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Chu MJ, Huang PS. Inguinal hernia following the use of fluid anti-adhesive agents in laparoscopic surgery: a literature review and case report. Ann Med Surg (Lond) 2024; 86:1805-1809. [PMID: 38463088 PMCID: PMC10923339 DOI: 10.1097/ms9.0000000000001810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/29/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Inguinal hernia is a rare complication in females occurring due to the use of common anti-adhesion agents, such as ADEPT. Some complications have been reported to date; however, there are no reported cases of ADEPT-induced inguinal hernia. Case presentation A 39-year-old woman underwent laparoscopic ovarian cystectomy for a right ovarian endometrioma, using ADEPT as an anti-adhesion agent. Subsequently, she developed an inguinal hernia diagnosed using pelvic computed tomography. The inguinal mass gradually decreased in size and disappeared four months after, without intervention. Clinical discussion While rare complications have been reported, no cases of inguinal hernias induced by anti-adhesion agents have been reported to date. To minimize the risk of this complication, avoiding excessive intra-abdominal pressure to prevent possible peritoneal fluid migration through small orifices into low-pressure areas is advised. Additionally, applying external pressure over the superficial/deep inguinal rings until CO2 is completely removed from the abdominal cavity might be helpful. Conclusion Inguinal hernia is a rare anti-adhesion solution complication in females. Minimizing the risk involves avoiding excessive intra-abdominal pressure and applying external pressure over the superficial/deep inguinal rings.
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Affiliation(s)
| | - Pei-Shen Huang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan
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2
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Tilva H, Tayade S, Kanjiya A. Contemporary Review of Masses in the Canal of Nuck. Cureus 2023; 15:e36722. [PMID: 37123808 PMCID: PMC10130799 DOI: 10.7759/cureus.36722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/26/2023] [Indexed: 03/29/2023] Open
Abstract
Canal of Nuck masses is a rare occurrence that can cause swelling in the abdominal-inguinal region of females for various reasons. This condition arises due to an abnormal persistence of the processus vaginalis opening. Although Canal of Nuck pathology is not widely known among general surgeons or gynecologists due to its rarity, it has been associated with significant morbidity and requires further research. In this comprehensive review, we aim to summarize the embryology and anatomy of the Canal of Nuck, followed by a description of the various types of masses that can occur in this region. We discuss the clinical presentation and diagnostic workup of Canal of Nuck masses, including imaging modalities and differential diagnoses. Next, we review the surgical management of these masses, including open and laparoscopic approaches. Finally, we discuss the potential complications and long-term outcomes associated with Canal of Nuck pathology. This review aims to compile the presently accessible literature on anomalies occurring in the Canal of Nuck in females, with a particular focus on describing their pathological nature, diagnosis, and management. In summary, this review provides an up-to-date understanding of the pathology, diagnosis, and management of Canal of Nuck masses and aims to raise awareness of this under-recognized surgical challenge among healthcare providers.
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3
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Brooks G, Bisoffi S, Virgone C, Gamba P. Inguinal Hernia Containing the Uterus in the Pediatric Patient: A Systematic Review. J Pediatr Adolesc Gynecol 2022; 35:182-187. [PMID: 34843975 DOI: 10.1016/j.jpag.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/23/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Inguinal hernia containing the uterus in pediatric patients with normal karyotype and phenotype is an extremely rare entity, and no consensus is available concerning diagnosis, surgical management, and follow-up. METHODS A systematic review according to the Synthesis Without Meta-analysis protocol was conducted. Studies including pediatric female patients with inguinal hernia containing the uterus were searched. Keywords and mesh term searches were conducted (Medline, Scopus, and Web of Science). We additionally reviewed our center's clinical records and found 1 patient with an inguinal uterus hernia that was included in the statistical analysis. RESULTS Thirty-six articles and 73 patients were considered for this analysis. The median gestational age at birth was 36 weeks. The inguinal mass was first noticed at the median age of 1.5 months (0-18 months), on the left side in 61% (on the right in 16, 39%). Sixty percent of patients had no associated symptoms or signs; 37.5% showed symptoms and signs of an incarcerated hernia. Median age at surgery was 2 months (1-72 months). In all patients, one or both adnexa herniated with the uterus. An open approach was more frequently used (56.4%). Contralateral duct exploration and ligation was performed in 7 patients (24.1%). No postoperative complications or recurrence have been described. CONCLUSIONS The data obtained do not allow us to draw univocal conclusions on which is the best management in these patients. It is still unclear if an elective approach in an asymptomatic patient might bear long-term consequences on reproductive functions. No surgical technique proved to be superior to others, but both the open and laparoscopic approaches seem to be effective without postoperative complications or recurrence.
