1
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Coumary S, Galidevara I, Naga Daliya V, Ghose S. Utero-cutaneous fistula following caesarean section. BMJ Case Rep 2024; 17:e255901. [PMID: 38331447 PMCID: PMC10860007 DOI: 10.1136/bcr-2023-255901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
A multiparous woman in her 20s, presented to the clinic with bleeding from caesarean scar site. After clinical examination and radiological evaluation with ultrasound and MR fistulogram, the diagnosis was utero-cutaneous fistula. Complete resection of fistulous tract with uterine defect closure and supportive omental patch placement was done after an intraoperative demonstration of the utero-cutaneous fistula by injecting methylene blue dye. Utero-cutaneous fistula is a rare complication after caesarean section. Cyclical bleeding from an abnormal opening in previous caesarean scar site is the classical presentation of this condition.
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Affiliation(s)
- Senthil Coumary
- Obstetrics and Gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| | - Indira Galidevara
- Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| | - Venna Naga Daliya
- Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
| | - Seetesh Ghose
- Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
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2
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Cicinelli R, Cicinelli E, Crupano F, Vinciguerra M, Lamanna B, Vimercati A. A rare but troublesome complication of cesarean section: the uterocutaneous fistula. Report of two cases and review of literature. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2021-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
The occurrence of a uterocutaneous fistula (UCF) as an uncommon and severe complication of caesarean section (CS). The aim of this study was to describe two cases of UCFs after CS and to discuss about symptoms, diagnosis and treatment.
Case presentation
Both women few days after CS had surgical site infection, fever and elevation of lab inflammation markers. bacterial culture of the wound drainage was positive for Escherichia Coli and Enterococcus Faecalis.
Conclusions
Fistula between uterine and skin is a rare condition but should be considered with signs of inflammation after cesarean section; 2D/3D ultrasound evaluation appears to be useful for diagnosis of UCFs when combined with CT fistulography and MRI in order to obtain early diagnosis and, consequently, a conservative surgery.
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Affiliation(s)
- Rossana Cicinelli
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
| | - Francesco Crupano
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
| | - Marina Vinciguerra
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
| | - Bruno Lamanna
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
| | - Antonella Vimercati
- Unit of Obstetrics and Gynecology, University of Bari, Piazza Giulio Cesare , Policlinico , Bari , Italy
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3
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Han C, Zhang W, Li X, Sun B, Cheng L. Postmyomectomy uterocutaneous fistula: a case report and literature review. Arch Gynecol Obstet 2022; 305:1099-1103. [DOI: 10.1007/s00404-022-06400-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/04/2022] [Indexed: 11/02/2022]
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4
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Uterocutaneous fistula after cesarean section; Case report. Int J Surg Case Rep 2021; 89:106621. [PMID: 34847394 PMCID: PMC8639420 DOI: 10.1016/j.ijscr.2021.106621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Fistula is an abnormal tract communicating two epithelial surfaces, uterocutaneous fistula is an extremely rare. The classical presentation is cyclical bleeding from an abnormal opening in the scar of previous cesarean section. Case presentation A 28 year-old was presented 6 months after cesarean section with history of severe pain and blood discharge during menstruation from the previous transverse supra-pubic scar. The patient had history of previous 2 cesarean sections. Abdominal examination revealed a localized tenderness at site of previous operation scar with 1*1 cm opening at the central part of the scar which was discharging blood during pressure over the lower abdomen. There was no urine discharge from the scar. Vaginal examination by the speculum was normal. Clinical discussion Endometriosis was suspected and the patient received medical treatment with little improvement. Later, surgical intervention was done, the scar was excised with an abnormal fistulous tract connecting endometrial cavity at the site of the previous scar was found. Complete excision of the tract was done and the uterus was re-sutured using a slowly-absorbable suture material. The patient had no complications with regular cycles. Conclusion Uterocutaneous fistula is rare and usually follow cesarean section, suturing the uterus with non-absorbable suture material is reported in this case to be one of the underlying causes, other causes include infection, necrosis, foreign bodies, or malignancy. The fistula tract must be defined and any associated infection controlled, complete resection of the fistulous tract and suturing the uterus with absorbable suture material is required. Causes of uterocutaneous fistulas are numerous like iatrogenic, endometriosis, malignancy, etc. The classical presentation is cyclical bleeding from the scar of previous cesarean section. A combined medical and surgical approach may be required.
