Yong-Kyoon Cho

A case of adhesive small bowel obstruction with pelvic inflammatory disease due to Chlamydia trachomatis

17세 여자가 골반염증성질환으로 입원하여 항생제 치료를 시작하였다. 증상 호전 중 입원 5일째 갑자기 오심과 구토 증상이 시작되었다. 보존적 처치에도 불구하고 증상이 심해져 7일째 시행한 단순복부촬영과 복부골반 전산화단층촬영에서 허혈성 소장폐쇄 소견이 보였다. 응급개복술을 시행하였고 소장 장간막 부위에 그물막이 붙어 유착띠가 형성되어 있었고 20 cm 정도의 소장이 끼어 있었다. 부분 그물막절제술, 유착띠박리술, 부수적으로 충수돌기절제술을 시행하였다. 수술 후 증상은 완전히 소실되었으며 11개월간 외래 추적 관찰에서도 특이사항은 없었다. 이 증례는 골반염과 동반된 오심 구토 증상이 지속될 경우 골반염증질환의 드문 합병증인 장폐쇄를 의심하여야 하겠고, 정확한 진단과 의사결정을 위해 단순복부촬영뿐만 아니라 복부골반 전산화단층촬영의 유용성을 보여준다. 저자들은 Chlamydia trachomatis 감염에 의한 골반염성 질환 환자에서 발생한 유착성 소장폐쇄 1예를 경험하였기에 이에 간단한 문헌 고찰을 함께 보고하는 바이다.

P49.11: Prediction of preterm delivery in threatened preterm labor: comparison between ultrasonographic cervical length measurement and digital examination

Introduction: The most frequent indication for intra-operatory ultrasound is dilation and curettage procedure and this may be difficult by extreme flexion or version of the uterus. Curet can be guided and with a monitored path between the cervix and endometrial cavity and completely uterine evacuation can be assessed. Methods: Three women with pregnancy complicated by trophoblastic gestational disease were included in this study. All patients showed a typical ultrasound images of trophoblastic gestational disease diagnosed at others hospitals and uterine curettage was done. However, all women persisted with vaginal bleeding and ultrasound showed the permanence of material in uterine cavity after the procedure and so these patients were led to our hospital. The ultrasound showed uterine volume above 300 mL and two patients had retroversion position of the uterus. Curettage was guided by transabdominal ultrasound with fluid-filled bladder appropriate and was performed by a senior obstetric ultrasonographer (transducer of 3–5-Mhz). There was continuous communication between the ultrasonographer and the obstetric surgeon. Ultrasound showed the dilation of cervix and the correct position of the canula of the vacuoextractor in the uterine, monitoring all the procedure and observing the complete evacuation of the uterine material. Ultrasound performed one day after the procedure demonstrated the absence of images of trophoblastic gestational disease. Conclusion: In difficult cases of uterine curettage, ultrasound can be used to help the obstetrician in order to make a safe procedure and total evacuation of uterine cavity in cases of trophoblastic gestational disease.