Pub Date : 2025-02-20DOI: 10.1016/j.crwh.2025.e00696
Roland Csorba , Paul Buderath , Marc Ingenwerth , Sa'ed Almasarweh , Zeynep Atas Elfrink
Despite the rarity of abdominal or chest wall metastases in ovarian cancer patients, reports have described instances of isolated late recurrence at surgical incision sites. We report the case of an 85-year-old woman who present with a massive metastatic tumor on the right anterior abdominal wall 42 years after undergoing a total abdominal hysterectomy and bilateral salpingo-oophorectomy for primary ovarian cancer. The abdominal wall tumor was resected en bloc, and abdominal wall reconstruction was performed using a mesh. Histology revealed a low-grade serous carcinoma.
This report highlights the possibility of abdominal wall metastases after prolonged survival following the treatment of ovarian cancer. Surgical excision combined with mesh reconstruction represents an adequate treatment approach for such cases. Caution should be exercised during laparotomy to ensure complete removal of malignant tissue and to prevent parietal dissemination. Long-term follow-up is crucial for ovarian cancer patients, as late recurrences, although rare, can occur even decades after initial treatment.
{"title":"Isolated abdominal wall metastasis 42 years after curative surgery for ovarian cancer: A case report","authors":"Roland Csorba , Paul Buderath , Marc Ingenwerth , Sa'ed Almasarweh , Zeynep Atas Elfrink","doi":"10.1016/j.crwh.2025.e00696","DOIUrl":"10.1016/j.crwh.2025.e00696","url":null,"abstract":"<div><div>Despite the rarity of abdominal or chest wall metastases in ovarian cancer patients, reports have described instances of isolated late recurrence at surgical incision sites. We report the case of an 85-year-old woman who present with a massive metastatic tumor on the right anterior abdominal wall 42 years after undergoing a total abdominal hysterectomy and bilateral salpingo-oophorectomy for primary ovarian cancer. The abdominal wall tumor was resected en bloc, and abdominal wall reconstruction was performed using a mesh. Histology revealed a low-grade serous carcinoma.</div><div>This report highlights the possibility of abdominal wall metastases after prolonged survival following the treatment of ovarian cancer. Surgical excision combined with mesh reconstruction represents an adequate treatment approach for such cases. Caution should be exercised during laparotomy to ensure complete removal of malignant tissue and to prevent parietal dissemination. Long-term follow-up is crucial for ovarian cancer patients, as late recurrences, although rare, can occur even decades after initial treatment.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00696"},"PeriodicalIF":0.7,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479041","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}
Pub Date : 2025-02-11DOI: 10.1016/j.crwh.2025.e00694
Caroline L.P. Muntinga , Sophieke C.H.A. van der Steen , Edith M.G. van Esch , Sander Kelderman
Imiquimod is an immunomodulating cream used in the treatment of cervical high-grade squamous intraepithelial lesions (cHSIL). Side-effects are common and mostly well tolerated, but can be severe. A woman using imiquimod for recurrent cHSIL presented with signs of a distributive shock nearly three weeks after the start of imiquimod treatment, for which she was admitted to a medium care unit. No infectious source was identified. The woman recovered well with conservative treatment. This case demonstrates the importance of monitoring patients for side-effects during imiquimod treatment. Side-effects, including the possibility of severe side-effects, should be discussed during patient counselling on therapy options for cHSIL treatment.
{"title":"Transient bacteraemia secondary to imiquimod use as a treatment for cervical high-grade squamous intraepithelial lesions – A case report","authors":"Caroline L.P. Muntinga , Sophieke C.H.A. van der Steen , Edith M.G. van Esch , Sander Kelderman","doi":"10.1016/j.crwh.2025.e00694","DOIUrl":"10.1016/j.crwh.2025.e00694","url":null,"abstract":"<div><div>Imiquimod is an immunomodulating cream used in the treatment of cervical high-grade squamous intraepithelial lesions (cHSIL). Side-effects are common and mostly well tolerated, but can be severe. A woman using imiquimod for recurrent cHSIL presented with signs of a distributive shock nearly three weeks after the start of imiquimod treatment, for which she was admitted to a medium care unit. No infectious source was identified. The woman recovered well with conservative treatment. This case demonstrates the importance of monitoring patients for side-effects during imiquimod treatment. Side-effects, including the possibility of severe side-effects, should be discussed during patient counselling on therapy options for cHSIL treatment.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00694"},"PeriodicalIF":0.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143402526","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}
Pub Date : 2025-02-04DOI: 10.1016/j.crwh.2025.e00693
Rayan R. Salahaldin, Mais E. Abubaker, Ghada M. Abdalqader, Anas R. Tuqan, Basel A. Zaben, Iba Barghouthi
Choriocarcinoma is a rare, aggressive gestational trophoblastic disorder with metastatic potential, often presenting with abnormal bleeding and increasing levels of beta-human chorionic gonadotropin (b-hCG). Diagnosis is confirmed through histopathologic examination after curettage, and treatment typically involves stage-dependent chemotherapy. This case report concerns a 25-year-old woman with heavy postpartum bleeding, later diagnosed with choriocarcinoma. Despite initial single-agent chemotherapy, disease progression led to uterine perforation and hemoperitoneum, requiring emergency surgery. Following recovery, multi-agent chemotherapy resolved her symptoms. Choriocarcinoma's rarity and varied presentation make diagnosis challenging, with lung metastases common. Levels of b-hCG indicate treatment response, and prompt management combining chemotherapy, monitoring, and surgery is crucial for positive outcomes.
