Ultrasound-guided oocyte retrieval is a standard procedure for ovum pick up (OPU) during in vitro fertilization. Possible complications include tubo-ovarian abscesses (TOAs) in the fallopian tubes, and endometriosis may be associated with increasing the severity of pelvic infection. A 35-year-old woman who had been treated for infertility and endometriosis presented with abdominal pain that appeared several days after OPU. There were no significant changes in the size of both ovaries and fallopian tubes. A week later, transvaginal echography revealed right oviduct enlargement. Because conservative treatment with antibiotics before this revelation had not been successful, laparoscopy was performed for abscess drainage and/or excision of the adnexa. Intraoperative findings were an abscess in the right adnexa involving the ovary and fallopian tube. Preservation of the right fallopian tube was difficult due to the risk of prolonged infection, and a right appendectomy was performed. The diagnosis was a right TOA. Severe cases of pelvic infection after OPU may cause infertility. The presence of endometriosis may aggravate the infection, but the relationship between the extent of the endometriosis and the severity of the infection is not known. Even if the endometriosis is mild, as it was in this patient, surgical treatment should be considered if a severe infection occurs after OPU and conservative treatment is not effective.
Significant scar defects of the uterine myometrium occur in 4-9% of women who undergo cesarean delivery. Women with prolonged menstruation, abnormal uterine bleeding, and/or secondary infertility attributable to a significant cesarean scar defect are diagnosed with cesarean scar syndrome (CSS).The incidence of CSS is expected to increase in Japan owing to the increasing rates of cesarean delivery being observed in obstetric practice. We describe two patients with CSS, who underwent successful minimally invasive surgery using a combined laparoscopic and hysteroscopic approach. Case 1: A 35-year-old Japanese woman with a history of cesarean delivery necessitated by arrested labor presented with atypical genital bleeding. Transvaginal ultrasonography (US) and magnetic resonance imaging (MRI) revealed a severe cesarean scar defect, and she underwent combined laparoscopic and hysteroscopic repair for CSS. The entire length of the uterine diverticulum was laparoscopically resected. The light source provided by hysteroscopy was useful during laparoscopic surgery to accurately determine the site and extent of the uterine diverticulum. The incision was laparoscopically closed with absorbable sutures after trimming, and successful surgical repair was confirmed both hysteroscopically and laparoscopically.Case 2: A 32-year-old woman who presented with prolonged menstruation underwent US and MRI, which revealed a significant cesarean scar defect. She underwent combined laparoscopic and hysteroscopic repair for CSS, although the method employed differed slightly from that used in Case 1. This treatment led to symptom resolution in both patients.In conclusion, combined laparoscopy and hysteroscopy may be useful for repair of a post-cesarean delivery uterine diverticulum because the site and extent of the uterine diverticulum can be easily determined under hysteroscopic guidance.
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