Case Reports in Women's Health最新文献

{"title":"Multidisciplinary perioperative management in dilatation and evacuation for a giant hydatidiform mole: A case report","authors":"Yoshitomo Tanaka ,&nbsp;Kiichiro Furuya ,&nbsp;Masanori Sumi,&nbsp;Saya Yamashita,&nbsp;Yangsil Chang,&nbsp;Kayoko Shikado,&nbsp;Hiroaki Tsubouchi,&nbsp;Kazuhide Ogita","doi":"10.1016/j.crwh.2023.e00556","DOIUrl":"10.1016/j.crwh.2023.e00556","url":null,"abstract":"<div><p>Gestational trophoblastic disease (GTD) is an abnormal pregnancy caused by the placenta, which can potentially metastasise. Suction evacuation is recommended for diagnosis and treatment, and dilatation and evacuation (D&amp;E) is usually performed under intravenous anaesthesia due to the short operation time and minimal blood loss. We refer to the guidelines produced by the Japan Society of Obstetrics and Gynaecology (JSOG), and acknowledge that practices vary globally. However, to the best of our knowledge, there is no evidence on perioperative management and arrangements in D&amp;E required for managing giant hydatidiform moles, such as preventing massive haemorrhage, respiratory dysfunction with a pathogenesis like ovarian hyperstimulation syndrome (OHSS), or intensive care needs. This case report describes perioperative considerations for managing a giant hydatidiform mole using D&amp;E in a uterus enlarged to the third-trimester pregnancy size. A 28-year-old multiparous woman was clinically diagnosed with a hydatidiform mole after a spontaneous miscarriage due to abnormal genital bleeding, systemic oedema, and abdominal distention. Ultrasound and computed tomography showed a ballooning uterus with a third-trimester pregnancy size, a robust intrauterine mass, and ascites. Serum hCG levels were extremely high (&gt;3,000,000 mIU/mL), confirming the clinical diagnosis of a hydatidiform mole. Emergency D&amp;E was safely performed under multidisciplinary perioperative management, with careful preparation and support. This is a rare experience-based case report and valuable documentation detailing multidisciplinary perioperative management under general anaesthesia. To the best of our knowledge, this is the first report describing the considerations, details, and innovations required in the perioperative management of giant hydatidiform moles using D&amp;E.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10637891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89717010","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":"Recurrent severe anemia associated with a jejunal arteriovenous malformation in pregnancy: A case report","authors":"Kazuhiko Oka ,&nbsp;Akihiro Hasegawa ,&nbsp;Hayato Mikuni ,&nbsp;Ryosuke Miyazaki ,&nbsp;Tomotaka Kumamoto ,&nbsp;Yasuhiro Takeda ,&nbsp;Natsuko Ukai ,&nbsp;Takako Kiyokawa ,&nbsp;Osamu Samura ,&nbsp;Aikou Okamoto","doi":"10.1016/j.crwh.2023.e00559","DOIUrl":"https://doi.org/10.1016/j.crwh.2023.e00559","url":null,"abstract":"<div><h3>Background</h3><p>Small intestinal arteriovenous (AV) malformations may cause gastrointestinal hemorrhage, occasionally leading to anemia; however, they are rarely seen in pregnancy. This report presents a case of a pregnant woman who had recurrent severe anemia that was attributed to a small hemorrhagic intestinal arteriovenous malformation.</p></div><div><h3>Case Presentation</h3><p>A 24-year-old pregnant woman (gravida 2, para 1) presented with a low hemoglobin concentration (3.6 g/dL) in her first pregnancy and underwent an emergency cesarean section at 36 weeks due to non-reassuring fetal status. In her second pregnancy, she was hospitalized at 30 weeks with epigastric pain and nausea. A low hemoglobin level (6.6 g/dL) and scant fecal occult blood were revealed upon examination. She was referred to the hospital for further evaluation and pregnancy management. Recurrent blood transfusions were required; however, neither hematemesis nor obvious fecal hemorrhage was observed. At 31 weeks, a cesarean section was performed owing to persistent anemia. Postoperative small intestinal capsule endoscopy and flexible fiberoptic proximal small intestinal endoscopy revealed a suspected bleeding small intestinal arteriovenous malformation. The patient underwent partial resection of the small intestine on hospitalization day 16. Histopathological examination confirmed a small intestinal arteriovenous malformation. The patient had a good postoperative course and was discharged on hospitalization day 24.