1) A 31-year-old woman comes to the physician for follow-up after an abnormal Pap test and cervical biopsy. The patients Pap test showed a high-grade squamous intraepithelial lesion (HGSIL). This was followed by colposcopy and biopsy of the cervix. The biopsy specimen also demonstrated HGSIL. The patient was counseled to undergo a loop electrosurgical excision procedure (LEEP). Which of the following represents the potential long-term complications from this procedure? A. Abscess and chronic pelvic inflammatory disease B. Cervical incompetence and cervical stenosis C. Constipation and fecal incontinence D. Hernia and intraperitoneal adhesions E. Urinary incontinence and urinary retention Explanation: The correct answer is B. The loop electrosurgical excision procedure (LEEP) is relatively simple and can be performed in the outpatient setting with local anesthesia. The procedure involves using a wire loop to excise lesions of the transformation zone. A benefit of LEEP, along with its ease of performance, is that it provides tissue that can be examined histologically. The most appropriate candidates for LEEP are women with high-grade squamous intraepithelial lesions (HGSIL). The immediate risks of LEEP are bleeding and infection. The possible long-term risks include cervical incompetence and cervical stenosis. These may seem like exact opposites, but LEEP can lead to both of them because, to a certain extent, it injures the cervix. If the bodys response to this injury is with too much scarring, then cervical stenosis can result. If too much of the cervix is injured, the cervix may be too weakened to carry a pregnancy to term, and cervical incompetence may result. Abscess and chronic pelvic inflammatory disease (choice A) are not known to be long-term complications of the procedure. Constipation and fecal incontinence (choice C) should not be caused by LEEP. LEEP involves the distal portion of the cervix and should not involve the intestines or rectum at all. Hernia and intraperitoneal adhesions (choice D) should not result from LEEP. The procedure does not involve entry into the peritoneal cavity; therefore, there should be no risk of hernia or intraperitoneal adhesions. Urinary incontinence and urinary retention (choice E) are not known to be long-term complications from LEEP, as the procedure does not involve the bladder.
Posted on: Tue, 12 Nov 2013 21:48:59 +0000
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