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5
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Wang Y, Wang S, Shi H, Lang J. Uterocutaneous fistula after abdominal myomectomy: A case report. J Obstet Gynaecol Res 2021; 47:3392-3395. [PMID: 34229365 DOI: 10.1111/jog.14863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 12/01/2022]
Abstract
Uterocutaneous fistula is an extremely rare postoperative complication and the most appropriate treatment remains unclear. In this case report, we described uterocutaneous fistula of a 41-year-old woman with persistent purulent discharge from a small opening in her midline incision after abdominal myomectomy. The patient was diagnosed as uterocutaneous fistula based on magnetic resonance imaging and the methylene blue dye test. Fertility-sparing surgery was performed and uterocutaneous fistula was successfully corrected. Some nonabsorbable silk sutures were found attached to the sinus tract. This could lead to infection, which could cause the formation of a uterocutaneous fistula. Since after 1-year of operation, no evidence of recurrence was found. Fertility-sparing surgery is effective for a patient with uterocutaneous fistula. Complete resection of the sinus tract and surrounding necrotic tissue is required in the repair of urterocutaneous fistula.
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Affiliation(s)
- Yongxue Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shu Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Honghui Shi
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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6
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Matei AM, Draghici-Ionescu AM, Cioplea M, Zurac SA, Boda D, Serban I, Caruntu C, Ilie MA, Fekete GL. Skin endometriosis: A case report and review of the literature. Exp Ther Med 2021; 21:532. [PMID: 33815605 DOI: 10.3892/etm.2021.9964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022] Open
Abstract
Skin endometriosis is a rare disease with variable clinical and histopathological characteristics that depend on hormonal stimuli. The skin is not a common location, as most cases of endometriosis involve pelvic sites, such as the ovaries, peritoneum and bowel. However, the most common extrapelvic site affected is the abdominal wall and this location of the disease is frequently associated with obstetric and gynecologic surgery. Here we report a case of skin endometriosis emerged as a painful subcutaneous nodule located near to the left side of an obstetrical surgery procedure scar. The patient affected was a woman in her reproductive age, with a history of right ovary endometriotic cyst laparoscopically removed and histologically confirmed as a primary endometriosis. Dermatologists should be aware of this condition in any woman with a painful lump located in the proximity of a pelvic surgery-induced scar. Its non-specific clinical appearance may confuse the clinician and may delay the diagnosis and management.
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Affiliation(s)
- Andreea-Mariana Matei
- Department of Dermatology, Colentina Clinical Hospital, 020125 Bucharest, Romania.,Department of Physiology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Mirela Cioplea
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Pathology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Sabina Andrada Zurac
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Pathology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Daniel Boda
- Department of Dermatology, 'Prof. N.C. Paulescu' National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania.,Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ioana Serban
- Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, 'Prof. N.C. Paulescu' National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | - Mihaela Adriana Ilie
- Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Gyula László Fekete
- Department of Dermatology, Dermatology Clinic, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540139 Târgu Mureș, Romania
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7
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Yesiladali M, Saridogan E, Saridogan E. Successful pregnancy and delivery following surgical treatment of postmyomectomy uterocutaneous fistula. BMJ Case Rep 2019; 12:12/12/e231594. [PMID: 31811107 DOI: 10.1136/bcr-2019-231594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Uterocutaneous fistula is an extremely rare clinical condition that may be caused by postoperative or postpartum complications, such as infection or inflammation. Although fibroids and myomectomy are common clinical entities among women of reproductive age, there are very few postmyomectomy uterocutaneous fistula cases in the literature. This article presents the first reported case of a succesful pregnancy and live birth following treatment of a postmyomectomy uterocutaneous fistula. After laparoscopic adhesiolysis, a minilaparotomy was performed to excise the fistula tract completely from both the abdominal wall and the uterus. The uterine wall defect was repaired in multiple layers. The patient had a good recovery after surgery, and the uterocutaneous fistula resolved completely. Due to obliteration of both tubal ostia, the patient was referred for in vitro fertilisation treatment. She conceived after the third frozen embryo transfer procedure and gave birth to a 4.4 kg baby at full term by caesarean section.
