Nicolas Galazis

To determine the oncological outcomes following fertility-sparing surgery (FSS) for the management of Borderline Ovarian Tumours (BOTs). A retrospective analysis of participants diagnosed with BOTs between January 2004 and December 2020 at the West London Gynaecological Oncology Centre was conducted. A total of 172 women were diagnosed; 52.3% (90/172) underwent FSS and 47.7% (82/172) non-FSS. The overall recurrence rate of disease was 16.9% (29/172), of which 79.3% (23/29) presented as the recurrence of serous or sero-mucinous BOTs and 20.7% (6/29) as low-grade serous carcinoma (LGSC). In the FSS group, the recurrence rate of BOTs was 25.6% (23/90) presenting a median 44.0 (interquartile range (IQR) 41.5) months, of which there were no episodes of recurrence presenting as LGSC reported. In the non-FSS group, all recurrences of disease presented as LGSC, with a rate of 7.7% (6/78), following a median of 47.5 months (IQR 47.8). A significant difference between the type of surgery performed (FSS v Non-FSS) and the association with recurrence of BOT was observed (Pearson Chi-Square: p = 0.000; x = 20.613). Twelve women underwent ultrasound-guided ovarian wedge resection (UGOWR) as a novel method of FSS. Recurrence of BOT was not significantly associated with the type of FSS performed (Pearson Chi- Square: x = 3.166, p = 0.379). Non-FSS is associated with negative oncological outcomes compared to FSS, as evidenced by the higher rate of recurrence of LGSC. This may be attributed to the indefinite long-term follow up with ultrasound surveillance all FSS women undergo, enabling earlier detection and treatment of recurrences.

Bowel obstruction accounts for 20% of hospital admissions due to acute abdominal pain. We report a case of acute bowel obstruction in a 31-year-old woman with a history of endometriosis diagnosed on laparoscopy a year before this presentation. Her clinical and biochemical picture suggested peritonitis and CT revealed an irregular soft tissue mass compressing a dilated rectosigmoid. Pockets of intraperitoneal gas were also documented and presumed to be secondary to bowel perforation at the level of the mass. Exploratory laparotomy was performed and the affected bowel was resected. Histology revealed extensive stricturing and fibrosis secondary to intestinal endometriosis. General practitioners, gastroenterologists and general surgeons are likely to encounter endometriosis, need to be competent in its diagnosis and management and collaborate promptly with the gynaecologist. Endometriosis should be considered in the differential diagnosis of every woman of childbearing age who presents with any gastrointestinal or abdominal symptom.