Us. This event is reported to occur in between 0.12 and 1.4 ofUs.

Us. This event is reported to occur in between 0.12 and 1.4 of
Us. This event is reported to occur in between 0.12 and 1.4 of hysteroscopies in German and American studies, respectively [4]. The lesion can occur during the dilatation of the cervix, curettage of the endometrium, or during the resection of septum, polyps, or leiomyomata. Small PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/27689333 perforations usually are not lifethreatening and can be treated with antibiotics and overnight observation. Greater lesions can produce acute bleeding of the injured area, leading to hemoperitoneum, rupture of uterine vessels causing hypovolemic shock or damage to adjacent bowel, with risk of peritonitis [1?]. Therefore, following the German guidelines, a diagnostic laparoscopy rather than an echography is recommended in every perforation to evaluate the extent and control of the injury such as coagulation or suture of the uterine wall, hysterectomy, repair of the affected organs, or a combination of these procedures [5]. Consequently, the risk of postsurgical peritoneal adhesions, chronic pain, or infertility is increased. Specially, postsurgical peritoneal adhesions constitute a major problem in terms of patient quality of life and costs for the health system [6?], with a high risk of intraoperative complications during a subsequent operation, if an adhesiolysis is performed. Hence it is recommended that surgeons adopt and implement anti-adhesion strategies, like the use of adhesion-reducing agents [9, 10].which were related to the previous abdominal surgeries. The bladder, bowel, and uterine vessels were intact, and the uterine perforation was confirmed. The active bleeding from the 1 cm wound was controlled in a few minutes by a single dose of 4DryField?powder. Consequently, further actions were not necessary and the postoperative patient recovery was satisfactory (Fig. 1). Nine weeks after curettage, a control hysteroscopy, adhesiolysis of the preexisting abdominal adhesions, and a laparoscopically assisted vaginal hysterectomy with bilateral salpingoophorectomy, because of an endometrial adenocarcinoma, were performed following the German guidelines. The uterine cavity exhibited CBR-5884 price multiple endometrial polyps, few synechias, and a completely healed wall. A total of 1.5 mL of ascites was found in the Douglas pouch. The pelvic organs were free of adhesions, and the uterine wall completely uneventful; the area of former perforation was prominent with the shiny surface of normal peritoneum. Despite the region having sustained a bleeding injury, there was no adhesion formation (Fig. 2). Additionally, a 0.5 cm white granuloma in the right Douglas pouch was excised. There were no intra or postoperative complications. The PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/29069523 histology reported ascites cells without atypia, an endometrioid adenocarcinoma of the corpus uteri (staging IA, pT1a, cN0, L0 V0 M0/G2), and a granuloma with a foreign body reaction and regressive calcification. The tumor immunohistology was positive for estrogen (80 ) and progestogen (80 ) receptors. Our patient received no adjuvant therapy.Case presentation A 71-year-old German woman presenting with serometra and endometrial hyperplasia was scheduled to undergo diagnostic hysteroscopy and fractional curettage. She had delivered twice, and had a history of multiple previous surgeries including appendectomy, cholecystectomy, diaphragm hernia repair, and two former curettages because of postmenopausal abnormal bleeding. At physical examination, her genital organs were atrophic and no masses were palpable. The ultrasound showed a 6-cmlong uterus.