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Affiliation(s)
- Mert Yesiladali
- Women's Health Division, University College London Hospital, London, UK
| | - Erdinc Saridogan
- Women's Health Division, University College London Hospital, London, UK
| | - Ertan Saridogan
- Institute for Women's Health, University College London, London, UK
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8
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Kotronis K, Zafrakas M, Papasozomenou P, Timologou A, Miliaras D, Tarlatzis BC, Grimbizis G. Protein expression pattern of tissue inhibitor of metalloproteinase-3 (TIMP3) in endometriosis and normal endometrium. Gynecol Endocrinol 2019; 35:1103-1106. [PMID: 31185764 DOI: 10.1080/09513590.2019.1625880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Given the involvement of different extracellular matrix (ECM) metalloproteinases (MMPs) in endometriosis, the protein expression pattern of tissue inhibitor of metalloproteinase-3 (TIMP3) was analyzed in this study in endometriosis and normal endometrium. Tissue samples were collected prospectively from 64 premenopausal patients undergoing operative laparoscopy. Protein expression of TIMP3 was analyzed immunohistochemically in endometriotic lesions (n = 30) and normal eutopic endometrium from patients with (n = 35) and without (n = 29) endometriosis. Comparison between the three different groups of tissue samples showed that TIMP3 was differentially expressed between the three groups (p = .04). Pair-wise comparisons showed that TIMP3 expression was lower in endometriotic lesions as compared with normal eutopic endometrium from controls (p = .006); the same non-significant trend was found, in the comparison between endometriosis lesions and matched eutopic endometrium. There were no differences in TIMP3 expression in the normal eutopic endometrium between patients with and without endometriosis. In conclusion, TIMP3 seems to be involved in the pathogenesis, pathophysiology, and maintenance of endometriosis and it might be useful as a diagnostic and prognostic marker of endometriosis. Future studies should further investigate this issue, as well as the interplay between TIMPs and different extracellular MMPs in endometriosis.
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Affiliation(s)
- Konstantinos Kotronis
- First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Menelaos Zafrakas
- First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- School of Health and Medical Care, αlexander τechnological εducational ιnstitute of Thessaloniki, Thessaloniki, Greece
| | - Panayiota Papasozomenou
- School of Health and Medical Care, αlexander τechnological εducational ιnstitute of Thessaloniki, Thessaloniki, Greece
| | - Anna Timologou
- First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimosthenis Miliaras
- Laboratory of Histology & Embryology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Basil C Tarlatzis
- First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Grigorios Grimbizis
- First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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9
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Uterocutaneous fistula after pelviscopic myomectomy - successful diagnosis with hystero-salpingo contrast sonography and complete tract resection and medical treatment for fertility preservation in young woman: a case report. Obstet Gynecol Sci 2018; 61:641-644. [PMID: 30255003 PMCID: PMC6137022 DOI: 10.5468/ogs.2018.61.5.641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/05/2017] [Accepted: 09/21/2017] [Indexed: 11/08/2022] Open
Abstract
A uterocutaneous fistula is rarely reported clinical condition after uterine procedures. Many diagnostic and management strategies are being suggested. In this case report, uterocutaneous fistula after pelviscopic myomectomy was diagnosed simply with hystero-salpingo contrast sonography and managed by surgical tract excision without hysterectomy and uterine wall dehiscence repair combined with medical treatment using gonadotropin-releasing hormone agonist succeeded to preserve fertility in young woman.