</p></div><div><h3>Conclusions</h3><p>Small intestinal arteriovenous malformations can bleed during pregnancy. They can go undetected if they spontaneously shrink postpartum. In severe anemia during pregnancy, hemorrhage from small intestinal arteriovenous malformations should be included in the differential diagnosis and promptly investigated even in the absence of gastrointestinal symptoms.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67738633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravascular leiomyomatosis with cardiac and pelvic involvement in a postmenopausal woman: A case report of multidisciplinary team management","authors":"Atanas Aleksandrov ,&nbsp;Aleksandar Lyubenov ,&nbsp;Polina Damyanova","doi":"10.1016/j.crwh.2023.e00557","DOIUrl":"https://doi.org/10.1016/j.crwh.2023.e00557","url":null,"abstract":"<div><p>Intravascular leiomyomatosis (IVL) is a rare benign condition in which a leiomyoma, originating from the uterus, propagates through the pelvic venous system and occasionally extends into the inferior vena cava (IVC), occasionally reaching the heart. Despite its low incidence and benign nature, IVL can lead to life-threatening obstructions in the right heart's outflow tract, potentially resulting in sudden death. In this article, we present a case of a 72-year-old postmenopausal patient with IVL, who initially presented with palpitations. The diagnosis was made through echocardiography and a computerized tomography (CT) scan, revealing a tumor that extended from the uterus through the IVC and into the right ventricle. The patient was managed by a multidisciplinary team of gynecologists and cardiothoracic surgeons, who performed a single-stage surgical removal of a tumor 25 cm long. The pathological report confirmed the diagnosis of IVL. Postoperative follow-up is crucial, as IVL recurs in up to 30% of cases. This article's objective is to provide a clinical illustration of this exceedingly rare condition, with fewer than 300 reported cases, and to offer a comprehensive overview of IVL, including its clinical presentation, diagnosis, treatment, and outcomes.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67735629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A levator ani midurethral support via single vaginal incision technique to treat stress urinary incontinence: A case report","authors":"Lai-Yet Lam ,&nbsp;Janice A. Santos-Cortes ,&nbsp;Timothy K. O'Rourke Jr","doi":"10.1016/j.crwh.2023.e00530","DOIUrl":"10.1016/j.crwh.2023.e00530","url":null,"abstract":"<div><p>Stress urinary incontinence affects more than one-fourth of adult women. The recommended surgical treatment involves the use of a synthetic mesh sling. Upon unsuccessful treatment using a mesh sling or when patients decline mesh, surgical treatments, including an autologous fascia sling, colposuspension, or bulking injections, are used. After unsuccessful treatment using three mesh slings, an autologous fascia sling, and a midurethral bulking agent, a patient was successfully treated with our modified Kelly plication technique.</p><p>A 51-year-old woman with recurrent stress urinary incontinence had had three previous mesh midurethral sling exposures with complete mesh removals followed by one autologous fascia sling with severe infection. We initially treated her with a set of urethral bulking injections, which was also unsuccessful. She was successfully treated with our modified Kelly plication technique, which plicates levator ani muscles to support the midurethral instead of plicating the vesicovaginal fascia at the bladder neck. The patient remained continent four years after the performance of this technique and had reported no pelvic pain or dyspareunia. The technique is detailed in this paper. This single vaginal incision native tissue technique may be considered when mesh slings or alternative native tissue procedures are not feasible for patients, as in this case.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/80/4a/main.PMC10407623.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10326399","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":"Uterine rupture in a term pregnancy after a previous uterine artery embolization to manage a large fibroid. A case report","authors":"Heba Abu Saleem ,&nbsp;Nouf Albalwi ,&nbsp;Lina Ba'Abbad","doi":"10.1016/j.crwh.2023.e00551","DOIUrl":"10.1016/j.crwh.2023.e00551","url":null,"abstract":"<div><p>Uterine artery embolization (UAE) is an effective minimally invasive alternative to surgery for the treatment of symptomatic uterine fibroids. Uterine rupture is an obstetrical emergency that requires early diagnosis and prompt management to improve perinatal and maternal outcomes.