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    Diagnosis and Management of Isolated Tubal Torsion Is Salpingectomy Mandatory?
    (SCI PRINTERS & PUBL INC, 2018) Ucar, Mustafa Gazi; Celik, Mehmet; Sanlikan, Fatih; Ilhan, Tolgay Tuyan; Gocmen, Ahmet; Celik, Cetin
    OBJECTIVE: To review the clinical characteristics of patients with isolated fallopian tube torsion (IFTT). STUDY DESIGN: We conducted a retrospective study of a consecutive series of IFTT cases presenting at 2 tertiary referral centers. All patients underwent laparoscopic assessment, and the fallopian tube and its ligamentous support were gently untwisted to assess ischemic lesions. Patients were classified based on the following 3 criteria: complete recovery (Group A), partial recovery (Group B), and without any recovery (Group C). RESULTS: Our series consisted of 9 patients. Group A (2 cases) and Group B (5 cases) were managed conservatively. Two patients were assigned to group C and underwent laparoscopic salpingectomy. During early postoperative period, in the conservatively managed group 4 patients underwent hysterosalpingography examination, and both fallopian tubes were found to be patent. One of these 4 patients had a spontaneous pregnancy and delivered a healthy infant, and another patient had a miscarriage at 6 weeks' gestation. Imaging revealed no pathological findings in the remaining 3 virgins in the conservatively managed group. No infections, peritonitis, thromboembolic events, or other complications occurred during the follow-up period. CONCLUSION: Conservative management of IFTT can be considered a safe option, even if little evidence of recovery is observed after detorsion.
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    Management of intra-abdominally translocated contraceptive devices, is surgery the only way to treat this problem?
    (TAYLOR & FRANCIS INC, 2017) Ucar, Mustafa Gazi; Sanlikan, Fatih; Ilhan, Tolgay Tuyan; Gocmen, Ahmet; Celik, Cetin
    This study was a multi-centre retrospective review of patients with uterine perforation caused by intrauterine contraceptive devices (IUDs). A total of 15 patients were registered, in a seven year period. Among them, five were asymptomatic and the rest were symptomatic. Asymptomatic patients were managed conservatively, except in one case in which the patient requested surgery because she also wanted a tubal ligation. Symptomatic patients all underwent surgery. All the surgeries were elective and all the surgical procedures were initiated laparoscopically. There were seven complications in the surgically managed group: conversion to laparotomy (n=3), bowel injury (n=2), bladder injury (n=1), and wound infection (n=1). Mild and severe adhesions (81.8%), and abscess (18.1%) formation related to translocated IUD (TIUD) were observed during surgery. All the patients were uneventful at 1 to 5 years of follow-up. A TIUD, by causing adhesions, complicates future laparoscopic surgery and increases the likelihood of conversion to laparotomy. While surgery is indicated to prevent TIUD-induced adhesive complications, it may also be the cause of both adhesions and complications, resulting in a vicious cycle. Some asymptomatic women, especially elderly patients with comorbidities, may not need or may be better managed without treatment. IMPACT STATEMENT In this study we try to find an answer for the question of "Should removal of a translocated intrauterine contraceptive device (TIUD) routinely be performed even if patients are asymptomatic?" From only the theoretical point of view there were some reports supporting conservative management in asymptomatic patients. The other studies addressing this issue were case reports including few patients with a short-term follow-up. The novelties of the present study include multi-centre design, detailed clinical and surgical information about the patients and the long period of follow-up. Most clinicians have limited experiences in managing TIUD because perforation is a rare event. So it can be difficult to know exactly what the surgeon will encounter intraoperatively. We undertook this study with the aim of providing a perspective about patients with TIUD for those faced with this situation. This is a descriptive study reporting 15 cases of TIUDs and management. Asymptomatic patients were managed conservatively, and symptomatic patients were operated. There are important implications resulting from this study that in asymptomatic patients leaving the IUD in place may be a reasonable option, mostly as the risk of surgical intervention is quite high with a high rate of complications with surgical management.