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10
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Hardy LE, Leung Y. Uterocutaneous fistula as the primary presentation of a gynaecological malignancy. BMJ Case Rep 2018; 2018:bcr-2018-224738. [PMID: 29884667 DOI: 10.1136/bcr-2018-224738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of high-grade gynaecological carcinoma presenting as a uterocutaneous fistula. A 59-year-old woman presented with a discharging abdominal wall wound. Imaging confirmed a large solid pelvic mass forming a sinus tract with the anterior abdominal wall. The tract tunnelled through a previous caesarean section scar. Biopsy indicated a high-grade gynaecological carcinoma, with features suggestive of endometrioid adenocarcinoma. The patient underwent two cycles of chemotherapy. Despite this, the mass increased in size and was complicated by abdominal wall wound breakdown. Chemotherapy was ceased. Surgical and palliative options are under consideration.
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Affiliation(s)
- Liesel Elisabeth Hardy
- Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
| | - Yee Leung
- Department of Gynaecological Oncology, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.,School of Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
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11
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Chattot C, Aristizabal P, Bendifallah S, Daraï E. Uteroabdominal Wall Fistula After Cesarean Section in a Patient With Prior Colorectal Resection for Endometriosis: A Case Report and Systematic Review. J Minim Invasive Gynecol 2017; 24:1234-1238. [DOI: 10.1016/j.jmig.2017.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 01/24/2023]
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12
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Maddah G, Fattahi AS, Rahnama A, Jamshidi ST. Uterocutaneous Fistula Following Cesarean Section: Successful Management of a Case. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:157-60. [PMID: 26989289 PMCID: PMC4764968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A uterocutaneous fistula is a rare clinical presentation that occurs following Cesarean section and other pelvic operations. There are only a few reports discussing the treatments. We describe a patient with successful surgical management and review the literature. A 25-year-old woman referred to our department 13 months after her first Cesarean section. She had a history of an abdominal mass and collection 2 months after surgery and some fistula opening with discharge from her previous incision. She had a previous surgical operation and antibiotic therapy without complete response. We performed fistulography to evaluate the tracts. In the operation - she had fistula tracts, one of which was between the uterus and skin. We debrided the necrotic tissue in the uterus, excised the fistula tracts, and drained the uterine cavity. At 8 months' postoperative follow-up, she had no recurrence. A uterocutaneous fistula is a rare condition with many causes and needs proper investigation and timely medical and surgical management.
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Affiliation(s)
- Ghodratollah Maddah
- Endoscopic and Minimally Invasive Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asieh Sadat Fattahi
- Endoscopic and Minimally Invasive Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Correspondence: Asieh Sadat Fattahi, MD; Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Ahmadabad Ave., Postal Code: 99199-9176, Mashhad, Iran Tel: +98 9151163883 Fax: +98 51 38417452
| | - Ali Rahnama
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shirin Taraz Jamshidi
- Solid Tumor Treatment Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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13
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Akkurt MÖ, Yavuz A, Tatar B, Özkaya MO, Ekici Eİ. Utero-cutaneous Fistula after Multiple Abdominal Myomectomies: A Case Report. Balkan Med J 2015; 32:426-8. [PMID: 26740905 DOI: 10.5152/balkanmedj.2015.151206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/16/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Utero-cutaneous fistula (UCF) is an extremely rare entity and only a few case reports have been published. Most UCFs develop secondary to post-partum or postoperative complications. CASE REPORT A 42 year-old woman began to complain from bleeding and malodorous discharge through her abdominal incision scar. The fistula tract with a thickness of 8 mm was observed between the uterus and wound using magnetic resonance imaging (MRI). The risks and benefits of conservative treatment have been discussed; the patient demanded definitive treatment, so hysterectomy and excision of the fistulous tract was performed. Histopathology of the fistulous tract showed endometrial epithelization of the tract lined by granulation. CONCLUSION There are many causes of such an extremely rare entity. Patients should be counseled for medical or surgical treatment considering their age, accompanied uterine pathologies such as fibroids and fertility expectations.