{"title":"Postpartum choriocarcinoma complicated by uterine perforation: A case report and literature review","authors":"Rayan R. Salahaldin, Mais E. Abubaker, Ghada M. Abdalqader, Anas R. Tuqan, Basel A. Zaben, Iba Barghouthi","doi":"10.1016/j.crwh.2025.e00693","DOIUrl":"10.1016/j.crwh.2025.e00693","url":null,"abstract":"<div><div>Choriocarcinoma is a rare, aggressive gestational trophoblastic disorder with metastatic potential, often presenting with abnormal bleeding and increasing levels of beta-human chorionic gonadotropin (b-hCG). Diagnosis is confirmed through histopathologic examination after curettage, and treatment typically involves stage-dependent chemotherapy. This case report concerns a 25-year-old woman with heavy postpartum bleeding, later diagnosed with choriocarcinoma. Despite initial single-agent chemotherapy, disease progression led to uterine perforation and hemoperitoneum, requiring emergency surgery. Following recovery, multi-agent chemotherapy resolved her symptoms. Choriocarcinoma's rarity and varied presentation make diagnosis challenging, with lung metastases common. Levels of b-hCG indicate treatment response, and prompt management combining chemotherapy, monitoring, and surgery is crucial for positive outcomes.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00693"},"PeriodicalIF":0.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143300885","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}
Pub Date : 2025-02-04DOI: 10.1016/j.crwh.2025.e00692
Lea C. George , Rebecca Gendelman , Anat Chemerinski , Pierre Lespinasse , Inessa A. Goldman , Sara Morelli
The evaluation of primary amenorrhea requires a thoughtful assessment for hormonal, structural and/or genetic causes. Although most cases of primary amenorrhea are caused by a single pathology, rarely multiple pathologies may be uncovered. We present the case of a 33-year-old woman with a history of pubertal failure and primary amenorrhea due to Kallmann syndrome. She reported previous short-term use of hormone replacement therapy, with onset of severe pelvic pain and vaginal bleeding following its discontinuation. Her workup revealed concern for uterine didelphys with OHVIRA syndrome on MRI. Surgical exploration revealed a normal-appearing vagina and cervix communicating with the left uterine horn and fallopian tube, a separate, contralateral, obstructed, and engorged right uterine horn with cervix and obstructed vagina, and normal ovaries bilaterally. She underwent laparoscopic resection of the obstructed right hemiuterus with right salpingectomy. Estrogen replacement therapy was initiated postoperatively with cyclic progestins, and she experienced complete resolution of her pain. In the workup of primary amenorrhea, it is important to consider that more than one pathology may be present. A thorough endocrine, genetic, and anatomic evaluation is imperative prior to confirming the diagnosis and initiating treatment. Kallmann syndrome has rarely been reported with Mullerian anomalies; in this case it represents a scenario in which the induction of puberty and menses brought an obstructive anomaly to light. The possibility of co-occurring pathologies should always be considered to provide optimal care to the patient.
