Uterine perforation, a complication of dilation and curettage, is typically recognized immediately after the procedure by clinical symptoms of peritoneal irritation resulting from intraperitoneal bleeding. Our patient complained of having an uncomfortable feeling, slight dizziness, palpitation in the sitting position and abdominal discomfort but did not show signs of peritoneal irritation 24 h after dilation and curettage. However, she suddenly complained of abdominal pain. Tenderness and rebound tenderness were detected at the lower abdominal wall. Ultrasonography and magnetic resonance imaging suggested uterine perforation. When the abdominal cavity was opened, a hematoma under the broad ligament of the uterus, laceration of the side wall of the uterine cervix and a small amount of bloody ascites and small clots in the abdominal cavity were observed. The uterine cervical wall was sutured. Physicians should postpone discharge and observe the clinical course carefully when a patient complains of inexplicable discomfort after dilation and curettage.
Toxic shock syndrome can be caused by methicillin‐resistant Staphylococcus aureus (MRSA). During puerperium this condition is rare, and proper treatment during this period has not been clarified. Two patients developed toxic shock syndrome caused by MRSA soon after cesarean section. Despite the administration of antibiotics, both developed severe conditions and one of them required hysterectomy. The dosage was adjusted in the same way as nonpregnancy, but the actual drug concentration was significantly different from expectation. When there is severe infection during the early postpartum period, maintaining drug concentration at optimal levels may be difficult, and this could be life‐threatening. Better understanding of the pharmacokinetics and establishment of a method to determine the optimal drug dose during puerperium is required.
Aim
Due to the U.S. Food and Drug Administration's order to cease the use of surgical mesh for transvaginal repair, an improvement of the native tissue repair (NTR) of pelvic organ prolapse (POP) could become important as one of the first‐line operative methods. This study details the surgical technique of an NTR method we developed, with report of our 5 years of experience.
Methods
Operative technique: A new fibromuscular layer (FL) was constructed using a thick and elastic tissue continuous with and obscured behind the original FL of the vaginal wall.
Patients: Between April 2017 and March 2020, we performed our novel repair technique on 87 women with POP of either quantification stage III or IV.
Results
We followed up 80 of the 87 women for over 24 months up to 60 months (follow‐up rate: 91.2%). POP recurred (defined as stage II or higher) in four patients (5.0%). Operation time was 49–70 min. The bleeding volume was 70–250 g. There were no intra‐ or postoperative complications that required further treatment.
Conclusions
This procedure could potentially become one of the first‐line operative methods for repairing POP.
We present a new, conservative treatment strategy for the cases in which an initial repair surgery of uterine rupture failed. In a case presented here, the patient underwent a repair surgery for the uterine rupture that became apparent 4 days after the cesarean delivery, but a part of the wound did not heal and an abscess formed in the surrounding area. The patient had purulent discharge from vagina, which led us to try to insert a Nelaton tube from vagina via cervical canal and to cleanse the abscess cavity. This procedure was successful and the abscess disappeared 38 days later, allowing the healing of the ruptured wound. The patient could deliver a baby 2 years later. Even if the initial repair treatment fails, a possibility of preserving the uterus should be considered for next pregnancy. One of the concrete treatment strategies for this purpose was presented.
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