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Affiliation(s)
- Mehmet Özgür Akkurt
- Department of Gynecology and Obstetrics, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - And Yavuz
- Department of Gynecology and Obstetrics, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Burak Tatar
- Department of Gynecology and Obstetrics, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Mehmet Okan Özkaya
- Department of Gynecology and Obstetrics, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Elif İlknur Ekici
- Department of Gynecology and Obstetrics, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
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14
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Diagnosis and treatment of perineal endometriosis: review of 17 cases. Arch Gynecol Obstet 2015; 292:1295-9. [PMID: 26041323 DOI: 10.1007/s00404-015-3756-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 05/11/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE To demonstrate the appropriate diagnosis and treatment of perineal endometriosis. METHODS Seventeen patients who presented with a tender perineal mass coinciding with the menstrual cycle on the scar of a previous vaginally procedure were examined retrospectively. Their clinical features and treatment were analyzed. RESULTS All patients presented with a palpable painful lesion. All of them had had vaginal delivery with episiotomy. The mean age of the patients was 34.35 years. The mean latent period was 46.82 months. The mean size was 2.38 cm. Thirteen patients presented with one subcutaneous nodule and four had multiple nodules. Color Doppler ultrasound revealed a subcutaneous nodule with an irregular outline and echo-complex density underlying the episiotomy scar. Only one patient suffered from perineal endometriosis combined with pelvic endometriosis. All endometriotic masses in perineum were completely excised and cured, and confirmed by the microscopic examination. CONCLUSIONS A detailed history and thorough pelvic examination are essential in diagnosing perineal endometriosis. Surgical intervention is the first choice of treatment.
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15
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Zafrakas M, Grimbizis G, Timologou A, Tarlatzis BC. Endometriosis and ovarian cancer risk: a systematic review of epidemiological studies. Front Surg 2014; 1:14. [PMID: 25593938 PMCID: PMC4286968 DOI: 10.3389/fsurg.2014.00014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 04/23/2014] [Indexed: 11/13/2022] Open
Abstract
Background: A possible etiological association between endometriosis and ovarian cancer has been repeatedly reported in the literature. Objective: Our aim was to evaluate published epidemiological data on this issue. Review Methods: We conducted an extensive search of the literature in MEDLINE, of articles ever published until February 2014, using the key-words “endometriosis” and “ovarian” and one of the following terms in the title: “cancer” or “malignancy” or “malignant” or “tumor” or “neoplasia” or “neoplasm” or “transformation.” Retrieved papers were checked for further relevant publications. Results: Overall, our search yielded 1 prospective cohort study, 10 retrospective cohort, and 5 case–control studies. A meta-analysis of these studies was not considered to be appropriate, due to differences in data reporting, study design, and adjustment for confounding factors. Limitations: The main limitation of studies found, with one exception, was the lack of operative confirmation of endometriosis. Conclusion: An association of endometriosis with clear-cell and endometrioid ovarian cancer was a consistent finding in most studies. On the other hand, existing epidemiological evidence linking endometriosis with ovarian cancer is insufficient to change current clinical practice. Prospective cohort studies, with prior laparoscopic confirmation, localization, and staging of endometriosis are needed, in order to further clarify this issue.