{"title":"Co-occurrence of a Mullerian anomaly and Kallmann syndrome: A case report","authors":"Lea C. George , Rebecca Gendelman , Anat Chemerinski , Pierre Lespinasse , Inessa A. Goldman , Sara Morelli","doi":"10.1016/j.crwh.2025.e00692","DOIUrl":"10.1016/j.crwh.2025.e00692","url":null,"abstract":"<div><div>The evaluation of primary amenorrhea requires a thoughtful assessment for hormonal, structural and/or genetic causes. Although most cases of primary amenorrhea are caused by a single pathology, rarely multiple pathologies may be uncovered. We present the case of a 33-year-old woman with a history of pubertal failure and primary amenorrhea due to Kallmann syndrome. She reported previous short-term use of hormone replacement therapy, with onset of severe pelvic pain and vaginal bleeding following its discontinuation. Her workup revealed concern for uterine didelphys with OHVIRA syndrome on MRI. Surgical exploration revealed a normal-appearing vagina and cervix communicating with the left uterine horn and fallopian tube, a separate, contralateral, obstructed, and engorged right uterine horn with cervix and obstructed vagina, and normal ovaries bilaterally. She underwent laparoscopic resection of the obstructed right hemiuterus with right salpingectomy. Estrogen replacement therapy was initiated postoperatively with cyclic progestins, and she experienced complete resolution of her pain. In the workup of primary amenorrhea, it is important to consider that more than one pathology may be present. A thorough endocrine, genetic, and anatomic evaluation is imperative prior to confirming the diagnosis and initiating treatment. Kallmann syndrome has rarely been reported with Mullerian anomalies; in this case it represents a scenario in which the induction of puberty and menses brought an obstructive anomaly to light. The possibility of co-occurring pathologies should always be considered to provide optimal care to the patient.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00692"},"PeriodicalIF":0.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372727","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}
Pub Date : 2025-01-31DOI: 10.1016/j.crwh.2025.e00691
Rie Okuya , Hiroshi Ishikawa , Nozomi Sakai , Eri Katayama , Kaori Kuroda , Kaori Koga
Acute appendicitis and adnexal torsion associated with ovarian tumors are possible causes of acute abdomen in women, yet differentiation remains challenging. Once adnexal torsion is suspected in young women, gynecologists should perform surgery to release the torsion as promptly as possible to preserve future fertility. Herein, we report a case of acute appendicitis that was unexpectedly discovered during laparoscopic surgery initially performed for suspected torsion of a right ovarian teratoma. A 20-year-old nulligravid woman with a history of left ovarian teratoma resection and ulcerative colitis presented with left lower abdominal pain. Non-contrast-enhanced computed tomography showed no findings suggestive of exacerbation of ulcerative colitis, such as bowel wall thickening or worsening ascites, while a mass suspected to be an ovarian teratoma was identified. Gynecologists and an emergency physician specializing in gastroenterology who attended the patient suspected an acute abdomen caused by adnexal torsion or tumor leakage associated with a right ovarian teratoma 5 cm across. However, laparoscopy revealed that the right ovarian teratoma was neither twisted nor ruptured. Instead, the appendix was swollen with yellow turbid ascites, compatible with acute appendicitis. Therefore, laparoscopic excision of the right ovarian teratoma and appendix was performed, and the patient's pain resolved postoperatively. The assumption that the pain was caused by torsion of the right ovarian teratoma was the primary reason for failing to diagnose acute appendicitis. This underscores the importance of evaluating the appendix during gynecologic laparoscopic surgery performed for suspected ovarian torsion.
{"title":"Unexpected acute appendicitis found at laparoscopic surgery for a right ovarian teratoma: A case report","authors":"Rie Okuya , Hiroshi Ishikawa , Nozomi Sakai , Eri Katayama , Kaori Kuroda , Kaori Koga","doi":"10.1016/j.crwh.2025.e00691","DOIUrl":"10.1016/j.crwh.2025.e00691","url":null,"abstract":"<div><div>Acute appendicitis and adnexal torsion associated with ovarian tumors are possible causes of acute abdomen in women, yet differentiation remains challenging. Once adnexal torsion is suspected in young women, gynecologists should perform surgery to release the torsion as promptly as possible to preserve future fertility. Herein, we report a case of acute appendicitis that was unexpectedly discovered during laparoscopic surgery initially performed for suspected torsion of a right ovarian teratoma. A 20-year-old nulligravid woman with a history of left ovarian teratoma resection and ulcerative colitis presented with left lower abdominal pain. Non-contrast-enhanced computed tomography showed no findings suggestive of exacerbation of ulcerative colitis, such as bowel wall thickening or worsening ascites, while a mass suspected to be an ovarian teratoma was identified. Gynecologists and an emergency physician specializing in gastroenterology who attended the patient suspected an acute abdomen caused by adnexal torsion or tumor leakage associated with a right ovarian teratoma 5 cm across. However, laparoscopy revealed that the right ovarian teratoma was neither twisted nor ruptured. Instead, the appendix was swollen with yellow turbid ascites, compatible with acute appendicitis. Therefore, laparoscopic excision of the right ovarian teratoma and appendix was performed, and the patient's pain resolved postoperatively. The assumption that the pain was caused by torsion of the right ovarian teratoma was the primary reason for failing to diagnose acute appendicitis. This underscores the importance of evaluating the appendix during gynecologic laparoscopic surgery performed for suspected ovarian torsion.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00691"},"PeriodicalIF":0.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143301157","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}
Uterine prolapse during pregnancy is rare, occurring in approximately 1 in 10,000 to 15,000 deliveries. It presents significant risks to both maternal and fetal health, and the optimal delivery method depends on the severity of prolapse, labor progression, and the well-being of both mother and baby.
