Sonographic and magnetic resonance imaging findings of pelvic abscess following uterine perforation sustained during office endometrial sampling

Abulafia, Ovadia; Shah, Tejas R.; Salame, Ghadir; Economos, Kathrine; Serur, Eli; Zinn, Harry L.; Sokolovkski, Margarita; Sherer, David M.

doi:10.1002/jcu.20770

Cited by 12 publications

(11 citation statements)

References 15 publications

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“…Although our study did not report any uterine muscle damage, pelvic infection or other complications, it is estimated that the risk of perforation during pipelle biopsy is 0.1-0.2% [28]. One of the most severe complication was the case of large pelvic abscess following uterine perforation in a 53-year-old woman after endometrial pipelle sampling [29]. Loops of the large bowel were encased in the abscess.…”

Section: Discussionmentioning

confidence: 59%

Assessment of the usefulness of pipelle biopsy in gynecological diagnostics

Piątek

Panek²,

Wielgoś³

2016

Ginekol Pol

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Objectives: The aim of this study is to assess the effectiveness of pipelle in sampling diagnostic material from the uterine cavity and determining clinical factors, which may affect its effectiveness. Material and methods:The retrospective analysis included 312 patients who underwent pipelle biopsy because of various indications. Evaluated factors which may affect the effectiveness of this method were: types of indications for the procedure, age, BMI, anteflexion or retroflexion of the uterus, presence of uterine fibroids, miscarriages, natural deliveries, deliveries in general. Results:In 259 (83.01%) cases sampled material allowed for a histopathological diagnosis. In 53 (16.99%) of the women we failed to sample tissue material from the uterine cavity. Indications for the procedure, BMI, age and menopausal status were factors of potential impact on the diagnostic effectiveness (p < 0.05). The diagnostic value of pipelle was found to be the lowest in women with overweight and obesity (BMI > 28), post-menopausal women, women over 55 years of age and where biopsy was performed for indications other than abnormal uterine bleeding. On the other hand, pipelle shows clearly the highest effectiveness in sampling diagnostic material from the uterine cavity in young women (< 45 years of age), menstruating women, women with normal body weight or underweight (BMI < 23) and abnormal uterine bleeding. Conclusions:Choosing a pipelle as an endometrial biopsy method should consider the indications, BMI, age and menopausal status. Omission of these factors can increase non-diagnostic outcomes resulting in necessity of repeated biopsies, the risk of complications and increases the costs of health care system.

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Section: Discussionmentioning

confidence: 59%

Assessment of the usefulness of pipelle biopsy in gynecological diagnostics

Piątek

Panek²,

Wielgoś³

2016

Ginekol Pol

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“…In our case, the presence of intestinal tissue in D&C specimen raised the following possibilities: (1) In view of imaging showing suspected bowel infiltration, there was a possibility of endometrial cancer perforating the adjacent bowel. However, the biopsy was negative for malignancy.…”

Section: Discussionmentioning

confidence: 76%

“…Endometrial biopsy is a routine and safe surgical procedure in gynecology. Complications are rare but can be fatal at times [1]. Uterine perforation can occur during D&C by sounding the uterus or during the cervical dilatation [2].…”

Section: Introductionmentioning

confidence: 99%

Unusual Bowel Perforation Following Dilatation and Curettage in a Case of Endometrial Cancer