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Affiliation(s)
- Menelaos Zafrakas
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece ; School of Health and Medical Care, Alexander Technological Educational Institute of Thessaloniki , Thessaloniki , Greece
| | - Grigorios Grimbizis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Anna Timologou
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Basil C Tarlatzis
- 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
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16
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Machairiotis N, Stylianaki A, Dryllis G, Zarogoulidis P, Kouroutou P, Tsiamis N, Katsikogiannis N, Sarika E, Courcoutsakis N, Tsiouda T, Gschwendtner A, Zarogoulidis K, Sakkas L, Baliaka A, Machairiotis C. Extrapelvic endometriosis: a rare entity or an under diagnosed condition? Diagn Pathol 2013; 8:194. [PMID: 24294950 PMCID: PMC3942279 DOI: 10.1186/1746-1596-8-194] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/23/2013] [Indexed: 12/16/2022] Open
Abstract
Endometriosis is a clinical entity characterized by the presence of normal endometrial mucosa abnormally implanted in locations other than the uterine cavity. Endometriosis can be either endopelvic or extrapelvicdepending on the location of endometrial tissue implantation. Despite the rarity of extrapelvic endometriosis, several cases of endometriosis of the gastrointestinal tract, the urinarytract, the upper and lower respiratory system, the diaphragm, the pleura and the pericardium, as well as abdominal scars loci have been reported in the literature. There are several theories about the pathogenesis and the pathophysiology of endometriosis. Depending on the place of endometrial tissue implantation, endometriosis can be expressed with a wide variety of symptoms. The diagnosis of this entity is neither easy nor routine. Many diagnostic methods clinical and laboratory have been used, but none of them is the golden standard. The multipotent localization of endometriosis in combination with the wide range of its clinical expression should raise the clinical suspicion in every woman with periodic symptoms of extrapelvic organs. Finally, the therapeutic approach of this clinical entity is also correlated with the bulk of endometriosis and the locum that it is found. It varies from simple observation, to surgical treatment and treatment with medication as well as a combination of those.
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Affiliation(s)
| | | | | | - Paul Zarogoulidis
- Pulmonary Department, "G, Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Exohi 1100, 57010 Thessaloniki, Greece.
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Athanasias P, Krishna A, Karoshi M, Moore J, Chandraharan E. Uterocutaneous fistula following classical caesarean delivery for placenta percreta with intentional retention of the placenta. J OBSTET GYNAECOL 2013; 33:906-7. [DOI: 10.3109/01443615.2013.825583] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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19
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Loué V, Koffi A, Adjoby R, N'Guessan K, Alla C, Gbary E, Abauleth R. Postmyomectomy Uterocutaneous Fistula. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2012.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Védi Loué
- Department of Gynecology and Obstetrics, National University of Abidjan, University Hospital of Cocody, Abidjan, Côte d'Ivoire
| | - Achille Koffi
- Department of Gynecology and Obstetrics, National University of Abidjan, University Hospital of Cocody, Abidjan, Côte d'Ivoire
| | - Roland Adjoby
- Department of Gynecology and Obstetrics, National University of Abidjan, University Hospital of Cocody, Abidjan, Côte d'Ivoire
| | - Koffi N'Guessan
- Department of Gynecology and Obstetrics, National University of Abidjan, University Hospital of Cocody, Abidjan, Côte d'Ivoire
| | - Christian Alla
- Department of Gynecology and Obstetrics, National University of Abidjan, University Hospital of Cocody, Abidjan, Côte d'Ivoire
| | - Eléonore Gbary
- Department of Gynecology and Obstetrics, National University of Abidjan, University Hospital of Cocody, Abidjan, Côte d'Ivoire
| | - Raphaèl Abauleth
- Department of Gynecology and Obstetrics, National University of Abidjan, University Hospital of Cocody, Abidjan, Côte d'Ivoire
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Gidwaney R, Badler RL, Yam BL, Hines JJ, Alexeeva V, Donovan V, Katz DS. Endometriosis of Abdominal and Pelvic Wall Scars: Multimodality Imaging Findings, Pathologic Correlation, and Radiologic Mimics. Radiographics 2012; 32:2031-43. [DOI: 10.1148/rg.327125024] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Lim PS, Shafiee MN, Ahmad S, Hashim Omar M. Utero-cutaneous fistula after caesarean section secondary to red degeneration of intramural fibroid. SEXUAL & REPRODUCTIVE HEALTHCARE 2012; 3:95-6. [PMID: 22578758 DOI: 10.1016/j.srhc.2012.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 02/13/2012] [Accepted: 03/02/2012] [Indexed: 11/28/2022]
Abstract
A 33 year-old woman had an emergency caesarean section for retained second twin which was complicated by utero-cutaneous fistula due to red degeneration of intramural fibroid. The utero-cutaneous communication was demonstrated by an examination under anaesthesia using dye test. She then underwent excision of the fistula tract and myomectomy. She recovered well following the surgery. This is the first case of utero-cutaneous fistula where the communication is between the endometrial cavity and skin lesion via a necrotic intramural fibroid following caesarean section. Fistulogram might fail to demonstrate the communication. In highly suspected case, other modalities of investigations could be utilised.
