Case Reports in Obstetrics and Gynecology最新文献

{"title":"Recurrent Anti-NMDAR Encephalitis Necessitating Oophorectomy in an Adolescent Patient: A Case Report.","authors":"Shadowen Caroline, Agrawal Nidhi, Fugina Alexa, Messersmith Cole, Terasaki Laurne, Allen Hannah, Goldberg Aaron, Pflugner Lindsey","doi":"10.1155/2024/6150107","DOIUrl":"https://doi.org/10.1155/2024/6150107","url":null,"abstract":"<p><p><b>Background:</b> Anti-NMDA receptor (A-NMDAR) encephalitis is an autoimmune condition often associated with ovarian teratoma. Surgical removal of the teratoma is generally curative, and recurrence is uncommon. <b>Case:</b> A 14-year-old female presented with psychiatric symptoms and was ultimately diagnosed with A-NMDAR encephalitis during a prolonged hospitalization. She was found to have bilateral ovarian teratomas, underwent laparoscopic bilateral ovarian cystectomy, and returned to neurologic baseline within 2 months. One year later, the patient was re-presented with similar symptoms and was diagnosed with recurrent A-NMDAR encephalitis. Initial imaging was negative for ovarian teratomas. After another prolonged hospitalization, repeat imaging ultimately demonstrated a suspected left ovarian teratoma. A left salpingo-oophorectomy was performed, and the patient's condition again fully recovered. <b>Conclusion:</b> This case of A-NMDAR encephalitis presented with many atypical features including neuropsychiatric presenting symptoms, bilateral teratomas, and severe recurrence of disease. While imaging is the recommended modality for investigation of etiology, no teratoma was identified on the second presentation, leading to an ethical and clinical conundrum in this adolescent patient. More research is needed to investigate other diagnostic methods for A-NMDAR encephalitis without distinct teratoma on imaging in female patients.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2024 ","pages":"6150107"},"PeriodicalIF":0.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11496578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative Laparoscopic Approach for the Management of a 14-Week Viable Ectopic Cesarean Scar Ectopic Pregnancy.","authors":"Wael Elbanna, Osama Azmy","doi":"10.1155/2024/6682029","DOIUrl":"https://doi.org/10.1155/2024/6682029","url":null,"abstract":"<p><p><b>Introduction:</b> Cesarean scar ectopic pregnancy (CSEP) is a rare gynecological disorder that occurs at a rate of approximately 0.05% of pregnancies and less than 0.2% of cesarean scars. The ultimate goal in the management of CSEP cases is to remove pregnancy and reduce morbidity while preserving fertility. This case report highlights the successful application of a conservative laparoscopic approach in managing a 14-week viable CSEP. <b>Case Presentation:</b> A 35-year-old multiparous woman (G8P5A2L5) with five previous cesarean sections and five normal healthy children presented to the clinic with a viable CSEP of 14 weeks of gestation as revealed by abdominal and transvaginal ultrasound examination. The decision for a conservative laparoscopic approach was made in light of the patient's desire to preserve fertility. <b>Intervention and outcome:</b> The laparoscopic procedure included the following steps: extensive dissection of adhesions between the bladder and the uterus; identification of the ectopic pregnancy at the level of the lower segment; extraction of the product of conception in an endobag; and suturing of the lower segment defect. The successful execution of these steps resulted in the removal of the ectopic pregnancy while addressing associated structural concerns. This approach allowed for mitigating morbidity and, importantly, preserving the patient's fertility. <b>Conclusion:</b> This case highlights the importance of a conservative laparoscopic approach for CSEP in the second trimester. Imaging techniques play a pivotal role in accurate diagnosis, with minimally invasive technologies offering effective solutions. Individualized, patient-centered approaches are necessary to prioritize clinical outcomes and patient preferences.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2024 ","pages":"6682029"},"PeriodicalIF":0.