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Primoz Petric - One of the best experts on this subject based on the ideXlab platform.
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Off-line magnetic resonance imaging navigation of cervix cancer brachytherapy in patients with risk factors for Uterine Perforation
Journal of Contemporary Brachytherapy, 2017Co-Authors: N. Al-hammadi, Suparna Halsnad Chandramouli, R. Hammoud, Primoz PetricAbstract:Purpose There are no reports on pre-insertion identification of cervix cancer patients at risk for Uterine Perforation during brachytherapy (BT). Our aim was to assess the incidence of risk factors in our patient cohort, and assess feasibility of a novel technique of magnetic resonance imaging (MRI)-guided navigation for applicator insertion (NAI) in high-risk cases. Material and methods All patients with locally advanced cervical cancer, treated with image guided adaptive BT at our department between October 2013 and June 2017 were considered for analysis. Tumor characteristics on initial MRI (MRIinitial), pre-BT MRI (MRIpre-BT), and BT MRI (MRIBT) were assessed. Frequency of risk factors (age above 60 years, retroverted/retroflected uterus, tumor necrosis, non-visible cervical orifice, distorted cervical canal) was recorded. Patients with two or more factors underwent MRI guided NAI. Time needed for NAI was estimated and procedure feasibility score assigned using a three-tiered scoring system. Results Twenty-seven patients (98 insertions) were included. Mean tumor volume was 70.2 (± 47.9), 17.8 (± 18.9), and 10.3 (± 9.1) cm3 on MRIinitial, MRIpre-BT, and MRIBT1, respectively (p < 0.05). In 16 (59%) cases, ≥ 1 Perforation risk factor was found on MRIpre-BT: distorted canal in 12 (44%), necrosis in 9 (33%), retroverted/retroflected uterus in 8 (30%) cases. Nine (33%) patients had ≥ 2 risk factors and underwent MRI guided NAI. Additional time to perform NAI was estimated at 105 minutes, and feasibility score was 1 in all cases. There were no cases of Uterine Perforation. Conclusions Using pre-insertion MRI, we found ≥ 2 risk factors for Uterine Perforation in 1/3 of patients. Off-line MRI navigation was feasible and enabled non-complicated insertion in all cases. Further studies with larger sample size are warranted to assess its clinical efficacy.
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Uterine Perforation 5 year experience in 3 d image guided gynaecological brachytherapy at institute of oncology ljubljana
Radiology and Oncology, 2013Co-Authors: Barbara Segedin, Jasenka Gugic, Primoz PetricAbstract:ABSTRACT Background and aim: Accurate applicator placement is a precondition for the success of gynaecological brachytherapy (BT). Unrecognized Uterine Perforation can lead to bleeding, infection, high doses to pelvic organs and underdosage of the target volume, resulting in acute morbidity, long-term complications and reduced chance of cure. We aimed to assess the incidence and clinical characteristics of our cases with Uterine Perforation, review their management and impact on the treatment course. Materials and methods: In all patients (pts), treated with utero-vaginal image guided BT for gynaecological cancer between january 2006 and december 2011, the CT/MR images with the applicator in place were reviewed. The incidence of Uterine Perforations was recorded. Clinical factors that may have predisposed to increased risk of Perforation were recorded. Management of Perforations and their impact on treatment course was assessed. Results: 219 pts (428 applications) were suitable for analysis. Uterine Perforation was found in 13 (3.0 %) applications in 10 (4.6 %) pts. The most frequent Perforation site was posterior Uterine wall (n = 9), followed by anterior wall (n = 2) and fundus (n = 2). All cases were managed conservatively, without complications. Prophylactic antibiotics were administered in 8 cases. In 4 pts, abdominal and/or transrectal ultrasound (US) guidance was used on subsequent applications for applicator insertion; adequate applicator placement was achieved and treatment completed as planned in all cases. Conclusions: 3D imaging for BT planning enables accurate identification of Uterine Perforations. The incidence of Perforations at our department is one of the lowest reported in the literature. US guidance of applicator insertion is useful and feasible, allowing to complete the planned treatment even in challenging cases.
Xing Xie - One of the best experts on this subject based on the ideXlab platform.
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A metastatic invasive mole arising from iatrogenic uterus Perforation
BMC Cancer, 2017Co-Authors: Yuanming Shen, Xiaoyun Wan, Xing XieAbstract:Invasive mole derives from hydatidiform mole, but its pathogenesis remains unknown. Invasive mole arising from iatrogenic Uterine Perforation has not been reported yet. A reproductive woman was admitted because she suffered form severe abdominal pain and acute intra-abdominal hemorrhage after suction evacuation due to misdiagnosis as inevitable abortion. The patient underwent hysteroscopy and laparoscopy, by which an iatrogenic Uterine Perforation and omentum and pelvic peritoneum metastases were confirmed. All lesions were removed and the final pathological diagnosis was metastatic invasive mole. The patient underwent post-operative chemotherapy with methotrexate and presented a good prognosis. Invasive mole arising form iatrogenic Uterine Perforation displays an unusual metastatic manner other than general invasive moles. The prevention of Uterine Perforation should be emphasized during suction evacuation for mole pregnancy.
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A metastatic invasive mole arising from iatrogenic uterus Perforation
BMC, 2017Co-Authors: Yuanming Shen, Xiaoyun Wan, Xing XieAbstract:Abstract Background Invasive mole derives from hydatidiform mole, but its pathogenesis remains unknown. Invasive mole arising from iatrogenic Uterine Perforation has not been reported yet. Case presentation A reproductive woman was admitted because she suffered form severe abdominal pain and acute intra-abdominal hemorrhage after suction evacuation due to misdiagnosis as inevitable abortion. The patient underwent hysteroscopy and laparoscopy, by which an iatrogenic Uterine Perforation and omentum and pelvic peritoneum metastases were confirmed. All lesions were removed and the final pathological diagnosis was metastatic invasive mole. The patient underwent post-operative chemotherapy with methotrexate and presented a good prognosis. Conclusion Invasive mole arising form iatrogenic Uterine Perforation displays an unusual metastatic manner other than general invasive moles. The prevention of Uterine Perforation should be emphasized during suction evacuation for mole pregnancy
Surang Triratanachat - One of the best experts on this subject based on the ideXlab platform.