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Affiliation(s)
- Pei Shan Lim
- Department of O&G, Medical Faculty, Universiti Kebangsaan Malaysia Medical Center, Cheras, Kuala Lumpur Malaysia.
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22
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Combined Conservative Surgical and Medical Treatment of a Uterocutaneous Fistula. J Minim Invasive Gynecol 2012; 19:244-7. [DOI: 10.1016/j.jmig.2011.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 10/12/2011] [Accepted: 10/21/2011] [Indexed: 11/19/2022]
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Baggish M, Bhati A. Uterocutaneous Fistula: A Complication of Ruptured Appendix and Crohn's Disease During Pregnancy. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2010.0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael Baggish
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH
| | - Anant Bhati
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH
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25
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Aromatase inhibitor for treatment of a recurrent abdominal wall endometrioma in a postmenopausal woman. Fertil Steril 2009; 92:1170.e1-1170.e4. [PMID: 19591983 DOI: 10.1016/j.fertnstert.2009.05.071] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Revised: 05/14/2009] [Accepted: 05/27/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Treat an abdominal wall endometrioma in a post-menopausal patient. DESIGN Case report. SETTING Academic medical center. PATIENT(S) A post-menopausal women with a large recurrent abdominal wall endometrioma. INTERVENTION(S) The patient was managed with the combination of an aromatase inhibitor, a progestin, and serial cyst aspiration. MAIN OUTCOME MEASURE(S) Serum and cyst estradiol levels as well as sonographic demonstration of resolution. RESULT(S) Serum and cyst estradiol levels were significantly diminished and the cyst diminished in size. CONCLUSION(S) Taken together, this case demonstrates a novel approach for managing and monitoring medical therapy for unusual clinical presentations of endometriosis. Furthermore, it illustrates that endometriotic implants can be a source of circulating estrogen in postmenopausal women, and that this source of estrogen is generated by increased aromatase activity.
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Pados G, Tympanidis J, Zafrakas M, Athanatos D, Bontis JN. Ultrasound and MR-imaging in preoperative evaluation of two rare cases of scar endometriosis. CASES JOURNAL 2008; 1:97. [PMID: 18706122 PMCID: PMC2533002 DOI: 10.1186/1757-1626-1-97] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 08/18/2008] [Indexed: 11/10/2022]
Abstract
Scar or incisional endometriosis is a rare, often misdiagnosed, pathologic condition of the abdominal wall. Two cases of incisional endometriosis are presented. Both patients presented with atypical cyclic pain and palpable nodules on scars of previous cesarean sections. In both cases, the mass was totally excised, after accurate preoperative evaluation with 2-D ultrasound, power Doppler and MRI. Microscopic examination confirmed the preoperatively presumed diagnosis of cutaneous endometriosis. In cases of suspected scar endometriosis, preoperative diagnostic imaging is valuable in determining the extent of disease, thus enhancing accurate and total excision.