</p><p>A 33-year-old woman at 37 weeks of gestation who had had previous two uncomplicated vaginal deliveries at term presented with abdominal pain and rupture of membranes. The patient had undergone UAE for the management of a large anterior wall uterine fibroid three years prior to conception. Vaginal examination revealed cord prolapse and ultrasound showed negative fetal heart. Intrauterine fetal demise with cord prolapse was diagnosed. After admission the patient developed vaginal bleeding and features of hypovolemic shock. Urgent laparotomy revealed a ruptured uterus with a large hemoperitoneum and dead fetus in the abdominal cavity.</p><p>Obstetricians should be attentive to the possibility of a spontaneous uterine rupture in pregnant women who have previously undergone UAE for the management of a uterine fibroid.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10565681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41192252","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":"Hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome in a young patient presenting with a large uterus: A case report and review of the literature","authors":"Nora Shero ,&nbsp;Esther Yoon ,&nbsp;Joel Cardenas Goicoechea","doi":"10.1016/j.crwh.2023.e00548","DOIUrl":"10.1016/j.crwh.2023.e00548","url":null,"abstract":"<div><p>Hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome is a rare genetic disorder caused by a germline mutation in the fumarate hydratase (FH) gene. It is clinically characterized by cutaneous leiomyomas, uterine leiomyomas and renal cell cancer. A 31-year-old woman presented with severe abdominopelvic pain associated with severe menorrhagia which required a visit to the emergency department. Computed tomography (CT) showed a severe enlargement of the uterus with newly diagnosed fibroids. Magnetic resonance imaging (MRI) confirmed the finding of an enlarged uterus with mild left and moderate right hydronephrosis and hydroureter. The patient tried to manage the pain with oral over-the-counter medications and heat pads without significant relief. She was recommended to proceed with total abdominal hysterectomy and bilateral salpingectomy. She tolerated the procedure well and had an uneventful postoperative recovery. Pathology showed morphologic features, including the staghorn vessels, alveolar edema, eosinophilic cytoplasmic inclusions and prominent nucleoli which are characteristics for FH-deficient leiomyomas. Genetic testing was positive for a pathogenic variant in the FH gene associated with HLRCC. This case highlights the importance of proceeding with genetic testing in patients with personal and family history of leiomyomas and unusual pathology findings. Early identification of the syndrome can lead to appropriate screening for renal cell carcinoma.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/09/main.PMC10522864.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41107979","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":"Isolated tubal metastasis from an incidental HPV-associated endocervical adenocarcinoma presented as an adnexal mass: A case report","authors":"Hessa Aljhdali ,&nbsp;Janos Balega ,&nbsp;Anthony Williams ,&nbsp;Raji Ganesan","doi":"10.1016/j.crwh.2023.e00532","DOIUrl":"10.1016/j.crwh.2023.e00532","url":null,"abstract":"<div><p>Tubal metastasis from endocervical adenocarcinoma is uncommon and is discovered as an incidental finding on routine sampling of fallopian tubes. In this paper, we present the case of an 81-year-old woman who presented with an adnexal mass during investigations of postmenopausal bleeding. Hysterectomy and bilateral salpingo-oophorectomy with excision of the left adnexal mass were performed, which led to the diagnosis of an incidental HPV-associated endocervical adenocarcinoma with secondary, macroscopic tubal involvement. The patient received adjuvant pelvic radiotherapy and remained well after three months of follow-up, with no evidence of recurrence. Only a few cases of endocervical adenocarcinoma with tubal metastasis have been reported in the literature, which are commonly associated with ovarian, uterine corpus, and/or parametrial tissue involvement. To date, there are only two reported cases of isolated tubal metastasis, and in both cases, tubal involvement was discovered microscopically. Data on the impact of secondary tubal involvement on patient outcomes are limited.