A 25-year-old woman presented at 38 weeks and 4 days of gestation with vaginal mass protrusion and pain on pushing down. Examination revealed an irreducible cervical prolapse with swelling during the early stage of labor. Fetal ultrasound confirmed a normal head-down position and adequate amniotic fluid. Due to persistent fetal tachycardia, an emergency cesarean section was performed, resulting in the delivery of a healthy 3000 g male infant. Postoperatively, the mother was placed in the Trendelenburg position, which led to the spontaneous resolution of the prolapse by the third postpartum day. At the six-week follow-up, the uterine prolapse had completely resolved.
This case emphasizes the importance of individualized management and timely intervention. Postpartum uterine prolapse often resolves spontaneously with conservative care. A multidisciplinary approach is crucial for optimizing maternal and fetal outcomes, especially in resource-limited settings.
{"title":"Cervical prolapse during labor: A case report","authors":"Adugnaw Bogale Worku , Molla Asnake Kebede , Abebe Agegn Wudineh , Adefris Getachew Techane , Mekuanint Dessie Lakew , Chuchu Arega Zeleke","doi":"10.1016/j.crwh.2025.e00690","DOIUrl":"10.1016/j.crwh.2025.e00690","url":null,"abstract":"<div><div>Uterine prolapse during pregnancy is rare, occurring in approximately 1 in 10,000 to 15,000 deliveries. It presents significant risks to both maternal and fetal health, and the optimal delivery method depends on the severity of prolapse, labor progression, and the well-being of both mother and baby.</div><div>A 25-year-old woman presented at 38 weeks and 4 days of gestation with vaginal mass protrusion and pain on pushing down. Examination revealed an irreducible cervical prolapse with swelling during the early stage of labor. Fetal ultrasound confirmed a normal head-down position and adequate amniotic fluid. Due to persistent fetal tachycardia, an emergency cesarean section was performed, resulting in the delivery of a healthy 3000 g male infant. Postoperatively, the mother was placed in the Trendelenburg position, which led to the spontaneous resolution of the prolapse by the third postpartum day. At the six-week follow-up, the uterine prolapse had completely resolved.</div><div>This case emphasizes the importance of individualized management and timely intervention. Postpartum uterine prolapse often resolves spontaneously with conservative care. A multidisciplinary approach is crucial for optimizing maternal and fetal outcomes, especially in resource-limited settings.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00690"},"PeriodicalIF":0.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098558","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}
Mesenteric desmoid tumors (DTs) are rare, and there are no specific imaging features that can aid definitive diagnosis. This article presents the case of a 61-year-old woman found to have intra-abdominal DT located in the mesentery at two-year follow-up after laparoscopy-assisted anterior resection for stage I endometrial cancer. Computed tomography (CT) indicated the presence of a solitary tumor arising from the intestinal wall or mesentery. Subsequent magnetic resonance imaging and integrated positron emission tomography/CT with 2-18F-fluoro-2-deoxy-d-glucose suggested DT rather than recurrence, but surgical resection was chosen after considering the potential risks. Surgery confirmed the diagnosis, revealing a tumor at the level of the jejunal mesentery and approximately 5 cm in diameter. The mesenteric tumor was resected, along with part of the jejunum and the greater omentum. Histopathological examination of the surgical specimens confirmed the diagnosis of DT. As mesenteric DT after laparoscopic resection of stage I endometrial cancer is rare, a high degree of suspicion is necessary for diagnosis. Given that laparoscopic surgery is increasingly used in gynecological clinical practice, gynecologists and radiologists should be aware that DT should be considered in the differential diagnosis when a mesenteric mass is detected during follow-up after a surgical procedure, including laparoscopy.
