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| Name | IR Guided Access to Uterine Cavity in a Case of Severe Cervical Stenosis |
| Video Uploader | Video From CanSAGE Secretariat |
| Upload Date | This Video Uploaded At 07-02-2024 19:14:12 |
| Video Discription | Presented By Dr. Caroline Lee Dr. Lindsay Machan Dr. Neeraj Mehra Affiliations University of British Columbia See full transcript here: www.cansagevideos.com/ir-guided-access-to-uterine-cavity-in-a-case-of-severe-cervical-stenosis/ The purpose of this video is to demonstrate an IR-guided approach to accessing the uterine cavity in a case of severe cervical stenosis. The authors have no relevant conflicts of interest to disclose. Here we present a case of a 42-year-old woman with a history of adenocarcinoma in situ and a complete LEEP excision. Ongoing follow-up was required to monitor her endocervical status, but this could not be completed due to severe cervical stenosis of both the internal and external cervical os. At initial counselling she expressed a strong desire to preserve her fertility and thus declined a hysterectomy. Multiple attempted hysteroscopies had been performed with the goal of locating her cervical canal and gaining access to her uterine cavity. Thus we planned for an interventional radiology-guided cervical cannulation and hysteroscopy guided release of cervical stenosis. Leading up to the procedure, she declined menstrual suppression, despite ongoing cyclical pelvic pain. On the day of her procedure, she underwent a preoperative endovaginal ultrasound. The ultrasound revealed moderate distension of the cervical canal and mild to moderate distension of the endometrial cavity. These findings had not been seen on previous ultrasounds. This video demonstrates a dynamic transverse view of the uterine cavity and the cervical canal on ultrasound. Under Fleroscopic guidance, we gained access to their uterine cavity. Distension of the uterus and cervix was seen. A loop catheter was positioned in the cervical canal and 400 millilitres of fluid was collected. The patient was then brought from the interventional radiology suite to the operating suite. The 8.5 French pigtailed catheter was removed, leaving the guide wire in place. We used a vaginoscopy approach to follow the guide wire up to the endocervical canal. Hysteroscopic scissors were then used to lyse the cervical stroma and gain access to the endocervical canal. The hysteroscope was then removed and os finders were used to enter the cervix. We confirmed that we had entered the uterine cavity after we identified the release of menstrual fluid. The cervix was serially dilated, first with larger os finders and subsequently with Pratt dilators. The hysteroscope was reinserted and the uterine cavity could now be evaluated. We noted that the guide wire had entered the uterine cavity just anterior to the true internal cervical os. Once we were in the uterine cavity, we were able to identify the left cornea and right cornea. A panoramic view of the uterine cavity revealed a thin endometrial lining. This final view illustrates the uterus and the dilated cervical canal just below it. Subsequently, an endocervical curettage was performed. A 24 French Foley catheter was used as a uterine and cervical stent. This was then secured in place. She was discharged on the same day with a seven-day prescription for doxycycline and metronidazole. The uterine and cervical stent was removed on postoperative day number seven. The final pathology revealed fibrovascular tissue with scanty fragments of endometrial and endocervical tissue. In conclusion, IR-guided cervical and uterine cannulation was successful in this patient with complete external cervical os stenosis. Access into the uterus and cervix was assisted by the fact that the patient was not on mental suppression and the subsequent development of hematometras and hematocolpos. This technique is a useful alternative method to consider in cases of failed hysteroscopic attempts due to cervical stenosis. |
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