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Affiliation(s)
- George Pados
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Uterocutaneous fistula after surgical treatment of an incomplete abortion: methylene blue test to verify the diagnosis. Arch Gynecol Obstet 2008; 279:225-7. [PMID: 18506462 DOI: 10.1007/s00404-008-0683-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2007] [Accepted: 05/05/2008] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Uterocutaneous fistula is an extremely rare clinical condition that can be seen after pelvic or uterine surgery. It can also complicate some obstetric procedures. CASE We report of an unusual case of an uterocutaneous fistula that developed in a multiparous woman after surgical evacuation of an incomplete first trimester septic abortion. The fistula tract was depicted on computed tomography, and to verify the diagnosis methylene blue was given through a transcervically introduced uterine catheter, and blue dye flow out through the external opening of fistula was observed. At laparatomy fistula tract was completely excised along with the enclosing omentum. Postoperative recovery and follow-up were uneventful. DISCUSSION Possible mechanisms of development of such a rare condition, and diagnostic and treatment options are discussed.
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Medical treatment of uterocutaneous fistula with gonadotropin-releasing hormone agonist administration. Obstet Gynecol 2008; 111:526-8. [PMID: 18239009 DOI: 10.1097/01.aog.0000281670.94265.5c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uterocutaneous fistula is a rare complication of uterine surgery. All published cases have been surgically treated with hysterectomy and excision of the fistulous tract. We report a case of uterocutaneous fistula that was successfully treated with gonadotropin-releasing hormone agonist administration. CASE A 25-year-old woman reported bloody discharge during her periods from a previous Pfannenstiel incision. A fistulous tract leading from the incision scar to the uterus was diagnosed. Leuprolide acetate depot was administered twice subcutaneously at a dose of 11.25 mg. The fistulous tract closed spontaneously, and the patient was symptom free thereafter. CONCLUSION Medical treatment with gonadotropin-releasing hormone agonists should be considered before resorting to surgery for treatment of uterocutaneous fistulae.
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Abstract
BACKGROUND Uterocutaneous fistula is a rare condition that may be difficult to manage. CASE A young woman who underwent surgical intervention for cryptomenorrhea 3 years ago developed menstrual discharge from the abdominal scar. A fistulous tract leading from the infraumbilical midline scar to the uterus was demonstrated on contrast study. Genital examination revealed vaginal agenesis. A vaginoplasty was performed as the first stage. This was followed one year later by excision of the fistulous tract and establishment of cervicovaginal communication. The patient is now menstruating from the vaginal passage. CONCLUSION This case shows that a stepwise, well-planned, and well-executed procedure can lead to a satisfactory repair of an uterocutaneous fistula.
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Affiliation(s)
- Dinesh Shukla
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
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Gunes M, Kayikcioglu F, Ozturkoglu E, Haberal A. Incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures. J Obstet Gynaecol Res 2005; 31:471-5. [PMID: 16176520 DOI: 10.1111/j.1447-0756.2005.00322.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To report 11 cases of incisional endometriosis after cesarean section, episiotomy and other gynecologic procedures. The diagnostic approaches and therapies for incisional endometriosis are also evaluated. METHODS Eleven patients who presented with a painful nodule that was increasing in size during menstruation on the scar of a previous gynecologic procedure were examined retrospectively. RESULTS All patients presented with a palpable painful lesion, located on the cesarean section incision, perineal episiotomy incision or the vaginal cuff after hysterectomy. All masses were increasing during menstruation and all patients had been having cyclical pain that worsened during menstrual periods. The mean age of the patients was 28.2 years. The onset of symptoms was referred at variable intervals after surgery ranging between 2 and 11 years (mean: 5.72 years). Ultrasound examination confirmed hypoechoic mass septated with cystic and solid components in the abdomen without intra-abdominal communications. All endometriotic masses were completely excised under general anesthesia. The excised masses were sent for microscopic examination which confirmed the diagnosis of endometriosis. CONCLUSION Incisional endometriosis seems to be common in women who have had a cesarean section, although it does occur after other procedures and de novo. It is suggested that caution is exercised during gynecologic procedures to avoid transplantation of endometrium to the anterior abdominal wall. The preferred management is to excise the lesion completely even if this necessitates fascial excision.
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Affiliation(s)
- Muzeyyen Gunes
- Department of Gynecology, SSK Ankara Maternity and Women's Health Teaching Hospital, Ankara, Turkey
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