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Uterine Perforation with lippes loop intraUterine device associated actinomycosis a case report and review of the literature
Contraception, 2000Co-Authors: Vorapong Phupong, Tanasak Sueblinvong, Kamthorn Pruksananonda, Surasak Taneepanichskul, Surang TriratanachatAbstract:A case of a 67-year-old postmenopausal woman, gravida 2, para 2, with an Uterine Perforation from actinomycotic infection with Lippes loop IUD is reported. She had the Lippes loop IUD inserted for 35 years, and had never had any pelvic examination nor Papanicolaou smear. She presented with acute abdominal pain. The clinical picture mimicked peptic ulcer Perforation. The woman underwent laparotomy and exudative fluid was discovered in the abdominal cavity with the tip of the Lippes loop IUD at one of the two small holes of the Uterine fundus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The postoperative microscopic pathological report demonstrated characteristics of actinomycosis. She was treated with parenteral high-dose penicillin for 4 weeks followed by oral penicillin for 6 months. The woman had an uneventful recovery. To our knowledge, this is the first case report of Uterine Perforation due to Lippes loop IUD-associated actinomycotic infection.
Jo Kitawaki - One of the best experts on this subject based on the ideXlab platform.
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Uterine Perforation with omentum incarceration after dilatation and evacuation curettage magnetic resonance imaging findings
Archives of Gynecology and Obstetrics, 2012Co-Authors: Akemi Koshiba, Hisato Koshiba, Toshifumi Noguchi, Kazuhiro Iwasaku, Jo KitawakiAbstract:Cervical dilatation and/or Uterine evacuation and curettage (D/E&C) is the most commonly performed and safest gynecological procedure. Although procedure-related Uterine Perforation is rare, this condition may require surgical intervention. Ultrasound examination and computed tomography are useful for diagnosing such Perforations with incarceration of an intra-abdominal organ. However, the use of magnetic resonance imaging (MRI) for detecting postabortal Uterine damage has seldom been discussed in the literature. A 31-year-old woman was referred to our department for lower abdominal pain and a small amount of vaginal bleeding 28 days after D/E&C for a missed abortion. Transvaginal ultrasound examination showed the presence of a hyperechogenic structure in the anterior wall of the Uterine body, which was verified to be fatty tissue by MRI, particularly on the fat-suppressed T1-weighted images. An emergency laparotomy showed a Uterine Perforation with omentum incarceration. After dissecting the omental loop, the Uterine Perforation site was incised, and the involved omental tissue was debrided appropriately. To our knowledge, this is the first report wherein MRI was used for the detection of incarcerated omental fat within the uterus. Delayed presentation of Uterine Perforation may be observed 1 month or more after D/E&C, although such a finding is extremely rare. Therefore, postabortal follow-up bimanual vaginal examination using transvaginal ultrasonography is recommended. The current study indicates the usefulness of MRI when myometrial Perforation with or without incarceration of an extraUterine organ is suspected.
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Uterine Perforation with omentum incarceration after dilatation and evacuation curettage magnetic resonance imaging findings
Archives of Gynecology and Obstetrics, 2012Co-Authors: Akemi Koshiba, Hisato Koshiba, Toshifumi Noguchi, Kazuhiro Iwasaku, Jo KitawakiAbstract:Introduction Cervical dilatation and/or Uterine evacuation and curettage (D/E&C) is the most commonly performed and safest gynecological procedure. Although procedure-related Uterine Perforation is rare, this condition may require surgical intervention. Ultrasound examination and computed tomography are useful for diagnosing such Perforations with incarceration of an intra-abdominal organ. However, the use of magnetic resonance imaging (MRI) for detecting postabortal Uterine damage has seldom been discussed in the literature.
Mariam Moshiri - One of the best experts on this subject based on the ideXlab platform.
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imaging evaluation of Uterine Perforation and rupture
Abdominal Radiology, 2021Co-Authors: Hassan Aboughalia, Deepashri Basavalingu, Margarita V Revzin, Laura Sienas, Douglas S Katz, Mariam MoshiriAbstract:Uterine Perforation and rupture, denoting iatrogenic and non-iatrogenic Uterine wall injury, respectively, are associated with substantial morbidity,and at times mortality. Diverse conditions can result in injury to both the gravid and the non-gravid uterus, and imaging plays a central role in diagnosis of such suspected cases. Ultrasound (US) is the initial imaging modality of choice, depicting the secondary signs associated with Uterine wall injury and occasionally revealing the site of Perforation. Computed tomography can be selectively used to complement US findings, to provide a more comprehensive picture, and to investigate complications beyond the reach of US, such as bowel injury. In certain scenarios, magnetic resonance imaging can be an important problem-solving tool as well. Finally, catheter angiography is a valuable tool with both diagnostic and therapeutic capability, with potential for fertility preservation. In this manuscript, we will highlight the clinical and imaging approach to Uterine Perforation and rupture, while emphasizing the value of various imaging modalities in this context. In addition, we will review the multi-modality imaging features of Uterine Perforation and rupture and will address the role of the radiologist as a crucial member of the management team. Finally, a summary diagrammatic depiction of imaging approach to patients presenting with Uterine Perforation or rupture is provided.
