Ligament release
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To evaluate the results of arthroscopic capsular release for the treatment of severe frozen shoulder syndrome. MATERIAL Between 2006 and 2008, 27 patients with severe frozen shoulder syndrome were treated by arthroscopic capsular release. The average age of the patients was 54 years (range, 34 to 75), 15 were men and 12 were women. The right shoulder was operated on more frequently (16 patients). The average pre-operative flexion was 73 degrees (range, 10 degrees to 150 degrees ) and pre-operative abduction was 56 degrees (10 degrees to 140 degrees ). The average Constant score was 35 points. METHODS With the patient in a lateral recumbent position, arthroscopic release of the joint capsule is performed with the Mitek VAPR 3 radiofrequency system, using a hook or an LPS electrode. The rotator interval, coracohumeral ligament, superior and middle glenohumeral ligaments and anterior part of the inferior glenohumeral ligament are gradually released, as well as the anterior glenohumeral joint capsule along its full width at the anterior rim of the labrum.To avoid damage to the axillary nerve, the axillary part of the joint capsule is released along the edge of the glenoid cavity. When internal rotation in abduction still remains restricted, release is extended to the posterior glenohumeral joint capsule.The procedure also involves exploration of the subacromial space and, if necessary, subacromial bursectomy or acromioplasty. Subsequently, the range of motion after release is tested and, when necessary, the remaining fibres of the joint capsule are disintegrated by careful manipulation (redress). The surgery is followed by analgesic and rehabilitation therapy. RESULTS All treated patients reported an improved range of motion. The average post-operative flexion and abduction extended to 160 degrees and 155 degrees, respectively, and 23 patients gained the motion range necessary for normal shoulder function.The average Constant score was 80.3 points and the University of California at Los Angeles (UCLA) score was 28.6 points. When using the school marking system, the average result evaluation was 1.75. All patients were satisfied with the outcome and were willing to undergo surgery on the other side if need be. No complications were recorded. DISCUSSION Therapy for frozen shoulder can be conservative or surgical. Most of the cases can be managed by correct conservative treatment. In accordance with the current literature data, we are using arthroscopic capsular release in resistant cases. This technique allows us to release contracted structures without the risk of iatrogenic injury and offers possibilities for the treatment of co-existing lesions. In the majority of patients this procedure can remedy their complaints, although the affected shoulder joint rarely remains asymptomatic. The aim of this approach is to accelerate the treatment of this disability; the long-term results are similar to those of conservative therapy. CONCLUSIONS Arthroscopic capsular release is the method of choice for the treatment of frozen shoulder syndrome in patients who have failed to respond to conservative therapy. It provides marked improvement in the range of motion and is associated with a minimum of post-operative complications. However, some patients may complain of persisting discomfort in the joint treated. Key words: frozen shoulder, arthroscopy, capsular release.
Podstatou operačnej liečby syndrómu karpálneho kanála je dekompresia n. medianus s discíziou transverzálneho karpálneho ligamenta. Z hľadiska voľby operačnej techniky pretrváva v odbornej verejnosti stála polemika o výhodách a nevýhodách konvenčných chirurgických techník (radikálna otvorená discízia verzus endoskopická discízia). Limitovaná otvorená disekcia transverzálneho karpálneho ligamenta sa nám preto prirodzene javí ako optimálne riešenie, nakoľko kombinuje v svojej podstate prevažne výhody konvenčných postupov (napr. priama explorácia nervu, zníženie morbidity, skrátenie pooperačnej rekonvalescencie a vytvorenie podmienok pre skorý návrat k pôvodnej pracovnej činnosti). Do štúdie bolo zaradených 38 pacientov so syndrómom karpálneho kanála chirurgicky riešených limitovanou otvorenou disekciou. V klinickom materiáli sme nezaznamenali žiadnu infekciu, alebo iné komplikácie v oblasti operačnej rany. U žiadneho z pacientov sa v pooperačnom období nevyskytla chronická pálivá bolesť dlane alebo operačnej jazvy ako následok poškodenia ramus cutaneus palmaris n. medianus. Z uvedeného počtu iba 1 pacient (2,6 %) udával v pooperačnom období rekurenciu symptómov. U ostatných pacientov sa limitovanou operáciou dosiahla spokojnosť s kompletným ústupom symptomatológie.