{"title":"Mesenteric desmoid tumor after laparoscopic resection of stage I endometrial cancer: A case report","authors":"Mamiko Kusaka , Tetsuo Maeda , Kazuhiro Kitajima , Homare Murakoshi , Takahiro Watanabe , Shigeki Yoshida , Yuka Sano , Noriko Osumi , Mieko Inagaki","doi":"10.1016/j.crwh.2025.e00688","DOIUrl":"10.1016/j.crwh.2025.e00688","url":null,"abstract":"<div><div>Mesenteric desmoid tumors (DTs) are rare, and there are no specific imaging features that can aid definitive diagnosis. This article presents the case of a 61-year-old woman found to have intra-abdominal DT located in the mesentery at two-year follow-up after laparoscopy-assisted anterior resection for stage I endometrial cancer. Computed tomography (CT) indicated the presence of a solitary tumor arising from the intestinal wall or mesentery. Subsequent magnetic resonance imaging and integrated positron emission tomography/CT with 2-<sup>18</sup>F-fluoro-2-deoxy-<span>d</span>-glucose suggested DT rather than recurrence, but surgical resection was chosen after considering the potential risks. Surgery confirmed the diagnosis, revealing a tumor at the level of the jejunal mesentery and approximately 5 cm in diameter. The mesenteric tumor was resected, along with part of the jejunum and the greater omentum. Histopathological examination of the surgical specimens confirmed the diagnosis of DT. As mesenteric DT after laparoscopic resection of stage I endometrial cancer is rare, a high degree of suspicion is necessary for diagnosis. Given that laparoscopic surgery is increasingly used in gynecological clinical practice, gynecologists and radiologists should be aware that DT should be considered in the differential diagnosis when a mesenteric mass is detected during follow-up after a surgical procedure, including laparoscopy.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00688"},"PeriodicalIF":0.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098559","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}
Pub Date : 2025-01-17DOI: 10.1016/j.crwh.2025.e00687
Alice Moylan , Jewel Brown , Melissa J. Chen , Mitchell D. Creinin
The etonogestrel implant is known to have high contraceptive efficacy for up to 5 years. This case report describes etonogestrel implant failure during year 4 of use in a patient with a normal body mass index. The patient was receiving thyroid hormone replacement after a thyroidectomy and was found to have iatrogenic thyrotoxicosis in the months preceding pregnancy. Further study of the effects of thyroid hormone on etonogestrel metabolism are indicated.
{"title":"Etonogestrel implant failure in a woman taking thyroid hormone replacement: A case report","authors":"Alice Moylan , Jewel Brown , Melissa J. Chen , Mitchell D. Creinin","doi":"10.1016/j.crwh.2025.e00687","DOIUrl":"10.1016/j.crwh.2025.e00687","url":null,"abstract":"<div><div>The etonogestrel implant is known to have high contraceptive efficacy for up to 5 years. This case report describes etonogestrel implant failure during year 4 of use in a patient with a normal body mass index. The patient was receiving thyroid hormone replacement after a thyroidectomy and was found to have iatrogenic thyrotoxicosis in the months preceding pregnancy. Further study of the effects of thyroid hormone on etonogestrel metabolism are indicated.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00687"},"PeriodicalIF":0.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098560","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}
Intramural pregnancy (IMP) is an extremely rare form of ectopic pregnancy (EP), typically associated with previous uterine trauma, adenomyosis, or assisted reproductive technology (ART), such as embryo transfer (ET). Despite its potentially life-threatening nature, the absence of definitive preoperative diagnostic criteria for IMP complicates its early detection and management, especially in patients without known risk factors. Additionally, management becomes more challenging when there is an elevated risk of hemorrhage. We report the case of a 34-year-old nulligravid woman referred to a tertiary hospital with suspected EP and bilateral ovarian endometriomas following intrauterine insemination. The patient had no history of uterine trauma or ET. Blood tests and ultrasonography supported the diagnosis of EP, and computed tomography suggested peritoneal pregnancy. Upon further investigation, the patient was diagnosed with idiopathic thrombocytopenic purpura, presenting with a platelet count of 30,000/μL. Due to the associated risk of hemorrhage, we proceeded with emergency exploratory laparoscopy after platelet transfusion. Intraoperatively, when an IMP was identified, the procedure was rapidly converted to laparotomy owing to bleeding risk associated with idiopathic thrombocytopenic purpura. The gestational sac covered with the uterine serosa was dissected, and the uterine defect was repaired to preserve fertility. The blood loss was 320 mL. The patient's postoperative recovery was uneventful, and histopathological examination confirmed the diagnosis of IMP. The patient later resumed ART and successfully achieved term pregnancy, leading to a normal vaginal delivery 3 years after the initial surgery. Early diagnosis and appropriate management of IMP are critical to prevent severe intraperitoneal bleeding, while preserving future fertility.
