endoanal ultrasonography in fecal incontinence: Current and future perspectives. World J Gastrointest Endosc 2015; 7:575-581. [PMID: 26078826 PMCID: PMC4461932 DOI: 10.4253/wjge.v7.i6.575] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/18/2015] [Accepted: 04/20/2015] [Indexed: 02/05/2023] Open
Abstract
Fecal incontinence has a profound impact in a patient’s life, impairing quality of life and carrying a substantial economic burden due to health costs. It is an underdiagnosed condition because many affected patients are reluctant to report it and also clinicians are usually not alert to it. Patient evaluation with a detailed clinical history and examination is very important to indicate the type of injury that is present. Endoanal ultrasonography is currently the gold standard for sphincter evaluation in fecal incontinence and is a simple, well-tolerated and non-expensive technique. Most studies revealed 100% sensitivity in identifying sphincter defect. It is better than endoanal magnetic resonance imaging for internal anal sphincter defects, equivalent for the diagnosis of external anal sphincter defects, but with a lower capacity for assessment of atrophy of this sphincter. The most common cause of fecal incontinence is anal sphincter injury related to obstetric trauma. Only a small percentage of women are diagnosed with sphincter tears immediately after vaginal delivery, but endoanal ultrasonography shows that one third of these women have occult sphincter defects. Furthermore, in patients submitted to primary repair of these tears, ultrasound revealed a high frequency of persistent sphincter defects after surgery. Three-dimensional endoanal ultrasonography is currently largely used and accepted for sphincter evaluation in fecal incontinence, improving diagnostic accuracy and our knowledge of physiologic and pathological sphincters alterations. Conversely, there is currently no evidence to support the use of elastography in fecal incontinence evaluation.
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Aigmueller T, Bader W, Beilecke K, Elenskaia K, Frudinger A, Hanzal E, Helmer H, Huemer H, van der Kleyn M, Koelle D, Kropshofer S, Pfeiffer J, Reisenauer C, Tammaa A, Tamussino K, Umek W. Management of 3rd and 4th Degree Perineal Tears after Vaginal Birth. German Guideline of the German Society of Gynecology and Obstetrics (AWMF Registry No. 015/079, October 2014). Geburtshilfe Frauenheilkd 2015; 75:137-144. [PMID: 26157195 PMCID: PMC4477621 DOI: 10.1055/s-0034-1396323] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- T. Aigmueller
- Universitätsklinik für Frauenheilkunde und Geburtshilfe Graz, Österreich
| | | | - K. Beilecke
- Klinik St. Hedwig, KH Barmherzige Brüder, Regensburg
| | | | - A. Frudinger
- Universitätsklinik für Frauenheilkunde und Geburtshilfe Graz, Österreich
| | - E. Hanzal
- Medizinische Universität Wien, Wien, Österreich
| | - H. Helmer
- Medizinische Universität Wien, Wien, Österreich
| | - H. Huemer
- Klinikum Wels-Grieskirchen, Österreich
| | | | | | - S. Kropshofer
- Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - J. Pfeiffer
- Universitätsklinik für Frauenheilkunde und Geburtshilfe Graz, Österreich
| | | | - A. Tammaa
- Wilhelminenspital Wien, Wien, Österreich
| | - K. Tamussino
- Universitätsklinik für Frauenheilkunde und Geburtshilfe Graz, Österreich
| | - W. Umek
- Medizinische Universität Wien, Wien, Österreich
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Lee SH, Kim DY, Oh SY, Lee KJ, Suh KW. Preoperative Localization of Early Colorectal Cancer or a Malignant Polyp by Using the Patient's Own Blood. Ann Coloproctol 2014; 30:115-7. [PMID: 24999461 PMCID: PMC4079808 DOI: 10.3393/ac.2014.30.3.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/01/2013] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Preoperative localization is the most important preparation for laparoscopic surgery. Preoperative marking with India ink has widely been used and is considered to be safe and effective. However, India ink can cause significant inflammation, adhesions and bowel obstruction. Therefore, we have used the patient's blood instead of the ink since 2011. In this retrospective study, we wanted to examine the feasibility of preoperative localization by using the patient's blood. METHODS Twenty-five patients who underwent preoperative localization in which 10 mL of their own venous blood was used as a tattooing agent were included in this study. The characteristics of the patients, the anatomy of the colon cancer, and the efficacy and the side effects of using this procedure were analyzed. RESULTS In 23 cases (92%), through the laparoscope, we found perfectly localized bloody smudges in the serosa. However, in 2 cases (8%), we could not find the exact location of the lesion. No patients showed any complications. CONCLUSION Preoperative localization of early colon cancer or a malignant polyp by using patient's blood is feasible, safe and simple. We think that using the patient's blood for localization of a lesion is better than using some other foreign material such as India ink.
