1/16. Vesicouterine fistulas following cesarean section: report on a case, review and update of the literature.Herein we report on 1 more case of vesicouterine fistula following cesarean section with review and update of the literature concerning this unusual topic. The disease presented with vaginal urinary leakage, cyclic hematuria and amenorrhea. The fistula was successfully repaired by delayed surgery. Actually, all over the world the prevalence of the disease is increasing for the frequent use of the cesarean section. Fistulas may develop immediately after a cesarean section, manifest in the late puerperium or occur after repeated procedures. Spontaneous healing is reported in 5% of cases. Vesicouterine fistulas present with vaginal urinary leakage, cyclic hematuira (menouria), amenorrhea, infertility, and first trimester abortions. The diagnosis is ruled out by showing the fistulous track between bladder and uterus as well as by excluding other more frequent urogenital fistulas. The disease treatment options include conservative treatment as well as surgical repair. Rarely, patients refuse any kind of treatment because of the benignity of symptoms and prognosis of the disease. Conservative management by bladder catheterization for at least 4-8 weeks is indicated when the fistula is discoveredjust after delivery since there is good chance for spontaneous closure of the fistulous track. Hormonal management should be tried in women presenting with Youssef's syndrome. Surgery is the maninstay and definitive treatment of vesicouterine fistulas after cesarean section. patients scheduled for surgery should undergo pretreatment of urinary tract infections. Surgical repair of vesico-uterine fistulas are performed by different approaches which include the vaginal, transvesical-retroperitoneal and transperitoneal access which is considered the most effective with the lowest relapse rate. Recently, laparoscopy has been proposed as a valid option for repairing vesicouterine fistulas. The endoscopic treatment may be effective in treating small vesicouterine fistulas. The pregnancy rate after repair is 31.25% with a rate of term deliveries of 25%. The disease may be prevented by emptying the bladder as well as by carefully dissecting the lower uterine segment. It is advisable that after vesicouterine fistula repair delivery should be performed by repeating a cesarean section since the risk of fistula recurrence. Usually, vesicouterine fistulas are diagnosed postoperatively. As a result, at least 95% of patients will undergo another operation for repairing the fistula. In the meantime they are bothered by related symptoms which impair their quality of life. As far as we are concerned intraoperative diagnosis is the gold standard in detecting vesicouterine fistulas for allowing immediate repair. We propose intraoperative sonography by the transvaginal (or transrectal) route for the Foley transurethral catheter producing bloody urine, for suspecting bladder injury while dissecting the uterine lower segment and for monitoring patients who already had had vesicouterine fistula repair. As a result patients will avoid the familial and social problems related to the disease as well another operation. Moreover, ultrasound Doppler examination may help in better investigating and understanding the pathophysiology of vesicouterine fistulas.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/16. Puerperal inversion of the uterus.Puerperal inversion of the uterus is very rare but dramatic and life-threatening. Prompt treatment is necessary. A case is reported and the literature reviewed.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
3/16. Heterotopic Caesarean scar pregnancy combined with intrauterine pregnancy successfully treated with embryo aspiration for selective embryo reduction: case report.Ectopic pregnancy situated in a Caesarean section scar is a rare but potentially life-threatening event. Because of its rarity, there are no universal treatment guidelines to manage this condition. We report a case of IVF-induced triplet heterotopic pregnancy of early gestational age that included one Caesarean scar pregnancy diagnosed as early as 6 weeks gestation. Treatment with embryo aspiration under vaginal ultrasonography for selective embryo reduction was given and the concurrent intrauterine twin pregnancy was preserved successfully.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
4/16. Tumor-like cystic endosalpingiosis of the uterus with florid epithelial proliferation. A case report.Mass-like cystic endosalpingiosis is very rare. The author reports such a lesion with histologic features of endosalpingiosis of the uterus with florid epithelial proliferation in a 51-year-old female who complained of lower abdominal pain. Preoperatively, it was considered to be left-sided ovarian cancer. Intraoperatively, a subserosal, sessile polypoid mass with multiple cysts in the uterine fundus measuring 12 x 6.5 x 5.5 cm was found. Histologically, it was composed of multiple cysts lined by benign-appearing tubal epithelium and bland smooth muscular and myofibromatous stroma. Part of the epithelium exhibited marked papillarity and tufting. Features of conventional endometriosis were present focally. Pathologists and clinicians should be aware of the existence of this type of non-neoplastic lesion, mass-like cystic endosalpingiosis, and should avoid overdiagnosis and overtreatment.- - - - - - - - - - ranking = 5keywords = life (Clic here for more details about this article) |