Decompression of the median nerve with flexor retinaculum release is the keystone of the surgical treatment of the carpal tunnel syndrome. There is still a scientific discussion about the risks and benefits of the conventional surgical techniques (radical open versus endoscopic dissection). In our mind limited-open release of the flexor retinaculum seems to be an optimal method, because of the fact that combines the predominant benefits of the conventional techniques (e.g. direct visual exploration of the nerve, decrease of the postoperative pain and morbidity, shortening of the postoperative reconvalescence etc.). Thirty-eight patients with carpal tunnel syndrome treated with an open-limited release were followed up. Any wound infection or other healing complication, any chronic pain of the palm (as a result of a palmar cutaneous branch of the median nerve injury), or painful scarring were remarked postoperatively. One patient (2.6%) underwent reoperation because of the symptoms recurrence. Other patients with complete resolution of the symptomatology were satisfied with the surgery.
PURPOSE OF THE STUDY The treatment of recurrent patellofemoral instability has undergone a paradigm change during the last 15 years. Instead of non-anatomical operations, the current concept favors the reconstruction of injured structures and the normalization of the biomechanical environment. Our aim was to briefly summarize the etiology, diagnostic regimen, and therapeutic decision making of this varied patient group and to review our own patients who underwent combined medial patellofemoral ligament reconstrucion and tibial tubercle transfer. MATERIAL AND METHODS Between 2015-2017 we performed combined ligament reconstruction and tubercle transfer for recurrent patellofemoral instability on 10 patients. The patients were examined for the degree of trochlea dysplasia, height of the patella, tibial tubercle trochlear groove distance. Additional intraarticular abnormalities were noted. The patients were assessed preoperatively and at follow-up using the Tegner Activity Scale and the Kujala score. Return to sports was also examined. RESULTS The average age of our patients was 22 years (15-40). We had 6 female patients and 4 male patient. The average followup time was 29 months (12-44). 9 patients had a medializing of the tibial tubercle, whilst one patient had a pure distalization to go along with the medial patellofemoral ligament reconstruction using PEEK tenodesis screws. We had no redislocations up to the last follow-up and patients were able to return to their previous activity level and/or sporting activity. The Kujala score improved from an average preoperative value of 48.9 (32-58) to an average follow-up value of 88.6 (70-97). DISCUSSION The essential steps in the treatment of recurrent patellofemoral instability are a thorough physical examination, appropriate imaging and the individual correction of the uncovered anatomical abnormalities. Neither isolated lateral retinacular release, nor medial capsular reefing can preictably produce satisfactory results. CONCLUSIONS Medial patellofemoral ligament reconstruction with tibial tubercle transfer (medializing and/or distalization) is a reliable surgical technique, that provides long term patellar stabilty in this selected group of young patients. Key words: patellar dislocation, joint instability, ligaments, tendon transfer.
- MeSH
- dospělí MeSH
- kloubní ligamenta MeSH
- kolenní kloub chirurgie MeSH
- lidé MeSH
- luxace pately * chirurgie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nestabilita kloubu * chirurgie MeSH
- patelofemorální kloub * chirurgie MeSH
- tibie chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Median arcuate ligament syndrome (MALS) describes clinical symptoms in patients with stenosis of the celiac artery due to external compression by the ligament. There is an ongoing debate, whether sole release of the median arcuate ligament warrants long-term relief of the symptoms. MATERIALS AND METHODS: Eight patients diagnosed with MALS underwent open surgical treatment beginning with the release of the ligament. Systemic pressure and pressure in the left gastric artery were measured before and after division of the median arcuate ligament and release of the celiac artery. In patients with persistent gradient above 15 mm Hg after the release a PTFE bypass was performed. RESULTS: After the release, the pressure gradient decreased from 66 ± 19 to 48 ± 14 mm Hg (p = .001) and therefore in all patients either an aorto-celiac bypass (n = 6) or aorto-hepatic bypass (n = 2) was created. Consequently, the gradient decreased to 7 ± 2 mm Hg (p = .0001). One month postoperatively, three patients were free of symptoms and the rest reported relief of symptoms. CONCLUSIONS: Release of the celiac artery resulted in insufficient decrease of pressure gradient, which was achieved by bypassing the segment with favorable mid-term outcome. We believe that the effect of the release should always be assessed to decide on subsequent treatment.
