Tuberculous peritonitis

Comparison of laparoscopy and laparotomy in managing hemodynamically stable patients with ruptured corpus luteum with hemoperitoneum

STUDY OBJECTIVE

To compare differences between laparoscopy and laparotomy in managing women ruptured corpus luteum with hemoperitoneum.

DESIGN

Three-year, prospective, nonrandomized study (Canadian Task Force classification II-2).

SETTING

University-affiliated regional hospital.

PATIENTS

Sixty hemodynamically stable women.

INTERVENTION

Laparoscopic surgery (30 women) and laparotomy (30).

MEASUREMENTS AND MAIN RESULTS

Laparoscopic surgery had significant advantages over laparotomy, including shorter hospital stay (55.33 +/- 7.67 vs 97.77 +/- 14.45 hrs, p < 0.001) without increased adverse events. Laparoscopic surgery also showed trends of shorter operating time, improved wound care, and less postoperative pain.

CONCLUSION

Laparoscopy surgery for diagnosis and treatment of women with ruptured hemorrhagic corpus luteum appears superior to laparotomy. We suggest that surgeons try laparoscopy first as a diagnostic and probably therapeutic procedure.

Advantages of open laparoscopic surgery over exploratory laparotomy in patients with tubo-ovarian abscess

STUDY OBJECTIVE

To compare laparoscopic surgery and conventional laparotomy in managing patients with tubo-ovarian abscess (TOA).

DESIGN

Retrospective study (Canadian Task Force classification II-2).

SETTING

Regional hospital.

PATIENTS

Sixty-nine women with clinically suspicious TOA.

INTERVENTION

Operative laparoscopy or laparotomy.

MEASUREMENTS AND MAIN RESULTS

Laparoscopic surgery in 19 women had significant advantages over laparotomy in 37 women. It decreased hospital stay (5.37 +/-1.38 days vs 8.92 +/- 2.59 days, p = 0.0001), had a lower percentage of wound infections, and had a shorter time for fever to subside (25.79 +/- 11.45 vs 39.46 +/- 17.47 hrs, p = 0.003).

CONCLUSION

Although management of TOA consists of conservative medical treatment with antibiotics, it is now widely accepted that surgical intervention should be pursued early after the diagnosis. Open laparoscopy seems to be a good alternative to traditional laparotomy in managing these patients.

Diagnosis and localization of testosterone-producing ovarian tumors: imaging or biochemical evaluation

OBJECTIVE

In the testosterone-secreting ovarian tumor (TSOT), the role of whole-body positron emission tomography (WBPET) with (fluorine-18)-2-deoxyglucose scanning (FDG) and/or [(11)C]acetate is unclear, although it presents a rationale that these functional tumors would be more active and have increased use of glucose and oxygen consumption than normal tissues.

CASE

A 52-year-old woman had a history of steroid cell tumors of the right ovary (IIA) and she received staging surgery including total hysterectomy, salpingo-oophorectomy, and lymph node sampling. Reelevated serum levels of T (5.24 ng/ml) were noted 52 months later. The patient received serial preoperative examinations including WBPET with FDG and acetate, ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI) to evaluate her recurrence. A suspicious mass on the liver was found on ultrasound, CT, and MRI. The ultrasound-guided biopsy was performed three times, and each of them failed to provide any pathological confirmation. Functional imaging studies showed an abnormal uptake in WBPET using [(11)C]acetate but were negative using FDG. Because of the size of the tumor, the patient's hesitatancy toward an operation, and good previous response to gonadotropin-releasing hormone (GnRH) agonist treatment, the patient received a six-cycle GnRH agonist treatment. Serum T levels returned to normal limits after administration of the first dose of GnRH agonist. At follow-up, serum hormone levels were all within the normal ranges consistent with menopause, but the size of the metastatic tumor was constant. The tumor was then completely excised pathologically proven to be a metastatic TSOT.

CONCLUSIONS

Recurrent TSOT might be successfully detected using WBPET with [(11)C]acetate. In addition, GnRH agonist could be tried in patients with TSOT if initial responses were excellent and surgical intervention could not be performed.