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Affiliation(s)
- Giulia Brooks
- Pediatric Surgery, Department of Women's and Children's Health, University Hospital of Padua, Italy
| | - Silvia Bisoffi
- Pediatric Surgery, Department of Women's and Children's Health, University Hospital of Padua, Italy
| | - Calogero Virgone
- Pediatric Surgery, Department of Women's and Children's Health, University Hospital of Padua, Italy.
| | - Piergiorgio Gamba
- Pediatric Surgery, Department of Women's and Children's Health, University Hospital of Padua, Italy
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4
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How embryology knowledge can help radiologists in the differential diagnosis of canal of Nuck pathologies. Radiol Med 2021; 126:910-924. [PMID: 33954897 DOI: 10.1007/s11547-021-01361-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
The Canal of Nuck (CN) is an anatomical structure which is often forgotten. It is the female equivalent of the male processus vaginalis and corresponds to a protrusion of parietal peritoneum that extends from the inguinal canal to labia majora. Radiologists rarely encounter patients with pathology of CN, especially in adult population. It is well known that CN diseases can occur in paediatric patient (especially younger than 5 years of age) and they are associated to high morbidity (for example ovarian hernia with high risk of incarceration and torsion). The aim of our work is to review embryology, anatomy and pathologies of the CN thanks to a multi modal approach-ultrasound (US), Computed Tomography (CT) and Magnetic Resonance imaging (MRI)-to make radiologists more aware of such conditions and guarantee a prompt and correct diagnosis not only in paediatric patients but also in the adult population.
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5
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Hassan M, Stutsrim AE, J Clark C. Large Canal of Nuck Hernia: The Female Equivalent of the Inguinoscrotal Hernia. Am Surg 2021:3134821998672. [PMID: 33626888 DOI: 10.1177/0003134821998672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our patient was a 78-year-old woman with a large indirect inguinal hernia who underwent Lichtenstein repair. Literature review of the pathophysiology of indirect hernias revealed important discussion of the canal of Nuck in women and understanding embryologic development of ovaries and descent of testes.
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Affiliation(s)
- Monalisa Hassan
- Department of General Surgery, 20814Howard University Hospital, Washington, DC, USA
| | - Ashlee E Stutsrim
- Department of General Surgery, 12280Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Clancy J Clark
- Department of General Surgery, 12280Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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6
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Amreen S, Yaseen Y. Ovarian inguinal hernia. J Ultrason 2020; 20:e226-e227. [PMID: 33365162 PMCID: PMC7705479 DOI: 10.15557/jou.2020.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/03/2020] [Indexed: 11/22/2022] Open
Abstract
Indirect inguinal hernia is a common congenital abnormality in children. In female infants, herniation of the ovaries, fallopian tubes and uterus has been reported. Herniation of the ovaries is a rare congenital condition that may be complicated by strangulation, torsion, and infertility. A 6-week-old female infant presented with visible swelling in the right inguinal region. This case highlights the utility of ultrasonography as a cheap and easily available imaging technique that can be used for the characterization of the hernial contents, and guide the management, further accentuated by the use of color Doppler imaging, of this subtle but crucial entity.
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Affiliation(s)
- Saika Amreen
- Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Soura, India
| | - Yawar Yaseen
- Medical Officer, Directorate of Health Services, Kashmir, India
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7
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Hamidi H, Rahimi M. Infantile presentation of the canal of Nuck hernia containing uterus and ovary: a case report. Radiol Case Rep 2020; 15:2557-2559. [PMID: 33082898 PMCID: PMC7553890 DOI: 10.1016/j.radcr.2020.09.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/19/2022] Open
Abstract
Indirect inguinal hernias of the canal of Nuck containing the uterus and the ovary is rare entity in girls presenting as labia major masses at infancy and early childhood. Authors present a case of the canal of Nuck hernia in a 5-month-old girl presented as palpable lump in the right labia majora which was diagnosed by ultrasonography. Ultrasound is the noninvasive diagnostic modality of choice in for evaluation of palpable external genital masses in children.