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11469927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Metastatic Vulvar Choriocarcinoma Misdiagnosed as Vulvar Abscess: A Case Report.","authors":"Alita Mrema, Prudence H Kiwia, Shaban J Shaban, Anwar Z Mohamed, Latifa Rajab Abdallah, Rajabu Kiaratu, John Mahoyogo, Agapiti Chuwa, David H Mvunta","doi":"10.1155/2024/9918452","DOIUrl":"10.1155/2024/9918452","url":null,"abstract":"<p><p><b>Background:</b> Metastatic vulvar choriocarcinoma, a rare ectopic gestational trophoblastic neoplasia (GTN), often presents a diagnostic challenge due to its mimicry of other conditions, particularly in resource-limited settings. Its primary symptom is abnormal vaginal bleeding without a clear cause. Consequently, diagnosing and managing it poses difficulties for many low-resource health facilities, as evidenced by the current case. <b>Case Presentation:</b> We present the case of a 25-year-old, P2+2+2L2, who had a large painless, bleeding vulva mass for nearly 5 months. This followed a spontaneous abortion the month prior. The mass gradually increased in size and was accompanied by fever, pus discharge, and weight loss. Despite being treated at multiple health facilities for a vulvar abscess, there was no improvement. A diagnosis was finally made at a tertiary facility where elevated quantitative serum beta-human chorionic gonadotropin (hCG) (<i>β</i>-hCG) was noted. Due to uncontrollable vulva bleeding, she was referred to another tertiary facility for emergency radiotherapy. Following stabilization, chemotherapy was administered using the EMA-CO protocol. <b>Conclusion:</b> The report highlights the difficulty in diagnosing vulvar choriocarcinoma, underscoring the importance of a high index of suspicion. Clinical tests such as serum (<i>β</i>-hCG) and imaging studies are crucial for diagnosis. In resource-limited settings, a simple strip-based urine pregnancy test with serial dilutions can be sufficient for diagnosing and managing vulvar choriocarcinoma.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2024 ","pages":"9918452"},"PeriodicalIF":0.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11371442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Management of Spontaneous Unilateral Twin Ectopic Pregnancy With Two-Step Dose of Methotrexate.","authors":"Lauren A Forbes, Navya Nuthivana, Renee Morales","doi":"10.1155/2024/5543780","DOIUrl":"10.1155/2024/5543780","url":null,"abstract":"<p><p>The incidence of unilateral tubal twin pregnancy is 1/20,000-1/250,000 with about 100 reported cases. Four of the six cases that were medically managed were successful. A 24-year-old female presented to the emergency department (ED) with vaginal bleeding and abdominal cramping. She was hemodynamically stable without signs of an acute abdomen. Laboratory evaluation revealed she was pregnant with a serum beta-human chorionic gonadotropin (b-hCG) of 798 mIU/mL. Transvaginal ultrasound (TVUS) revealed a single left tubal pregnancy with a yolk sac. The patient elected medical management with body surface area (BSA)-based intramuscular (IM) methotrexate (MTX). On Day 4, the patient returned to the ED; her b-hCG was 727 mIU/mL. TVUS revealed twin left tubal pregnancies with yolk sacs and fetal poles without cardiac activity. The patient elected to continue medical management with a second dose of BSA-based IM MTX. On Day 6, the patient returned to the ED with abdominal and rectal pain. She was hemodynamically stable without signs of an acute abdomen. Her b-hCG was 533 mIU/mL. TVUS showed persistent twin left tubal pregnancies-one at 5 weeks gestational age and the other at 6 weeks gestational age-without evidence of rupture. The patient continued serial b-hCGs. Thirty-one days after the first dose of MTX, her b-hCG was < 1 mIU/mL. TVUS showed resolution of tubal pregnancies. The patient consented to the publication of this case report. This case documents the successful treatment of spontaneous, unilateral tubal twin pregnancies with two-step dosing of IM MTX.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2024 ","pages":"5543780"},"PeriodicalIF":0.6,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Treatment of Uterine Arteriovenous Malformation Using a 16 Fr Miniresectoscope in an Office Setting Without Anesthesia: A Case Report.","authors":"Giovanni Lipari, Alessandro Messina, Carolina Teston, Paolo Alessi, Alessia Mariani, Tiziana Bruno, Fernanda Florio, Sofia Vegro, Livio Leo, Bianca Masturzo","doi":"10.1155/2024/9216109","DOIUrl":"10.1155/2024/9216109","url":null,"abstract":"<p><p>Arteriovenous malformations (AVMs) are abnormal connections between arteries and veins that bypass the capillary system. Among AVMs, uterine ones are very rare, and it is not possible to have clear data on their incidence, as a good part of the patients remain clinically asymptomatic. Uterine AVMs consist of abnormal communications between branches of the uterine artery and the myometrial venous plexus. They can lead to significant bleeding, resulting in severe anemia and the need for transfusions. Both medical and surgical therapeutic approaches are described in the