Nail-gun injuries are one of the most common causes of foreign bodies in soft tissue. Intraperitoneal foreign bodies caused by nail-gun injuries were usually removed surgically. We report a 20-years-old carpenter with an intraperitoneal nail, which was finally successfully removed by the ultrasound-guided interventional method for the first time.
Background Bilateral ectopic pregnancy is extremely rare, with a tremendous maternal mortality and morbidity risk, requiring rapid diagnosis and management. This condition is usually diagnosed during surgery, as radiologists may not pay enough attention to the contralateral side of interest. Therefore, reminding of this rare but emergent situation can be beneficial for both radiologists and gynecologists. Here we report a case of bilateral ectopic pregnancy, which was first diagnosed with ultrasound and was confirmed during laparoscopy. Case presentation A 34 years old woman complaining of light vaginal bleeding at 6 weeks of gestation by her last menstrual period presented to our institute. The serum β-HCG levels were analyzed and followed during patient’s admission. Unfortunately, serum levels weren’t decreasing and blood test titration before surgery were as: 851,894,975 IU/l (checked daily and not every 48 h because of patient’s status and being bilateral). There was no evidence of intrauterine pregnancy at the transvaginal ultrasound, but heterogeneous adnexal masses were seen at both adnexa, suspected of bilateral ectopic pregnancy. She underwent laparoscopic exploration, which confirmed the diagnosis. Bilateral salpingostomy was done to preserve fertility, and the patient’s recovery was uneventful. Conclusions Even with a unilateral report of ectopic pregnancy preoperatively in ultrasonography, surgeons should always be aware of the probability of bilateral ectopic pregnancies anytime facing susceptible cases, especially in patients with known risk factors. Also, it is an important reminder for radiologists to check both adnexa when facing a unilateral adnexal mass resembling ectopic pregnancy.
Literature review suggests that surgery is the only option for dealing with intraperitoneal foreign bodies (laparoscopy and laparotomy). We showed that an interventional method using ultrasound guidance could be considered alongside surgical options.
Aim: Cesarean scar pregnancy can cause life-threatening complications for pregnant women, so early diagnosis and treatment is crucial for prevention of maternal mortality. Transvaginal color Doppler ultrasonography besides serum β-hCG level follow-up can be a noninvasive and proper method for post-treatment follow-up of a cesarean scar pregnancy. In the present study, we investigated the Doppler resistance index changes in cesarean scar pregnancies after medical management together with sac diameter and serum β-hCG level measurement. Methods: 28 patients with cesarean scar pregnancy and a history of previous cesarean delivery, gestational age of less than 9 completed weeks at ultrasonography, decision to medical management by gynecologist and with having a β-hCG level before treatment were enrolled and initially examined by ultrasound and Doppler studies. The resistance index of the closest myometrial artery to cesarean scar pregnancy mass and its diameter were measured. After 72 hours, 1 week and 2 weeks after medical therapy, mentioned variables were measured again and were compared to the values of the pretreatment time point. Results: Resistance index values were significantly higher in all of the follow-up time points compared with the pretreatment time points, while serum β-hCG levels were significantly lower. Moreover, sac diameter values were increased 72 hours post-treatment and then declined. Conclusions: Serial Doppler ultrasound examinations can be a useful method to evaluate the success or failure of medical management of cesarean scar pregnancies as the increase in resistance index values occur rapidly after medical treatment and correlate well with serum β-hCG levels.
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