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8
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Brainwood M, Beirne G, Fenech M. Persistence of the processus vaginalis and its related disorders. Australas J Ultrasound Med 2020; 23:22-29. [PMID: 34760578 DOI: 10.1002/ajum.12195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The processus vaginalis is a blind-ended evagination of the abdominal wall that develops during fetal life and typically undergoes obliteration in early life. Persistence of the processus vaginalis is associated with a number of pathologies including congenital indirect inguinal hernias, communicating hydroceles, funicular and encysted hydroceles, canal of Nuck cysts, and acquired undescended testis. Whilst all are detectable sonographically, there is little educational material relevant to the field of ultrasound with much of the literature directed at surgical and primary care physicians. Furthermore, within the literature there is a lack of consensus on several areas including the anatomy and embryology of the processus vaginalis and the mechanisms behind its obliteration. As such the objective of this paper is to distil the information regarding the persistent processus vaginalis as it is relevant to ultrasound and in doing so address the literature gap for sonographers and sonologists. The anatomy and embryology of the persistent processus vaginalis will be discussed including causative mechanisms for anomalies with their sonographic appearance highlighted.
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Affiliation(s)
- Michelle Brainwood
- Department of Ultrasound Qscan Radiology Clinics College Junction 2-12 Wagner Road Clayfield Queensland 4011 Australia
| | - Geraldene Beirne
- Locum Senior Sonographer Matraville New South Wales 2036 Australia
| | - Michelle Fenech
- School of Health, Medical and Applied Sciences Central Queensland University 160 Ann Street Brisbane Queensland 4000 Australia
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9
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Amini R, Baker N, Woolridge DP, Echeverria AB, Amini A, Adhikari S. Emergency department diagnosis of an ovarian inguinal hernia in an 11-year-old female using point-of-care ultrasound. World J Emerg Med 2018; 9:291-293. [PMID: 30181799 DOI: 10.5847/wjem.j.1920-8642.2018.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Richard Amini
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, USA
| | - Nicola Baker
- Department of Emergency Medicine, Northwest Medical Center, Tucson, AZ, USA
| | - Dale P Woolridge
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, USA
| | | | | | - Srikar Adhikari
- Department of Emergency Medicine, The University of Arizona, Tucson, AZ, USA
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10
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11
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Nasser H, King M, Rosenberg HK, Rosen A, Wilck E, Simpson WL. Anatomy and pathology of the canal of Nuck. Clin Imaging 2018; 51:83-92. [PMID: 29448124 DOI: 10.1016/j.clinimag.2018.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/17/2018] [Accepted: 02/02/2018] [Indexed: 11/26/2022]
Abstract
The canal of Nuck is the female equivalent of the processus vaginalis in the male but is less well known than its male counterpart. It is a rare entity not commonly encountered by radiologists, particularly in the adult population. Knowledge of the embryology and anatomy of the canal of Nuck is essential for identification of the various pathologic conditions that may occur in this location. Moreover, radiologists should be familiar with this entity to compose an appropriate and thorough differential diagnosis of a labial mass/swelling. In this review, we discuss both the anatomy and the more common pathology that can be encountered within it.
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Affiliation(s)
- Hussein Nasser
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Michael King
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | | | - Ally Rosen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Eric Wilck
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - William L Simpson
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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12
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Canal of Nuck hernia: a multimodality imaging review. Pediatr Radiol 2017; 47:893-898. [PMID: 28444423 DOI: 10.1007/s00247-017-3853-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/11/2017] [Accepted: 03/28/2017] [Indexed: 01/28/2023]
Abstract
Canal of Nuck abnormalities are a rare but important cause of morbidity in girls, most often those younger than 5 years of age. The canal of Nuck, which is the female equivalent of the male processus vaginalis, is a protrusion of parietal peritoneum that extends through the inguinal canal and terminates in the labia majora. The canal typically obliterates early in life, but in some cases the canal can partially or completely fail to close, potentially resulting in a hydrocele or hernia of pelvic contents. Recognition of this entity is especially important in cases of ovarian hernia due to the risk of incarceration and torsion. We aim to increase awareness of this condition by reviewing the embryology, anatomy and diagnosis of canal of Nuck disorders with imaging findings on US, CT and MRI using several cases from a single institution.