- MeSH
- bolesti břicha diagnóza etiologie MeSH
- cévní rezistence fyziologie MeSH
- chirurgická dekomprese metody MeSH
- CT angiografie metody MeSH
- Dunbarův syndrom diagnostické zobrazování patofyziologie chirurgie MeSH
- hodnocení rizik MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- peroperační péče metody MeSH
- předoperační péče metody MeSH
- retrospektivní studie MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- tlak MeSH
- výkony cévní chirurgie metody MeSH
- výsledek terapie MeSH
- vzorkové studie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY In this double-blind prospective study, pain after reconstruction of the anterior cruciate ligament (ACL) was evaluated using the visual analogue scale (VAS). Comparisons were made between patients administered an intra-articular analgesic mixture of adrenaline, morphine and bupivacaine (Marcaine) and those without it, between patients surgically treated by the BTB technique and those undergoing hamstring tendon ACL reconstruction, and between men and women undergoing the same procedure. MATERIAL Eighty-five randomly selected patients were allocated by five groups according to the surgery performed: 1. ACL reconstruction by the BTB technique, without administration of the analgesic mixture (20 patients); 2. hamstring tendon ACL reconstruction, without the analgesic mixture (20 patients); 3. ACL BTB technique with intra-operative, intra-articular analgesia (20 patients); 4. hamstring tendon ACL reconstruction, with intra-operative, intra-articular analgesia (20 patients), 5. ACL reconstruction using a cadaver graft, without intra-operative analgesia (5 patients). METHODS ACL reconstruction was carried out, in tourniquet-induced ischemia, by one of the standard techniques mentioned above. An analgesic mixture of adrenaline (1 ml/1 mg), morphine (1 ml/10 mg) and Marcaine (0.5 %/20 ml) was administered into the joint under arthroscopic control before the procedure was terminated. In all cases, the drain was released at 30 min. after the end of surgery. The limb was immobilized in a brace and the joint was cooled with ice. When requested, intramuscular analgesics (Dolmina and Dipidolor) were given. VAS pain scores were recorded at 30 min, 1, 2, 4, 8, 12 and 24 h after surgery. The range was from 0 (no pain) to 10 (maximum pain) scores. In addition, the amount of intramuscular analgesics and the time of their administration after surgery were noted. RESULTS VAS pain scores were lowest in the patients with ACL reconstruction by cadaver BTB grafting, the highest scores were reported by the patients with autologous BTB graft reconstruction. Women perceived the operation as more painful than men. When the intra-operative analgesic mixture was used, the amount of post-operative opiate analgesics was reduced by 29 % and 46 % in group 3 and group 4 patients, respectively, and in group 3 its administration was postponed (first administration after an interval 1.7-times longer than in group 4). The number of patients not requiring any opiate drugs increased markedly in both these groups. Intra-operative analgesia resulted in only a slight decrease in VAS pain scores, more in group 3 than group 4. DISCUSSION Several analgesics are used for intra-articular administration in order to alleviate post-operative pain. The most frequently used drugs include bupivacaine, morphine or epinephrine, but their mixtures are more effective than any of the drug administered alone. The most apparent evidence of the effect was the reduced amount of opiate drugs required after surgery, which was significant in all patients treated with intra-articular analgesia (groups 3 and 4) and particularly in men. However, VAS pain scores in the two groups decreased only slightly. Since maximum pain is experienced at the graft donor site, the effect of the evaluated mixture is regarded as complementary and multi-modal analgesic therapy is recommended. CONCLUSIONS The use of intra-articular analgesia has a significant effect on the reduction of opiate amounts administered to patients during the 24-hour post-operative period after ACL reconstruction, regardless of the surgical technique used. These patients also reported slightly lower perception of pain, as assessed by the VAS pain score. The effect was higher in men than in women.