{"title":"Intramural pregnancy after intrauterine insemination in a nulligravid patient without previous uterine trauma, complicated by idiopathic thrombocytopenic purpura: A case report","authors":"Koyo Yamamoto , Tsuyoshi Takiuchi , Kengo Kiso , Saki Ishii , Satoshi Nakagawa , Yasuto Kinose , Michiko Kodama , Yutaka Ueda , Kenjiro Sawada , Takahiro Tsuboyama , Tadashi Kimura","doi":"10.1016/j.crwh.2025.e00684","DOIUrl":"10.1016/j.crwh.2025.e00684","url":null,"abstract":"<div><div>Intramural pregnancy (IMP) is an extremely rare form of ectopic pregnancy (EP), typically associated with previous uterine trauma, adenomyosis, or assisted reproductive technology (ART), such as embryo transfer (ET). Despite its potentially life-threatening nature, the absence of definitive preoperative diagnostic criteria for IMP complicates its early detection and management, especially in patients without known risk factors. Additionally, management becomes more challenging when there is an elevated risk of hemorrhage. We report the case of a 34-year-old nulligravid woman referred to a tertiary hospital with suspected EP and bilateral ovarian endometriomas following intrauterine insemination. The patient had no history of uterine trauma or ET. Blood tests and ultrasonography supported the diagnosis of EP, and computed tomography suggested peritoneal pregnancy. Upon further investigation, the patient was diagnosed with idiopathic thrombocytopenic purpura, presenting with a platelet count of 30,000/μL. Due to the associated risk of hemorrhage, we proceeded with emergency exploratory laparoscopy after platelet transfusion. Intraoperatively, when an IMP was identified, the procedure was rapidly converted to laparotomy owing to bleeding risk associated with idiopathic thrombocytopenic purpura. The gestational sac covered with the uterine serosa was dissected, and the uterine defect was repaired to preserve fertility. The blood loss was 320 mL. The patient's postoperative recovery was uneventful, and histopathological examination confirmed the diagnosis of IMP. The patient later resumed ART and successfully achieved term pregnancy, leading to a normal vaginal delivery 3 years after the initial surgery. Early diagnosis and appropriate management of IMP are critical to prevent severe intraperitoneal bleeding, while preserving future fertility.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00684"},"PeriodicalIF":0.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058310","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}
Pub Date : 2025-01-08DOI: 10.1016/j.crwh.2025.e00682
Nour Saleh , Amin Bahabri , Ross Vander Wal
Subinvolution of the placental site can lead to severe post-partum haemorrhage, though it is a rare cause of the condition. Subinvolution of the placental site is an abnormal persistence of widely dilated uteroplacental spiral arteries in the absence of retained products of conception, and is associated with an increased risk of maternal morbidity and mortality. This report presents a case of an uneventful caesarean section that was followed by multiple presentations of major secondary post-partum haemorrhage, with a subsequent diagnosis of subinvolution of the placental site on histopathology. The patient was eventually treated with uterine artery embolisation after trials of medical and other interventional measures.
{"title":"Successful treatment of subinvolution of the placenta site with uterine artery embolisation, sparing the patient's fertility: A case report","authors":"Nour Saleh , Amin Bahabri , Ross Vander Wal","doi":"10.1016/j.crwh.2025.e00682","DOIUrl":"10.1016/j.crwh.2025.e00682","url":null,"abstract":"<div><div>Subinvolution of the placental site can lead to severe post-partum haemorrhage, though it is a rare cause of the condition. Subinvolution of the placental site is an abnormal persistence of widely dilated uteroplacental spiral arteries in the absence of retained products of conception, and is associated with an increased risk of maternal morbidity and mortality. This report presents a case of an uneventful caesarean section that was followed by multiple presentations of major secondary post-partum haemorrhage, with a subsequent diagnosis of subinvolution of the placental site on histopathology. The patient was eventually treated with uterine artery embolisation after trials of medical and other interventional measures.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00682"},"PeriodicalIF":0.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063926","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}
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