literature; as regards surgical treatments, the hysteroscopic excision of the endometrial mass represents a conservative and minimally invasive approach. However, there are no reported cases in the literature of AVMs treated using a hysteroscopic approach under local anesthesia and in an office setting. In this article, we propose the case of a young woman diagnosed with postpartum uterine AVM, treated using a 16 Fr miniresectoscope (GUBBINI system; Tontarra Medizintechnik®, Tuttlingen, Germany) in an office setting with a pain control protocol (pericervical infiltration and nitrous oxide via bucconasal mask). No complications occurred, and the woman was discharged immediately after the procedure. Finally, the patient was asked how tolerable and acceptable the procedure was compared to expectations; the woman defined the procedure as very bearable and well tolerated. The outpatient treatment, with an adequate pain control protocol, proved to be less invasive for the woman, did not require narcosis and hospital admission, but was equally therapeutic and effective compared to the treatment performed in the operating room.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2024 ","pages":"9216109"},"PeriodicalIF":0.6,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11303048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative ICG Application in Benign Gynaecological Surgery: Enhancing Safety and Precision.","authors":"Summer Deah Menezes, Tanushree Rao","doi":"10.1155/2024/1642315","DOIUrl":"10.1155/2024/1642315","url":null,"abstract":"<p><p>In the context of increased adoption of minimally invasive surgery for benign gynaecological conditions, this study underscores the paramount importance of patient safety. We explored the efficacy of indocyanine green (ICG), a fluorescent dye, in enhancing the visualisation of critical anatomical structures during complex laparoscopic procedures. Our methods involved the direct administration of ICG into the ureters for precise identification and dissection, as well as an innovative vaginal application to delineate the rectovaginal plane in cases with distorted pelvic anatomy. The study presented two cases: a laparoscopic hysterectomy for a multifibroid uterus and a case of advanced endometriosis with rectal involvement. Results indicated that ICG use significantly improved real-time visualisation of the ureters and the rectovaginal plane, which facilitated the surgeries and reduced the cognitive load on surgeons. There were no intraoperative complications, and the postoperative phase showed positive patient outcomes. In conclusion, the application of ICG in these laparoscopic surgeries proved to be a beneficial adjunct, suggesting its potential for broader application in benign gynaecological surgeries. Future research is warranted to explore additional uses of ICG, with a focus on enhancing patient safety and surgical efficacy.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2024 ","pages":"1642315"},"PeriodicalIF":0.6,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141892978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fifteen-Centimeter Giant Tamoxifen-Associated Endometrial Polyp Presenting With Constipation: A Case Report and Review of the Literature.","authors":"Sompon Apornvirat, Komsun Suwannarurk","doi":"10.1155/2024/9826447","DOIUrl":"10.1155/2024/9826447","url":null,"abstract":"<p><p>Endometrial polyps are benign disorganized growth of endometrial glands and stroma in the uterine cavity. They are associated with subfertility, abnormal uterine bleeding, and tamoxifen use. While most polyps are smaller than 2 cm in size, rare giant polyps can cause concerns over malignancy. We report a case of a 15 cm giant endometrial polyp in a 58-year-old woman with a history of tamoxifen use who presented with an uncommon complaint of constipation. Additionally, a literature review of giant endometrial polyp cases is presented. This case represents the largest reported endometrial polyp to date.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2024 ","pages":"9826447"},"PeriodicalIF":0.6,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11250697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydatid of Morgagni in Young Female: A Rare Case of Acute Abdomen-Case Report and Literature Review.","authors":"Taisia Bollettini, Francesco Molinaro, Alice Benigna, Enrico Ciardini, Gabriele Centini, Natale Calomino, Giulia Fusi, Messina Mario, Rossella Angotti","doi":"10.1155/2024/4559795","DOIUrl":"10.1155/2024/4559795","url":null,"abstract":"<p><p>Torsion of the hydatid of Morgagni is a rare condition which can cause acute abdominal pain in young female. We present a case report of a 13-year-old girl with acute abdominal pain and treated for torsion of the hydatid of Morgagni. Less than 20 cases of female younger than 18 years old with this condition are been described in the literature. Through our systematic review performed following the PRISMA statement, we want to emphasize the difficulty in diagnosis and the importance of considering this pathology in the differential diagnosis of acute abdomen in females with the aim of obtaining a timely surgical treatment to preserve fertility in these patients.