| Autor: |
A.R. Schmidt, Amanda Ulrich, Danielle E. Luciano |
| Rok vydání: |
2021 |
| Předmět: |
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| Zdroj: |
Journal of Minimally Invasive Gynecology. 28:S94 |
| ISSN: |
1553-4650 |
| DOI: |
10.1016/j.jmig.2021.09.704 |
| Popis: |
Study Objective We aim to present a combined hysteroscopic and laparoscopic approach to the resection of a post-cesarean section scar causing complete obstruction of the endometrial cavity. Design Video presentation. Setting Ambulatory surgery center, academic hospital. Patients or Participants 31-year-old multiparous patient with history of c-section who presented with secondary amenorrhea and infertility due to Asherman's Syndrome. She underwent laparoscopic guided hysteroscopic adhesiolysis followed by postoperative hormone therapy and close follow up. Interventions The patient's workup included saline infusion sonohysterogram, 2D ultrasound, and 3D ultrasound. She underwent a combined hysteroscopic and laparoscopic procedure in which hysteroscopic scissors were used to remove the adhesion under laparoscopic guidance. An intrauterine balloon catheter was placed postoperatively. She took postoperative antibiotics while the balloon remained in situ as well as postoperative hormone therapy to promote growth of healthy endometrium and prevent new adhesion formation. Measurements and Main Results The use of a combined hysteroscopic and laparoscopic approach resulted in a safe and successful removal of post-cesarean uterine scar tissue and treatment of Asherman's Syndrome with subsequent resumption of menses. Conclusion Asherman's Syndrome should remain on the differential for women who present with secondary amenorrhea. The addition of 3D ultrasound to saline infusion sonohysterogram is useful for surgical planning. A combined hysteroscopic and laparoscopic approach to the resection of uterine adhesions should be considered when managing severe cases of Asherman's Syndrome and dense adhesions, especially when the location of adhesions is not clear from imaging. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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