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Affiliation(s)
- Seung Hwan Lee
- Colon Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Do Yoon Kim
- Colon Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Seung Yeop Oh
- Colon Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Jae Lee
- Colon Cancer Center, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Wook Suh
- Colon Cancer Center, Ajou University School of Medicine, Suwon, Korea
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Stemmer SM, Shurshalina A. Colonoscopic tattoo dye spillage mimics endometriosis on laparoscopy. J Minim Invasive Gynecol 2014; 21:704-7. [PMID: 24473152 DOI: 10.1016/j.jmig.2014.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/20/2014] [Accepted: 01/20/2014] [Indexed: 11/27/2022]
Abstract
Rare adverse effects of India ink injection spillage during colonoscopy have been reported. We present a case report in which prior colonoscopic India ink tattooing was found to mimic intraperitoneal endometriosis in a 48 year-old woman undergoing laparoscopic sterilization. Multiple black lesions suspicious for endometriosis involving the anterior and posterior cul-de-sac, left ovary, and omentum were found. A pathological assessment showed peritoneal tissue with focal dark pigment associated with mild chronic inflammation and deposition of tattoo pigment; there was no evidence of endometriosis in the specimens. Surgical recognition of tattoo ink spillage in the peritoneum is very important to prevent misinterpretation of peritoneal findings.
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Affiliation(s)
- Shlomo M Stemmer
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Virtua Hospital, Voorhees, New Jersey
| | - Anna Shurshalina
- Genesis Biotechnology Group, Medical Diagnostic Laboratories L.L.C., Hamilton, New Jersey.
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20
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Aigmueller T, Umek W, Elenskaia K, Frudinger A, Pfeifer J, Helmer H, Huemer H, Tammaa A, van der Kleyn M, Tamussino K, Koelle D. Guidelines for the management of third and fourth degree perineal tears after vaginal birth from the Austrian Urogynecology Working Group. Int Urogynecol J 2012; 24:553-8. [PMID: 23160871 DOI: 10.1007/s00192-012-1982-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 10/15/2012] [Indexed: 01/25/2023]
Abstract
The purpose of this guideline is to provide a decision aid for diagnosis, treatment, and follow-up of patients with major perineal tears and thus minimize the risk of persistent symptoms. In 2007, the "Guideline for the management of third and fourth degree perineal tears after vaginal birth" was established by members of the Austrian Urogynecologic Working Group (AUB). The guideline was updated in 2011, including literature published up to 30 November 2011. The DELPHI method was used to reach consensus. Evidence-based and consensus-based statements were defined for epidemiology, risk factors, classification, diagnosis, surgery, and follow-up of major perineal lacerations at vaginal birth.
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Affiliation(s)
- T Aigmueller
- Department of Gynecology, Medical University of Graz, Graz, Austria.
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Novel Technique for Preoperative Localization of Colorectal Tumors for Laparoscopic Resection. Surg Laparosc Endosc Percutan Tech 2012; 22:e281-3. [DOI: 10.1097/sle.0b013e31825b3aaa] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Abstract
Female pelvic floor dysfunction encompasses a range of morbidities, including urinary incontinence, female pelvic organ prolapse, anal incontinence and obstructed defecation. Patients often present with symptoms covered by several specialties including gastroenterology, colorectal surgery, urology and gynecology. Imaging can therefore bring clinicians from multiple specialties together by revealing that we frequently deal with different aspects of one underlying problem or pathophysiological process. This article provides an interdisciplinary imaging perspective on the pelvic floor. Modern pelvic floor imaging comprises defecation proctography, translabial and endorectal ultrasound, and static and dynamic MRI. This Perspectives focuses on the potential use of translabial ultrasound, including 3D and 4D applications, for diagnosis of pelvic floor disorders. Over the next decade, pelvic floor imaging will most likely be integrated into mainstream diagnostics in obstetrics and gynecology and colorectal surgery. Using imaging to facilitate communication between different specialties has the potential to greatly improve the multidisciplinary management of complex pelvic floor disorders.