- MeSH
- analgetika klasifikace terapeutické užití MeSH
- artroskopie metody trendy využití MeSH
- injekce intraartikulární trendy využití MeSH
- koleno chirurgie MeSH
- lidé MeSH
- ligamentum cruciatum anterius chirurgie MeSH
- muži MeSH
- pooperační bolest farmakoterapie terapie MeSH
- prospektivní studie MeSH
- ženy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
PURPOSE OF THE STUDY When a larger opening of high-tibial osteotomy is necessary to achieve good correction of the lower extremity axis, partial release of the attachments of the medial stabilisers of the knee may be required. The aim of the study was to ascertain, in cadaver specimens, the effect of loosening the medial knee stabilisers on the magnitude of correction in medial opening-wedge high-tibial valgus osteotomy. MATERIAL AND METHODS Thirty-eight knees obtained from cadavers of Caucasian race were dissected. Medial opening-wedge high-tibial valgus osteotomy was performed using a dynamic distractor, constructed by us, with a dynamometer to ensure constant force action. Using a kinematic navigation system, the lower leg axis was studied at opening-wedge osteotomy under constant forces of 100 N and 150 N. The change in its angulation was recorded after each step in releasing the medial stabilisers whose structures were gradually made loose, under constant action of the given force, in the following order: superficial portion of the medial collateral ligament, tendons of the gracilis, semitendinosus and sartorius muscles. RESULTS The results were statistically analysed using descriptive statistical methods and the two-sample paired t-test with the level of statistical significance set at p < 0.05. Loosening of the medial stabilisers one by one under a constant load led to a statistically significant change in alignment. The most significant change in angulation, both in clinical and statistical terms, was that of 3.4° occurring after the superficial portion of the medial collateral ligament was made loose under a constant force of 100 N applied to osteotomy. Thus, this loosening contributed by 62% to an overall change of 5.5° in the lower extremity mechanical axis, as compared with the condition not allowing for loosening of the stabilisers. Under a load of 150 N applied to osteotomy, loosening of the medial collateral ligament resulted in a change by 4.1°, which accounted for 56% of an overall change of 7.3° that occurred after all stabilisers were released. On distraction of the osteotomy using a higher force, an increase in a stabilising effect of the pes anserinus was apparent. DISCUSSION The evolution of angle-stable implants has advanced options for reliable fixation of high-tibial corrective osteotomy which involves cutting out a wedge and forcing it open on the medial side. These implants provide stable fixation even when a large correction of the limb mechanical axis is required, and allow for rehabilitation with early weight-bearing. As with a large correction the force needed to make the wedge open is increasing, it is necessary to consider loosening of the medial stabilisers of the knee. According to our knowledge, no study on the effect of individual medial stabilising structures of the knee on the force required to open high-tibial osteotomy with the wedge opened medially has been published. CONCLUSIONS The process of correcting lower extremity alignment by high-tibial opening-wedge valgus osteotomy brings about an increase in tension of the stabilisers on the concave side of the deformity. Our results show an important role of releasing the superficial portion of the medial collateral ligament in the reduction of forces necessary to correct a deformity.
- MeSH
- biomechanika MeSH
- interpretace statistických dat MeSH
- kloubní ligamenta chirurgie MeSH
- kolenní kloub chirurgie patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- ligamentum collaterale tibiale chirurgie MeSH
- mrtvola MeSH
- nestabilita kloubu chirurgie MeSH
- osteotomie metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- šlachy chirurgie MeSH
- tibie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
The important part of hallux valgus deformity operations, especially in the case of an incongruent joint, is the release of the soft tissue on the lateral side of the first metatarsophalangeal joint. The purpose of the present anatomic study was, with preparation of the lateral structures of the joint and lateral conjoined tendon, to provide a background for a surgical tip of the release of the joint for an additional metatarsal osteotomy. For the present study, we used 30 specimens (15 left and 15 right) from 19 cadavers at the Institute of Anatomy, First Faculty of Medicine, Charles Faculty (Prague, Czech Republic). Only specimens that met the criteria of hallux valgus were included in the present study. The technique was based on the incision of the lateral sesamoid ligament and partial tenotomy of the lateral conjoined tendon from the first interdigital web space. The release was done gradually with supination and abduction of the big toe to achieve the smallest size of the tenotomy. The median of the tenotomy size of the conjoined tendon was 6.5 (range 5 to 14) mm. The median size of the conjoined tendon in the frontal plane just ventral to the sesamoid bone was 10.6 (range 8 to 14) mm. The technique of the release, in which the big toe was abducted and supinated, can minimize the size of the lateral conjoined tendon release and can minimize the possibility of a postoperative deformity.