5/16. Uterine arteriovenous malformation.INTRODUCTION: Uterine arteriovenous malformations are very rare and potentially life-threatening. They can present with menorrhagia, postpartum bleeding, postmenopausal bleeding, an asymptomatic mass, or congestive heart failure. CASE REPORT: We present a 37-year-old woman with massive uterine bleeding that started abruptly 3 weeks after D and C and was found to be due to arteriovenous malformations.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/16. Placenta percreta causing rupture of an unscarred uterus at the end of the first trimester of pregnancy: case report.Reports on placenta percreta in early pregnancy leading to a spontaneous rupture of the uterus are rare. We report a case of this potentially life-threatening complication in the 14th week of pregnancy in an otherwise healthy woman who underwent a manual extraction of the placenta during a previous delivery but who had no history of severe pathology that could have potentially resulted in uterine damage. The occurrence of severe abdominal pain and the presence of a large quantity of free fluid in the abdomen necessitated an emergency laparotomy, revealing a haemoperitoneum due to rupture of the uterus, which was followed by a hysterectomy. This case demonstrates that in patients with a history of placenta accreta and subsequent manual extraction of the placenta, a close investigation of the uterine wall and placentation should be performed in the first trimester in order to anticipate a placenta percreta.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
7/16. Successful microwave endometrial ablation in a uterus enlarged by adenomyosis.adenomyosis can cause severe menorrhagia, which is a common indicator of the need for hysterectomy. None of the ablative techniques developed over the last two decades are of use in treating menorrhagia in a uterus enlarged by deep adenomyosis. Using a curved microwave applicator specifically developed for enlarged uterine cavities, microwave endometrial ablation at a frequency of 2.45 GHz was successfully applied in the treatment of menorrhagia in a patient with adenomyosis and an enlarged uterine cavity 12 cm in length. Two weeks after the operation, the patient experienced a menstrual period of ten days with no flooding. Menstrual duration gradually decreased to six days over the following six months. The quality of life score recovered to within the normal range six months after the operation. The post-operative sub-endometrial low signal intensity zone on the T2-weighted magnetic resonance images, which corresponds to the region of necrotic tissue, vanished 12 months after the operation. Although microwave endometrial ablation using the curved applicator could not treat bleeding from deep adenomyosis lesions, it improved menorrhagia in the uterus, which would conventionally require a hysterectomy.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
8/16. Beneficial outcome after prostaglandin-induced post-partum cardiac arrest using levosimendan and extracorporeal membrane oxygenation.BACKGROUND: Administration of high doses of prostaglandins is a frequently performed and effective method for the treatment of atonic uterine haemorrhage in order to increase uterine muscle tone. Rarely, however, these drugs may cause life-threatening complications including bronchospasm, acute pulmonary oedema and myocardial infarction caused by coronary spasms. methods: We discuss the management of a patient suffering post-partum atonic uterine bleeding, catecholamine-resistant cardiac arrest and fulminant pulmonary failure due to deleterious side-effects of treatment with prostaglandins. RESULTS: During therapy resistant cardiopulmonary resuscitation, the addition of levosimendan to standard medications resulted in a prompt stabilization of haemodynamics. Subsequent treatment of pulmonary failure was successfully managed with ECMO. CONCLUSION: Although levosimendan is not approved for pharmacological treatment of cardiopulmonary arrest, the beneficial effects in this patient suggest an important role of calcium sensitization and vasodilation during prostaglandin-induced cardiac arrest.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
9/16. Mitotically active leiomyoma of the uterus in a postmenopausal breast cancer patient receiving tamoxifen.OBJECTIVE: Mitotically active leiomyoma of the uterus complicated with postmenopausal vaginal bleeding has never been reported in taiwan. Here, we present a case of mitotically active leiomyoma of the uterus complicated with postmenopausal vaginal bleeding in a breast cancer patient who had been receiving tamoxifen for 2 years. CASE REPORT: A 56-year-old woman visited our clinic due to abnormal vaginal spotting for 3 months. This patient had been menopausal for about 6 years without hormone replacement therapy. She had been suffering from breast cancer, had undergone conservative breast surgery, and had been taking tamoxifen (20 mg/day) for 2 years. Pelvic ultrasound was performed and revealed an 8.9 x 7.7 cm uterine mass. After simple total hysterectomy, we found an enlarged uterus with a mass over the posterior wall. Final pathology demonstrated a mitotically active leiomyoma, adenomyosis of the uterus, and proliferation of the endometrium. CONCLUSION: Endometrial cancer is rarely noted in breast cancer patients taking tamoxifen. Further, none have reported mitotically active leiomyoma of the uterus. From this case, endometrial proliferation and mitotically active leiomyoma of the uterus may be related to tamoxifen therapy, and should not be neglected in breast cancer patients.- - - - - - - - - - ranking = 2keywords = life (Clic here for more details about this article) |
10/16. Avoidance of maternal morbidity in acute intrauterine infection following chorionic villus sampling.Serious maternal morbidity has been a feature of the few documented cases of acute intrauterine infection after chorionic villus sampling. A case is described in which infection manifested 14 days after transcervical chorion biopsy. Broad-spectrum antibiotics were begun, and ultrasound demonstrated a live fetus. After vacuum curettage was performed, repeat scan showed an empty uterus. Anaerobes isolated from the cervix both before chorionic villus sampling and during the infection were also implicated in published reports of patients developing life-threatening complications, but were not treated specifically until after morbid sequelae had occurred. Serious morbidity was avoided in this patient by aggressive management with early anaerobic cover, uterine evacuation despite the presence of a live fetus, and confirmation of complete evacuation by ultrasound.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
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