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Derpapas A, Digesu GA, Fernando R, Khullar V. Imaging in urogynaecology. Int Urogynecol J 2011; 22:1345-56. [DOI: 10.1007/s00192-011-1462-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 05/18/2011] [Indexed: 11/30/2022]
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Black macular patches on parietal peritoneum and other extraintestinal sites from intraperitoneal spillage and spread of India ink from preoperative endoscopic tattooing: an endoscopic, surgical, gross pathologic, and microscopic study. Dig Dis Sci 2010; 55:2599-605. [PMID: 19957037 DOI: 10.1007/s10620-009-1044-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 10/26/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Three cases, including one case report and two clinical images, have been reported of extraintestinal or peritoneal black maculae detected at laparoscopy after colonoscopic tattooing, presumably from intraperitoneal spillage of India ink during tattooing. AIMS Report three cases of inadvertent extraintestinal tattooing from endoscopic tattooing of intestinal lesions, provide histologic evidence for the presumed pathophysiology, and promulgate recommendations to prevent this complication. METHODS Three patients underwent endoscopic tattooing of intestinal lesions using India ink, surgery for lesion removal, and pathologic analysis. RESULTS Three patients had black macular patches or streaks identified intraoperatively at extraintestinal sites after endoscopic tattooing of intestinal lesions with India ink: (1) black patches on peritoneum 7 days after colonoscopic tattooing of cecal cancer, (2) black streaks on band connecting cecum to peritoneum 13 days after colonoscopic tattooing of cecal cancer, and (3) blackish band on jejunal mesentery 28 days after tattooing presumptive bleeding jejunal lesion. Pigmentation was detected at both injection and extraintestinal sites in all patients by (1) surgery, (2) gross pathology, and (3) microscopic examination demonstrating intracellular black pigmentation within mesothelial cells and macrophages. Special histologic stains were consistent with a carbon-based pigment, and inconsistent with iron or melanin as the pigment. The proposed mechanism is intraperitoneal India ink spillage from deep intestinal injection, as supported by histologic findings of subserosal pigment accumulation. An alternative histologic mechanism is migration of pigment-laden macrophages via lymphovascular channels. CONCLUSIONS Endoscopic injection of India ink using standard sclerotherapy needles can inadvertently tattoo extraintestinal sites in addition to tattooing the primary lesion. Despite its striking appearance, this intraoperative, gross, and microscopic finding is likely not pathologically significant, given its proposed pathophysiology. Surgical recognition of this entity is important, however, to prevent misinterpretation of findings as peritoneal melanoma, endometrial implants, infarcted mesentery, or tattooed cancer. This complication may be prevented by proper tattooing technique.
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Fritel X. Périnée et grossesse. ACTA ACUST UNITED AC 2010; 38:332-46. [DOI: 10.1016/j.gyobfe.2010.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 03/16/2010] [Indexed: 01/26/2023]
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Abstract
Pelvic floor function and structure are complex, and imaging (integrated with an understanding of physiology) is central to guiding the clinician in managing patients with incontinence, constipation, difficult rectal evacuation and pelvic organ prolapse. Multimodal imaging techniques such as static and dynamic imaging techniques (sometimes combined in a single sitting) have revolutionised our understanding of functional anatomy. The advent of endo-luminal imaging has increased our spatial resolution by its closer proximity to the area of interest. Dynamic imaging gives us a near physiological data set which helps us to simulate what is likely to happen in real life and gives us a better understanding of the multifactorial causes, and consequences, of pelvic floor dysfunction.
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Affiliation(s)
- Stuart A Taylor
- Clinical Radiology, University College London, 235 Euston Road, London NW1 2BU, UK.
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