PURPOSE OF THE STUDY Operations of hallux valgus deformity are very well known in orthopaedic surgery. The important part of these procedures is the release of soft tissue on the lateral side of the first metatarsophalangeal joint. Soft tissue procedures became routinely used in the 1920s and 1930s and several techniques of soft tissue release have been published in the past seventy years. We found several inaccuracies between the anatomy published and the routine clinical performance. The purpose of the study was to describe the anatomy of the first metatarsophalangeal joint's lateral part, especially the adductor hallucis muscle attachment, and to assess to what extent the lateral structures of the first metatarsophalangeal joint should be released to correct hallux valgus deformity. MATERIAL We described and compared the anatomy of the lateral part of the first metatarsophalangeal joint on 30 dissected specimens obtained from cadavers that met the criteria of hallux valgus deformity. METHODS The standard preparation method was used for anatomical dissection; whole leg specimens including the pelvic girdle were fixed in formaldehyde, acetone, ethyl-alcohol and glycerol. The detailed course and shape of the adductor muscle attachment was described as well as its relation to the lateral sesamoid bone, lateral portion of the flexor hallucis brevis and the transverse metatarsal ligament. Dissection of the joint's lateral capsule was used to show the course of the lateral collateral ligament, sesamoid ligament and conjoined tendon of the adductor hallucis and flexor hallucis brevis muscles. Subsequently, we released the lateral sesamoid ligament with a standard longitudinal cut and then released the conjoined tendon and lateral collateral ligament at the level of the joint gap in the frontal plane. We evaluated the proposed technique in terms of the extent of soft tissue release and the size of tenotomy necessary to correct the deformity. RESULTS The mean valgus deformity was 32° (range, 18° to 50°). We were not able to define space between the medial border of the adductor hallucis and the flexor hallucis brevis in 23 cases (77%). The mean size of release was 6.4 mm (range, 5 to 15 mm) and the width of a conjoined tendon at the level of release was 11.2 mm (range, 8 to 15 mm). We did not achieve satisfactory release with our technique in two cases (7%, deviation 45° and 50°). DISCUSSION We compared our results with those of similar anatomical studies. We found several inaccuracies in anatomical descriptions of the adductor hallucis attachment. We confirmed the difficulty in separation of the adductor hallucis from the lateral head of the flexor hallucis brevis in total tenotomy of the adductor. Our technique was successful in releasing the first metatarsophalangeal joint's lateral structures. CONCLUSIONS Our study showed than even partial tenotomy of the conjoined tendon of the adductor hallucis and flexor hallucis brevis muscles is successful in correcting hallux valgus deformity. The release has to be combined with release of the lateral sesamoid ligament.
Úvod: Dunbarův syndrom je onemocnění způsobené útlakem truncus coeliacus (TC) nejčastěji zde procházejícím ligamentem arcuatum mediale. Chronická repetitivní komprese TC tímto ligamentem při dýchání vede k fibrózní přestavbě stěny tepny a vzniku fixované stenózy. Tento útlakový syndrom doprovázejí specifické příznaky, jako časná postprandiální bolest v epigastriu a váhový úbytek. V této studii shrnujeme naše zkušenosti na souboru 14 pacientů. Metody: U celkem 14 pacientů, u kterých byl diagnostikován Dunbarův syndrom a kteří byli indikováni k operačnímu řešení, jsme během operace prováděli invazivní měření systémového tlaku cestou a. radialis a porovnávali ho s invazivně měřeným tlakem v a. gastrica sinistra za stenózou, a to před a po důkladné deliberaci TC. U 13 (93 %) pacientů, u kterých přetrvávala významná stenóza (gradient nad 15 mmHg), byl proveden bypass. Výsledky: Tlakový gradient, který byl iniciálně 56 ± 19 mmHg, poklesl po uvolnění TC na 39 ± 16 mmHg (p < 0,0001). U 13 pacientů s přetrvávajícím gradientem nad 15 mmHg byl proveden bypass. Následné přeměření gradientu ukázalo jeho pokles na 5 ± 3 (p < 0,0001). U všech pacientů došlo ke klinickému zlepšení a rok po operaci byli bez obtíží. Během sledování jsme nezaznamenali žádné komplikace či nutnost provedení dalšího zákroku. Závěr: Chirurgické řešení Dunbarova syndromu je bezpečnou léčebnou modalitou s dlouhodobě uspokojivými výsledky. Domníváme se, že při chirurgickém řešení Dunbarova syndromu je vždy vhodné posoudit, jak úspěšné bylo uvolnění TC, a případě významné reziduální stenózy zvážit další postup - našem případě přemostění stenotického úseku TC bypassem.
