Distal tubal pregnancy in a patient with a bicornuate uterus and segmental absence of the fallopian tube

Torsion causing interruption of the ampullary portion of the fallopian tube

OBJECTIVE

To present a description of a young girl who presented acutely with symptoms and findings that are consistent with acute adnexal torsion, where resultant outcome would have led to perception of a congenital anomaly.

DESIGN

Case report.

SETTING

Tertiary pediatric hospital.

PATIENT(S)

A young girl who presented acutely with symptoms consistent with adnexal torsion but who was found to have a torsion affecting a paratubal cyst and the midsegment of her fallopian tube.

INTERVENTION(S)

A salpingectomy was performed because of damage involving the ischemic paratubal cyst and tubal segment that left too little residual tube to allow for a future anastomosis of the residual unaffected components.

MAIN OUTCOME MEASURE(S)

Operative findings, which give an explanation for midsegmental tubal absence.

RESULT(S)

This case challenges previous reports that absent midsegment of a tube is a rare congenital anomaly.

CONCLUSION(S)

Absent midsegment of a tube can be explained as an acquired anomaly, rather than proposing an unusual congenital anomaly.

Congenital partial atresia of the Fallopian tube

Partial tubal atresia is a rare anomaly of unknown pathogenesis. It can occur unilaterally or bilaterally, mainly including the proximal isthmic portion or the proximal ampullary segment ('mid-portion'), and is especially associated with uterine anomalies. Any more extensive pelvic surgery, including preoperative diagnosis of associated urological anomalies, must be well planned in such patients. Salpingostomy and fimbrial approximation is a realistic option in patients with congenital ampullary atresia who wish to have a child. A MEDLINE search was performed and 18 patients found with partial atresia of different tubal portions. This report describes a further patient and reviews the available literature.

Fertility potential of women with congenital ampullary atresia of the fallopian tube

OBJECTIVE

To determine the fertility potential of women with congenital ampullary atresia of the fallopian tube.

DESIGN

Case report and review of literature.

SETTING

University-affiliated tertiary care infertility clinic.

PATIENT(S)

Six infertile women with congenital ampullary atresia of the oviduct.

INTERVENTION(S)

Salpingostomy and fimbrial approximation.

MAIN OUTCOME MEASURE(S)

Pregnancy.

RESULT(S)

Of six reported cases of congenital ampullary atresia of the fallopian tube who underwent surgery, four women conceived intrauterine pregnancies (IUP) and another, a pregnancy of undetermined site.

CONCLUSION(S)

Salpingostomy and fimbrial approximation is a therapeutic option for infertile women with congenital ampullary atresia of the fallopian tube.

Unicornuate uterus with rudimentary horn

OBJECTIVES

To identify the effects of unicornuate uterus with rudimentary horn on reproductive function and analyze the diagnosis and treatment of the condition.

METHODS

The study was based in the gynecological unit of a city based Medical Center in Mainland China. Twenty-two cases of this anomaly were selected from a group of 130 cases of uterine abnormalities and were retrospectively analyzed.

RESULTS

This kind of anomaly can cause hematometra and endometriosis leading to acute abdominal pain, infertility, rupture of pregnant rudimentary horn and obstetrical complications with pregnant semi-uterus.

CONCLUSIONS

Rudimentary horn should be removed if detected.

Reproductive performance of women with unicornuate uterus

The reproductive history of 19 women with a diagnosis of unicornuate uterus confirmed by laparoscopy or laparotomy is analyzed. The patients were followed for 2 to 10 years. One patient had a cavitary communicating rudimentary horn, four a cavitary noncommunicating rudimentary horn, seven a noncavitary rudimentary horn, and seven no rudimentary horn. Six of the patients presented with primary infertility. The other 13 women had a total of 29 pregnancies, 1 (3.4%) in a rudimentary horn determining rupture; abortions occurred in 17 (58.6%), premature labor in 3 (10.3%), and term births in 8 (27.6%), with a live birth rate of 38%. Of the 11 births, 6 (54.5%) were breech presentations, and 9 (81.8%) were cesarean sections. In five cases the rudimentary horn was removed, with associated salpingooophorectomy in three patients. Cervical cerclage was not performed in any of the patients.

Ectopic pregnancy in unrepaired distal tubal remnant after contralateral tubal anastomosis

A case is described in which, after a tubal sterilization procedure and subsequent unilateral tubal anastomosis, an ectopic gestation occurred in the contralateral, unrepaired, distal tubal segment. On the basis of this case and related evidence, the authors suggest that in cases in which only a unilateral tubal anastomosis is possible, strong consideration should be given to removal of the contralateral, unrepaired, distal tubal remnant.

Unruptured pregnancy in a heterotopic fallopian tube: evidence for transperitoneal sperm migration

A case of an unruptured pregnancy in a heterotopic left fallopian tube isolated from a unicornuate uterus with a normal contralateral tube and ovary is presented. The corpus luteum of pregnancy was in the left ovary. This case provides supportive evidence for transperitoneal sperm migration.

Congenital absence of fallopian tube segments

A case is reported in which laparotomy demonstrated that the proximal portion of the left Fallopian tube was absent and that the distal end was separated into 3 portions. There is no previous report of a congenital abnormality of this type.