Tubenprolaps als Komplikation nach vaginaler Hysterektomie

Abstract

Material und Methodik: Wir berichten über 4 Fälle eines Tubenprolaps nach vaginaler Hysterektomie, die in einem durchschnittlichen Zeitraum von 8 Monaten nach Primäroperation auftraten. 3 Patientinnen berichteten über wäßrigen Fluor vaginalis, eine Patientin war asymptomatisch. Bei der Spekulumuntersuchung war Granulationsgewebe am Scheidenende bei allen Patientinnen sichtbar. Präoperativ erfolgte die Diagnosesicherung mittels Biopsie, wobei in allen Fällen Tubenschleimhaut nachweisbar war. Ergebnisse: Bei 3 Patientinnen mit kleinem prolabierten Tubenanteil erfolgte die transvaginale Koagulation und Exzision des prolabierten Tubenanteils. Bei einer Patientin mit großem prolabierten Tubenanteil wurde die laparoskopische Salpingektomie durchgeführt. Intra-und postoperative Komplikationen traten nicht auf. Zum Entlassungszeitpunkt waren alle Patientinnen beschwerdefrei. Schlußfolgerung: Die transvaginale Versorgung stellt bei minimalem prolabierten Tubenanteil eine effiziente Methode der Behandlung dar. Ist ein größererer Anteil der Tube in die Vagina prolabiert, so sollte die laparoskopische Salpingektomie erfolgen.

Surgical management of endosalpingiosis with tubovaginal fistulization after hysterectomy by a combined laparoscopic‐vaginal route, and histological findings

“…This phenomenon is usually explained in terms of inadequate peritoneal closure 5 . Recommended treatment modalities for this type of rare complication are salpingectomy by a vaginal approach, laparoscopy or electrocoagulation and excision of the prolapsed tube section via a vaginal approach; 2,6 , 7 these methods have different advantages and disadvantages. However, on account of the small number of cases, no general recommendations for therapy can be given as yet.…”

“…A vaginal tube prolapse subsequent to a vaginal or abdominal hysterectomy is considered to be a rare complication which can occur at widely varying times, up to 28 years, postoperatively 2 . One‐third of cases are observed after abdominal hysterectomy and two‐thirds after a vaginal procedure 3,4 .…”

Abdominal Actinomycosis: Case Report

“…Microbiological diagnosis; it is necessary to send samples for cultivation in anaerobic conditions (material obtained by biopsy, taking sputum by washing the bronchi, swab of the cervix). Histological findings -pathognomonic findings are granules or drusen, which represent conglomerates of microorganisms, which are formed only in vivo, and are not formed by artificial cultivation on substrates [3,4].…”

“…Actinomycosis can appear in almost all organs and organ systems, that is, actinomycetes show pathogenicity in all tissues of the human body, but the diagnosis of this disease is rare [1,2]. The most common localization of actinomycosis is the head and neck, thorax, and then the abdomen, while localization in the pelvis, localization in the central nervous system, and disseminated forms preceded by states of marked immunodeficiency are very rare [3,4].…”

“…In the case of abdominal localization, the pathogenetic prerequisite is most often appendicitis, diverticulitis, foreign bodies in the intestinal tract, surgical procedures. Histologically, an actinomycete lesion is characterized by a granulation zone, made up of collagen fibers and fibroblasts, a purulent zone made up of neutrophils and granules or drusen, and made of conglomerates of actinomycetes, while the outer zone contains plasma cells, lymphocytes, eosinophils or multinuclear cells [1][2][3][4].…”