Stabile Guglielmo, Ripepi Chiara, Ricci Giuseppe, Nappi Luigi, Oletto Giulia, Ludovisi Manuela, Scambia Giovanni, Bruno Matteo
Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.
Department of Medicine, Surgery and Health Sciences, University of Trieste, UOC Clinica Ostetrica e Ginecologica, Trieste, Italy.
Facts Views Vis Obgyn. 2025 Mar 28;17(1):39-49. doi: 10.52054/FVVO.2024.12791.
Dilation and curettage and vacuum aspiration are frequently performed gynaecological procedures used to treat uterine pathology. This procedure carries a risk of uterine perforation, which can lead to injury of abdominal organs and, rarely, to fallopian tubes.
To evaluate symptoms and diagnostic signs and to propose the most appropriate management for the intussusception and incarceration of fallopian tubes following uterine aspiration and curettage.
We screened three major databases (Medline, Scopus, Google Scholar) from 2000 to May 2024. Our review examined tubal incarceration, causes, management, symptoms, parity, diagnosis timelines, visceral injury, and surgical complications. The methodological quality of the included studies was assessed using the JBI Critical Appraisal Checklist for case reports.
Diagnostic methods, complications and management of tubal incarceration following uterine perforation.
We identified 24 papers, all of which were case reports or case series. In our analysis, tubal incarceration was observed in 25 of 26 cases (96.2%) and in 2 of which (7.7%) it was associated with the entrapment of the infundibulopelvic ligament. In 1 of 26 cases (3.8%) intussusception of the fallopian tube was observed. The most frequently manifested symptoms were abdominopelvic pain, vaginal bleeding, vaginal discharge and amenorrhoea. The mean time to diagnosis was 15.4 months, with transvaginal ultrasound being the primary diagnostic tool, followed by hysteroscopy and diagnostic laparoscopy.
Diagnosing this condition should involve a detailed medical history, a comprehensive clinical examination, and imaging evaluations. If instrumental investigations are negative but suspicion remains, hysteroscopy and/or laparoscopy may be necessary.
WHAT IS NEW?: Tubal incarceration complicating uterine perforation can be managed using hysteroscopy and laparoscopy.
刮宫术和负压吸宫术是常用于治疗子宫病变的妇科手术。该手术存在子宫穿孔风险，可导致腹部器官损伤，输卵管损伤则较为罕见。
评估子宫吸宫和刮宫术后输卵管套叠和嵌顿的症状及诊断体征，并提出最合适的处理方法。
我们检索了2000年至2024年5月的三个主要数据库（Medline、Scopus、谷歌学术）。我们的综述研究了输卵管嵌顿、病因、处理、症状、产次、诊断时间线、内脏损伤和手术并发症。使用JBI病例报告关键评价清单评估纳入研究的方法学质量。
子宫穿孔后输卵管嵌顿的诊断方法、并发症及处理。
我们共识别出24篇论文，均为病例报告或病例系列。在我们的分析中，26例中有25例（96.2%）观察到输卵管嵌顿，其中2例（7.7%）与漏斗骨盆韧带受压有关。26例中有1例（3.8%）观察到输卵管套叠。最常见的症状是下腹盆腔疼痛、阴道出血、阴道分泌物增多和闭经。诊断的平均时间为15.4个月，经阴道超声是主要诊断工具，其次是宫腔镜检查和诊断性腹腔镜检查。
诊断这种情况应包括详细的病史、全面的临床检查和影像学评估。如果器械检查结果为阴性但仍有怀疑，可能需要进行宫腔镜检查和/或腹腔镜检查。
子宫穿孔并发的输卵管嵌顿可通过宫腔镜检查和腹腔镜检查进行处理。
