Kenro Chikazawa

Surgical excision of umbilical endometriotic lesions with laparoscopic pelvic observation is the way to treat umbilical endometriosis.

Primary umbilical endometriosis is extremely rare, although cases secondary to previous surgery have occasionally been reported. Here, we report three cases of umbilical endometriosis: two cases with previous cesarean section and one case of primary umbilical endometriosis. The treatment of choice for umbilical endometriosis is the excision of the lesions, and we believe laparoscopic pelvic observation is a beneficial addition, as 13%–15% of umbilical endometriosis cases are accompanied by pelvic endometriosis.

Predictors of recurrent/residual disease after loop electrosurgical excisional procedure

The aim of this study was to identify predictors of recurrent/residual disease for management after loop electrosurgical excisional procedure.

Expectant management of a case of uterine arteriovenous malformation with an ovarian artery aneurysm

Uterine arteriovenous malformations are rare and their true prevalence is unknown. Selective arterial embolization is used as first‐line therapy for acute severe vaginal hemorrhage associated with uterine arteriovenous malformations. However, some patients with no vaginal bleeding have been treated conservatively, so the optimal treatment modality for arteriovenous malformations is unclear. We describe a 58‐year‐old woman with uterine arteriovenous malformation and an ovarian artery aneurysm who was successfully treated with an expectant management approach along with an assessment of age, symptoms, and imaging findings.

Delayed diagnosis of single compartment muscle contusion after radical hysterectomy in the lithotomy position: A case report

Highlights • In lithotomy position, surgeries performed can result in muscle contusion.• MRI can help to detect light muscle contusion.• Routine physical examination may be needed for identification of muscle contusions.

Cyst contents aspiration before laparoscopically assisted cystectomy in pregnant women

At present, laparoscopic surgery is widely performed for ovarian cysts in pregnant women (El-Shawarby et al. 2005). Recently, the experience and the safety of laparoscopic surgery in pregnant women was reported (Chikazawa et al. 2017). However, surgeons/institutions which are not familiar with laparoscopic surgery for ovarian cysts often avoid it. One possible reason for this is that they are concerned about the risk of spillage of the cystic content. Indeed, a previous study reported that 55% of patients who underwent a laparoscopic cystectomy experienced a rupture during the operation (Hursitoglu et al. 2013). In a laparoscopic myomectomy, the use of the isolated morcellation technique and the necessity of reduction of scattering have been widely reported (Chikazawa et al. 2015). Therefore, we have to make an effort to reduce or avoid spillage of the cystic content during laparoscopic operations. Here, we introduce our technique for aspirating the contents of ovarian cysts in laparoscopic ovarian cystectomy procedures involving pregnant women.

Rupture of hidden abnormal myometrial vessels during cesarean delivery of a patient with subserosal leiomyoma: A possible pathogenesis of sudden-onset disseminated intravascular coagulation

We report a case of sudden‐onset disseminated intravascular coagulation during cesarean delivery for a patient with a subserosal leiomyoma. Rupture of hidden anastomotic vessels resulted in a significant decrease in fibrinogen levels and uncontrolled bleeding. Uterine venous flow disturbance caused by subserosal leiomyoma compression can possibly cause such a situation.

Open fan sign: An ultrasound finding suggesting postpartum intrauterine forgotten gauze

Gauze counting is regarded as the most essential way to prevent forgotten gauze inside the body during any surgery. However, incident may still occur due to artificial mistake. An open fan sign on ultrasonography may indicate a gauze left in the intrauterine cavity.

Preoperative administration of eculizumab to prevent surgery-triggered hemolysis during cesarean section with paroxysmal nocturnal hemoglobinuria

Eculizumab in pregnancy has been reported to be effective in improving outcomes in patients with paroxysmal nocturnal hemoglobinuria. However, a cesarean section may result in surgery‐triggered hemolysis. An additional dose of eculizumab just prior to delivery is an appropriate choice to prevent postoperative hemolysis.

Increase in the cervical length after the loop electrosurgical excision procedure for grade III cervical intraepithelial neoplasia

Abstract This study aimed to determine whether the cervical length increases over a period of six months, after the loop electrosurgical excision procedure (LEEP) for grade III cervical intraepithelial neoplasia (CIN), and to identify the factors associated with an increase in the cervical length. We retrospectively reviewed the medical records of 183 patients who underwent the LEEP between April 2011 and March 2014, at the Department of Gynaecology, Kyosai Hospital. Transvaginal ultrasonography was performed at two, three and six months after the LEEP, and the mean increase in the cervical length between two and three months, two and six months, and three and six months were 2.07, 5.23 and 2.92 mm, respectively. The increase in the cervical length was not associated with age, gravidity, parity and the width of CIN. In conclusion, the cervical length may increase gradually over a period of six months after the LEEP.

A pregnant woman with clinical and radiological findings compatible with posterior reversible encephalopathy syndrome in early pregnancy without discernable underlying disorders: atypical type of this syndrome?

Posterior reversible encephalopathy syndrome, if it occurs in late pregnancy, requires pregnancy termination. Here, we report a woman without a discernable underlying condition who developed neurological deficits at 14 weeks of pregnancy. Magnetic resonance imaging demonstrated an occipitoparietal brain lesion suggestive of posterior reversible encephalopathy syndrome. Neurological symptoms ameliorated spontaneously and she continued her pregnancy to term. A decision to terminate pregnancy based on only neurological and magnetic resonance imaging findings should be avoided.