Introduction: Dunbar syndrome is caused by compression of the truncus coeliacus (TC), most commonly by the median arcuate ligament. Chronic irritation of the TC during breathing leads to fibrous changes of the arterial wall and formation of fixed stenosis. This compression syndrome is often associated with specific complaints including weight loss and early postprandial epigastric pain. In this study, we summarize our experience with a group of 14 patients from a single institution. Methods: In 14 patients who were diagnosed with Dunbar syndrome and who were referred for surgery, we performed an invasive measurement of systemic pressure in a. radialis during the operation and compared it with invasively measured pressure in a. gastrica sinistra before and after the release of TC. In patients with significant stenosis (pressure gradient above 15 mmHg), a bypass was performed. Results: The initial pressure gradient of 56 ± 19 mmHg decreased after the release of TC to 39 ± 16 mmHg (p < 0.0001). In 13 (93%) patients with a persisting elevated gradient (above 15 mmHg) this decreased by 5 ± 3 (p < 0.0001) after subsequent bypass surgery. All patients experienced a clinical improvement, and one year after the operation their symptoms disappeared altogether. During the follow-up, we did not record any complications or the need to perform an additional procedure. Conclusion: Surgical treatment of Dunbar syndrome is a safe modality with satisfactory long-term results. We believe that it is always convenient to assess how successful the release of TC was and, in the case of a significant residual stenosis, to consider further steps in our case bypassing the stenotic segment.
Endometrióza je běžné gynekologické onemocnění způsobené usazením aktivních buněk endometria vně děložní dutiny. Ve většině případů se endometrióza vyskytuje v pánvi, tedy v oblasti vaječníků, Douglasova prostoru nebo uterosakrálního vazu. Ve vzácných případech může mimopánevní endometrióza vzniknout v perineu, močových cestách, gastrointestinálním traktu, nervovém systému, hrudníku, podkoží a kůži. Endometrióza perineaobyvkle vzniká sekundárně po poranění při porodu, např. při laceraci perinea nebo episiotomii. Dosud bylo zaznamenáno jen málo případů spontánní endometriózy perinea. V tomto článku popisujeme vzácný případ spontánní hluboké endometriózy perinea. Pozoruhodné je, že pacientka měla typické symptomy v podobě pravidelné bolesti při menstruaci, a to bez porodu nebo poranění perinea v anamnéze. Po pooperačním podání injekce agonisty hormonu uvolňujícího gonadotropin se pacientka plně uzdravila.
Endometriosis is a common gynecological disease caused by the implantation of active endometrial cells outside the uterine cavity. In most cases, endometriosis occurs in the pelvic area, such as the ovary, Douglas’ pouch, or uterine sacral ligament. Some rare cases of extrapelvic endometriosis can also occur in the perineum, urinary system, gastrointestinal tract, nervous system, chest, subcutaneous tissue, and skin. Endometriosis of the perineum is usually secondary to obstetric trauma, such as perineal laceration or episiotomy. To date, few cases of spontaneous perineal endometriosis have been reported. Herein, we report a rare case of spontaneous deep perineal endometriosis. Notably, the patient had typical symptoms of regular pain during menstruation with no history of delivery or perineal trauma. The patient recovered well after postoperative gonadotropin releasing hormone agonist injection.
- MeSH
- dospělí MeSH
- endometrióza * chirurgie diagnóza patologie terapie MeSH
- gynekologické chirurgické výkony metody MeSH
- hormon uvolňující gonadotropiny farmakologie terapeutické užití MeSH
- lidé MeSH
- menstruační cyklus fyziologie MeSH
- perineum * chirurgie patologie MeSH
- ultrasonografie metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