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2024 ","pages":"4559795"},"PeriodicalIF":0.6,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11245333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141615933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Pregnancy after 4D-Hysterosalpingo-Sonography (HyCoSy) in the Same Menstrual Cycle: A Case Report and an Updating Review of the Current Literature regarding the Positive Impact of Tubal Flushing Effect on Fertility.","authors":"Francesco Bisogni, Francesco Galanti, Serena Riccio, Simona Ghanitab, Stefania Polletta, Valentina Annesi, Domenico Antonaci, Andrea Rago, Michele Carlo Schiavi, Vincenzo Spina, Rocco Rago","doi":"10.1155/2024/7774854","DOIUrl":"10.1155/2024/7774854","url":null,"abstract":"<p><p>Infertility is increasing worldwide, as well as in Italy, and fallopian tube pathology represents one of the most impacting causes of infertility for multiple women. Indeed, tubal patency assessment is a crucial step in medical evaluation for women attending an in vitro fertilization (IVF) center. Currently, different methods for tubal investigation are available, such as chromosalpingoscopy, hysterosalpingography (HSG), and hysterosalpingo-contrast sonography (HyCoSy). This diagnostic exam is performed by ultrasonography and an air-water-based contrast agent represented by air-water, or foam solution (HyFoSy). An additional side benefit of these assessment tests is a fertility-enhancing effect, thanks to a positive effect defined as \"tubal flushing,\" which in current literature is more strongly associated with HyFoSy with respect to HyCoSy. In this report, we present a case of a 34-year-old woman presented to our attention at the Reproductive and Physiopathology Unit of Sandro Pertini Hospital, Rome, in 2023, with unexplained infertility for 3.1 years of free sexual intercourse with a partner who did not report sperm abnormalities. Subsequently, in this exam, the woman spontaneously conceived in the same menstrual cycle that the 4D-HyCoSy was performed, without any additional fertility enhancement interventions. In this case report, we also include an updating review of the current literature regarding the insurgence of spontaneous pregnancy after this technique in order to explore the physiopathological and etiopathogenetic mechanisms underlying the achievement of spontaneous pregnancy and to confront our case with other recent works published. According to our clinical experience and the current literature, 4D-HyCoSy is the easiest, safest, and cheapest diagnostic exam for investigating tubal patency, which can lead to medical success in some cases of \"unexplained infertility\" as the achievement of a spontaneous pregnancy.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2024 ","pages":"7774854"},"PeriodicalIF":0.6,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New Onset of Symptomatic Peptic Ulcer Disease Postpartum Secondary to Nonsteroidal Anti-Inflammatory Drug Use.","authors":"Maggie Tallmadge, Margaret MacBeth, Anna Palatnik","doi":"10.1155/2024/6422824","DOIUrl":"10.1155/2024/6422824","url":null,"abstract":"<p><p>The use of nonsteroidal anti-inflammatory drug (NSAID) medications is a risk factor for peptic ulcer disease (PUD). PUD in the postpartum period is rare, despite the common use of NSAIDs. A G1P0 presented 6 days postcesarean section with fatigue, lightheadedness, melenic stools, and a hemoglobin of 5.4 g/dL after using NSAIDs and acetaminophen for postoperative pain control. An esophagogastroduodenoscopy (EGD) was performed for a suspected upper gastrointestinal bleed and found one gastric and one duodenal ulcer. Though typically used for a short course in the postpartum period, NSAIDs remain a predisposing risk factor for PUD postpartum, and patients and providers must be aware of this risk.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2024 ","pages":"6422824"},"PeriodicalIF":0.6,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11221993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141500147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}