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13
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Chin EL, Troncoso R, Shimkaveg M, Dietz E. Labial Mass in an Irritable 35-Day-Old Female. Clin Pediatr (Phila) 2017; 56:492-495. [PMID: 27149988 DOI: 10.1177/0009922816646724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Erica L Chin
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruben Troncoso
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan Shimkaveg
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edith Dietz
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
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14
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Castro ADAE, Morandini F, Calixto CP, Barros WH, Nakatani ET, Castro ADAE. Ectopic ovary with torsion: uncommon diagnosis made by ultrasound. Radiol Bras 2017; 50:60-61. [PMID: 28298734 PMCID: PMC5347505 DOI: 10.1590/0100-3984.2014.0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ultrasound is an important diagnostic tool in inguinal hernia and in the
evaluation of the contents of the hernia sac. This report presents a case in
which ultrasound revealed a herniated ectopic ovary, complicated by torsion of
its vascular pedicle, in the right labia majora. We also present a brief
discussion of ovarian hernia, its potential complications, and the treatments
available.
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Affiliation(s)
- Adham do Amaral E Castro
- MSc, Doctoral Student at the Medical Research Institute of the Faculdade Evangélica do Paraná - Hospital Evangélico de Curitiba, Curitiba, PR, Postgraduate Student in Musculoskeletal Radiology at the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Caroline Paludo Calixto
- MD, Resident in Radiology and Diagnostic Imaging at the Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil
| | - Wagner Haese Barros
- MD, Radiologist for the Grupo Fleury / Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - Edson Tetsuya Nakatani
- MD, Gynecologist and Obstetrician, Specialist in Fetal Medicine at the Instituto da Mulher e Medicina Fetal, Curitiba, PR, Brazil
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15
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Rafailidis V, Varelas S, Apostolopoulou F, Rafailidis D. Nonobliteration of the Processus Vaginalis. Sonography of Related Abnormalities in Children. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:805-818. [PMID: 26960801 DOI: 10.7863/ultra.15.04060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The objective of this pictorial essay is to systematically classify processus vaginalis– related disorders in the light of embryology and present illustrative sonograms with corresponding diagrams. Failure of the processus vaginalis to obliterate during gestation results in a wide spectrum of anomalies, including communicating and noncommunicating hydroceles and inguinal and inguinoscrotal hernias, along with other related disorders of the genital system. There are varying classifications in the literature regarding the aforementioned entities. Proper and timely diagnosis of these entities is essential, given the differences in treatment. Although physical examination can narrow the differential diagnosis, sonography plays an essential role in establishing the diagnosis.
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16
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Heller DS. Lesions of the Round Ligament and Canal of Nuck—It Is Not Always an Inguinal Hernia: A Review. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2015.0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Debra S. Heller
- Department of Pathology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ
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17
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18
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Pahwa AK, Siegelman ES, Arya LA. Physical examination of the female internal and external genitalia with and without pelvic organ prolapse: A review. Clin Anat 2014; 28:305-13. [PMID: 25256076 DOI: 10.1002/ca.22472] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/08/2014] [Accepted: 08/28/2014] [Indexed: 11/11/2022]
Abstract
Pelvic organ prolapse, a herniation of pelvic organs through the vagina, is a common condition in older women. Pelvic organ prolapse distorts vaginal anatomy making pelvic examination difficult. A clinician must accurately identify anatomic landmarks both in women presenting with symptoms of prolapse and in women noted to have coincidental prolapse during routine gynecologic examination. We present a systematic approach to the female pelvic examination including anatomic landmarks of the external genitalia, vagina, and uterus in women with normal support as well as changes that occur with pelvic organ prolapse. Knowledge and awareness of normal anatomic landmarks will improve a clinician's ability to identify defects in pelvic support and allow for better diagnosis and treatment of pelvic organ prolapse.
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Affiliation(s)
- Avita K Pahwa
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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