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/b7/main.PMC10425887.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10021007","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":"Delayed diagnosis of a non-communicating right uterine horn: A case report and literature review","authors":"Lindsay A. Hartup ,&nbsp;Katherine E. Kostroun ,&nbsp;Belinda J. Yauger","doi":"10.1016/j.crwh.2023.e00535","DOIUrl":"10.1016/j.crwh.2023.e00535","url":null,"abstract":"<div><h3>Background</h3><p>Accurate diagnosis of a müllerian anomaly is essential for appropriate management and prevention of complications. However, diagnosis is often missed or delayed.</p></div><div><h3>Case</h3><p>This is a case of a nulliparous woman with a müllerian anomaly diagnosed at the age of 36 despite prior evaluation with ultrasound and laparoscopy. Magnetic resonance imaging (MRI) suggested a unicornuate uterus with a right non-communicating rudimentary horn. Hysteroscopy and chromopertubation confirmed the diagnosis. The rudimentary horn was resected laparoscopically using bipolar energy.</p></div><div><h3>Conclusion</h3><p>An undiagnosed müllerian anomaly should be considered in the setting of persistent dysmenorrhea. Three-dimensional ultrasound or MRI should be used judiciously in patients with refractory dysmenorrhea or when ultrasound raises concern for a müllerian anomaly.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0b/ec/main.PMC10457418.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10482851","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 one-step conservative surgical approach to undiagnosed focal accreta: A case report","authors":"Kumaressan Ragunathan,&nbsp;Amin Bahabri,&nbsp;Heidi Hughes-D'Aeth,&nbsp;Arisudhan Anantharachagan","doi":"10.1016/j.crwh.2023.e00540","DOIUrl":"10.1016/j.crwh.2023.e00540","url":null,"abstract":"<div><p>Placenta accreta spectrum (PAS) refers to abnormal trophoblast invasion into the myometrium. The global prevalence of PAS is rising as the number of caesarean deliveries increases. PAS is associated with higher rates of maternal morbidity and mortality. Although mainstream management has been caesarean hysterectomy, uterine conservative techniques are also used, such as the extirpative technique, leaving the placenta in situ, the triple-P procedure, embolisation, uterine balloon tamponade and methotrexate medication.</p><p>This case report describes an innovative yet simple and safe technique, namely partial myometrial resection of the focal adherent placenta. Unlike hysterectomy, this technique can preserve fertility. It was performed on an undiagnosed focal placental accreta during a caesarean section with a routine caesarean section theatre set-up and did not require obstetric follow-up after the patient was discharged.</p><p>This procedure can be considered an option for managing focal placenta accreta.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/76/26/main.PMC10504492.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10307532","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":"Tubo-ovarian abscess after vaginal delivery: A case report and review of current literature","authors":"Ruairí Floyd,&nbsp;Breffini Anglim","doi":"10.1016/j.crwh.2023.e00526","DOIUrl":"10.1016/j.crwh.2023.e00526","url":null,"abstract":"<div><p>Tubo-ovarian abscesses in pregnancy and the post-partum period are extremely rare. We report a case of a 31-year-old woman who presented with an acute abdomen and sepsis in the post-partum period with a background of a large endometrioma diagnosed prior to conception. Exploratory laparoscopy revealed a ruptured tubo-ovarian abscess which was surgically drained and then treated with intravenous antibiotics. This report is seemingly unique in presenting the development of antenatal endometrioma into a tubo-ovarian abscess and an unusual differential for abdominal pain to consider in the immediate postpartum period.</p></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10344697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10202797","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}