Background: The aim of this study was to determine the value of diagnostic laparoscopy in patients with chronic right iliac fossa pain. Methods: A retrospective study at Echuca Hospital involving case‐note review and telephone questionnaire of patients who had undergone diagnostic laparoscopy for chronic right iliac fossa pain at least 12 months earlier (September 1992 to August 1995)was carried out. Results: Forty‐one cases were identified and followed up 12‐40 months postoperatively (median 21 months). Eleven cases had positive findings at laparoscopy, of whom eight obtained lasting relief after treatment. Of the remaining 30 patients 17 had a normal‐looking appendix removed and 12 were cured; these were younger patients with episodic symptoms and localized signs. Of eight patients who had adhesions divided, four with adhesions beneath old scars obtained relief. Altogether 32 of the 41 patients considered the laparoscopy worthwhile even though in some cases it did not relieve their chronic pain. Conclusions: Diagnostic laparoscopy is worthwhile for patients with chronic right iliac fossa pain. Concurrent appendicectomy should be considered in young patients with episodic, well‐localized symptoms associated with systemic malaise while adhesiolysis may be beneficial for viscero‐parietal adhesions beneath abdominal wall scars.
We describe two small atypical leiomyomas. The first was a 6-mm de novo lesion in a 53-year-old woman. The second was a 3-mm focus in a 12-mm leiomyoma in a 45-year-old woman. Both lesions showed moderate atypia and a mitotic rate of six per 10 high-power fields. Coagulative necrosis was not seen. Neither patient had received exogenous oestrogen or progestogen. There was no evidence of recurrence or metastasis in either patient after 60 months of follow-up. Our report provides evidence that atypical uterine leiomyomas may arise either de novo or within a leiomyoma.
Injuries to the female urethra can vary from urethral contusion to partial/circumferential rupture. 1 Injury at the level of the proximal urethra is often complete disruption and commonly associated with vaginal laceration and rectal injuries in 75% and 33% of cases, respectively. 1,5 Longitudinal injuries with concurrent vaginal laceration are more common than circumferential injuries. 8 Similar to trauma to the male, a high index of suspicion is required for a urethral injury in females in the presence of pelvic fractures, inability to void, blood at the urethral meatus or haematuria, with the additional concerning features of labial swelling, vaginal bleeding and/or laceration. 9 The most clinically useful investigation for urethral injury in the female is direct examination; 5 however, up to 40% are missed in the initial emergency assessment. 10 To localize the site and extent of injury, imaging and endoscopic evaluation can be utilized. Guidelines recommend primary repair 'immediately', that is within 48 h, 9 or '(when) fit for surgery' as there are often severe concurrent injuries. 1,4,5,8 Evidence for urethral repair in females suggests that early repair results in the least complications such as vaginal stenosis, urethral strictures, incontinence, fistulae and urethral strictures. 4,5,7,9 This is the first reported case of a blunt trauma in a female resulting in a circumferential disruption of the urethra without significant concurrent pelvic injuries. It highlights examination as the key for identifying urethral injuries in women. In our experience, early repair of urethral disruption with an interposition flap resulted in the immediate complication of urethral narrowing. However, following dilatation, the patient reported good stream, flow, minimal post void residual and no cosmetic concerns.
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