Bhat

Ahuja

Somashekhar

et al. 2018

Indian J Gynecol Oncolog

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We present an unusual case of iatrogenic small bowel perforation in a woman with endometrial cancer. A 57-year-old postmenopausal woman with past history of total colostomy with loop ileostomy for ulcerative colitis, was referred to our department for evaluation and further management of suspected endometrial cancer following dilatation and curettage (D&C) elsewhere. The histopathology showed intestinal element which was attributed to metaplasia; however, no malignancy was identified in the biopsy specimen. Imaging carried out elsewhere after D&C showed thickened endometrium with suspicious small bowel infiltration. The patient was completely asymptomatic with no signs of bowel injury or peritonitis. After a complete evaluation, a class 1 extrafascial hysterectomy and bilateral salpingo-oophorectomy with segmental ileal resection and anastomosis and frozen section were performed. Intraoperatively, small bowel loop was found adherent to the posterior uterine wall extending up to the cervix with no obvious sign of any uterine or bowel perforation. The final histopathology revealed endometrioid adenocarcinoma grade 1, stage IA, with tumor located at the fundus along with cervical isthmic perforation on the posterolateral wall with full thickness ileum perforation. Uterine perforation at D&C is a known complication, but a silent bowel injury presenting with intestinal tissue in endometrial biopsy is very unusual. A high degree of suspicion is required to detect such complications at D&C especially in postmenopausal women with past history of abdominal surgery.

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“…Postprocedure complications are minimal 0.1-0.2% compared to 0.3-2.6% in D&C. 12 Pipelle has a very low risk for uterine perforation versus other sampling devices, though one case has been reported. 13 Pipelle produced significantly lesser pain than D&C. 14 There is no therapeutic benefit with pipelle as compared to D&C. Hence, it can be used only for the diagnostic purpose, where it yields adequate sample with reliable histopathology reports. [4][5][6][7][8][9][10][11][12] Prophylactic antibiotics may not be necessary during office endometrial sampling.…”

Section: Discussionmentioning

confidence: 99%

Abnormal Uterine Bleeding in Perimenopausal Women: Relevance of Transvaginal Ultrasound, Office Endometrial Biopsy, Dilatation and Curettage—An Observational Study

Pai¹,

Kodandapani²

2018

International Journal of Infertility &Amp; Fetal Medicine

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Introduction: Abnormal uterine bleeding (AUB) in perimenopausal women requires careful evaluation due to the risk of endometrial malignancy. Symptomatic women with thick endometrium by transvaginal ultrasound (TVS) warrant endometrial sampling. D&C has been the mainstay over decades whereas pipelle has gained popularity due to good tissue yield and easy technique with no admission or anesthesia. This study aims to determine the use of office endometrial biopsy in perimenopausal women with AUB and the endometrial pathology detected by TVS. Materials and methods:In this observational study over five years, 159 women with AUB who underwent endometrial sampling were included. The patients were randomly assigned D&C or pipelle depending on symptoms and endometrial thickness after clinical examination and laboratory investigations. 79.2% of women underwent office endometrial sampling, and 20.8% underwent D&C. samples were sent for histopathology. Statistical analysis was done with respect to the type of sampling and endometrial thickness by TVS.Results: Mean age of the study group was 44 years. About 60.3% of these women had ET of 10-20 mm. It was noted that women with thinner endometrium had more benign lesions and no atypia or malignancy. Sampling was 100% adequate in D&C cases compared to 97.8% of office biopsy group, though statistically not significant. Office endometrial biopsy and D&C yielded adequate sample and a reliable histopathological report and were comparable with respect to sampling, reports and endometrial thickness. Endometrial malignancy was diagnosed in 1.3% of the study group. 56.6% of women had simple hyperplasia without atypia, and 27% had a normal endometrium. Conclusion:Office endometrial biopsy is a sensitive method to detect abnormal endometrium in women with AUB. Diagnostic Office endometrial sampling is comparable to D&C with lesser complications. TVS prior to endometrial sampling improves the sensitivity to diagnose endometrial pathology.

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Sonographic and magnetic resonance imaging findings of pelvic abscess following uterine perforation sustained during office endometrial sampling

Cited by 12 publications

References 15 publications

Assessment of the usefulness of pipelle biopsy in gynecological diagnostics

Assessment of the usefulness of pipelle biopsy in gynecological diagnostics

Unusual Bowel Perforation Following Dilatation and Curettage in a Case of Endometrial Cancer

Abnormal Uterine Bleeding in Perimenopausal Women: Relevance of Transvaginal Ultrasound, Office Endometrial Biopsy, Dilatation and Curettage—An Observational Study

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