Pub Date : 2024-12-21DOI: 10.1016/j.crwh.2024.e00679
Lara Strakian , Sonal Karia
Toxic shock syndrome secondary to Group A Streptococcus infection is a rare but serious cause of women's morbidity and mortality which can easily be misdiagnosed. A 37-year-old woman presented to the emergency department in a state of shock after a two-day history of abdominal pain, fever, diarrhoea and green vaginal discharge. Following extensive investigations, she was proved to have septic shock secondary to Group A Streptococcus pyogenes. Despite receiving intravenous antibiotics, she required explorative laparotomy, which proceeded to subtotal hysterectomy and bilateral salpingectomy. Subsequently, she developed multi-organ failure, disseminated intravascular coagulation, and limb ischemia requiring below-knee amputation of the right limb. She was discharged home. The aim of this report is to raise the awareness about toxic shock syndrome from Streptococcus pyogenes. A high index of suspicion is required to promptly diagnose this rare yet potentially fatal infection.
{"title":"Toxic shock syndrome secondary to Group A Streptococcus infection: A case report","authors":"Lara Strakian , Sonal Karia","doi":"10.1016/j.crwh.2024.e00679","DOIUrl":"10.1016/j.crwh.2024.e00679","url":null,"abstract":"<div><div>Toxic shock syndrome secondary to Group A <em>Streptococcus</em> infection is a rare but serious cause of women's morbidity and mortality which can easily be misdiagnosed. A 37-year-old woman presented to the emergency department in a state of shock after a two-day history of abdominal pain, fever, diarrhoea and green vaginal discharge. Following extensive investigations, she was proved to have septic shock secondary to Group A <em>Streptococcus pyogenes.</em> Despite receiving intravenous antibiotics, she required explorative laparotomy, which proceeded to subtotal hysterectomy and bilateral salpingectomy. Subsequently, she developed multi-organ failure, disseminated intravascular coagulation, and limb ischemia requiring below-knee amputation of the right limb. She was discharged home. The aim of this report is to raise the awareness about toxic shock syndrome from <em>Streptococcus pyogenes</em>. A high index of suspicion is required to promptly diagnose this rare yet potentially fatal infection.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00679"},"PeriodicalIF":0.7,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000761","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 : 2024-12-17DOI: 10.1016/j.crwh.2024.e00678
Hamza A. Abdul-Hafez , Mahmoud N. Khadra , Alaa Hamed , Ibrahim Ayman Majjad , Mohammed A. Barakat , Adham B. Nazzal , Issa Al-Khdour
Acute type A aortic dissection during pregnancy is rare but life-threatening. It requires early multidisciplinary diagnosis and intervention to optimize maternal and fetal outcomes. We report the case of a 35-year-old woman (gravida 7 para 6) at 34 weeks of gestation who presented with epigastric pain, initially suspected to be gastroenteritis. Despite stable initial findings, her condition deteriorated and a CT angiogram confirmed the diagnosis of DeBakey Type I aortic dissection, which extended from the aortic root to the iliac arteries. She underwent an emergency cesarean section followed by a Bentall procedure, a surgical technique first described by Bentall and De Bono in 1968 to manage the aortic valve, root, and ascending aorta abnormalities. Both mother and baby survived, with an uneventful recovery. However, this case highlights the diagnostic challenges of aortic dissection in pregnancy, as non-specific symptoms can mimic benign conditions. Multidisciplinary management and timely surgical intervention are crucial for maternal and fetal survival.
{"title":"Successful management of acute type A aortic dissection in the third trimester of pregnancy: A case report","authors":"Hamza A. Abdul-Hafez , Mahmoud N. Khadra , Alaa Hamed , Ibrahim Ayman Majjad , Mohammed A. Barakat , Adham B. Nazzal , Issa Al-Khdour","doi":"10.1016/j.crwh.2024.e00678","DOIUrl":"10.1016/j.crwh.2024.e00678","url":null,"abstract":"<div><div>Acute type A aortic dissection during pregnancy is rare but life-threatening. It requires early multidisciplinary diagnosis and intervention to optimize maternal and fetal outcomes. We report the case of a 35-year-old woman (gravida 7 para 6) at 34 weeks of gestation who presented with epigastric pain, initially suspected to be gastroenteritis. Despite stable initial findings, her condition deteriorated and a CT angiogram confirmed the diagnosis of DeBakey Type I aortic dissection, which extended from the aortic root to the iliac arteries. She underwent an emergency cesarean section followed by a Bentall procedure, a surgical technique first described by Bentall and De Bono in 1968 to manage the aortic valve, root, and ascending aorta abnormalities. Both mother and baby survived, with an uneventful recovery. However, this case highlights the diagnostic challenges of aortic dissection in pregnancy, as non-specific symptoms can mimic benign conditions. Multidisciplinary management and timely surgical intervention are crucial for maternal and fetal survival.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00678"},"PeriodicalIF":0.7,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098548","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 rupture is a rare but serious complication that predominantly occurs in the third trimester of pregnancy. It is exceptionally uncommon in the second trimester, particularly in the presence of uterine anomalies such as a bicornuate uterus or uterus didelphys. This case report presents a significant instance of second-trimester uterine rupture associated with a bicornuate uterus, resulting in a life-threatening intra-abdominal hemorrhage of approximately 4000 mL. The case report details the clinical presentation, diagnostic challenges, and management strategies used in this case, highlighting the critical importance of prompt recognition and intervention in similar scenarios to improve maternal outcomes.
{"title":"Second-trimester uterine rupture in bicornuate uterus: A case report","authors":"Mesfin Ayalew Tsegaye, Zelalem Adugna Mekonnen, Dawit Takele Lemma, Alemayehu Nigusssie Adugna, Rebecca Haile Tesfay","doi":"10.1016/j.crwh.2024.e00676","DOIUrl":"10.1016/j.crwh.2024.e00676","url":null,"abstract":"<div><div>Uterine rupture is a rare but serious complication that predominantly occurs in the third trimester of pregnancy. It is exceptionally uncommon in the second trimester, particularly in the presence of uterine anomalies such as a bicornuate uterus or uterus didelphys. This case report presents a significant instance of second-trimester uterine rupture associated with a bicornuate uterus, resulting in a life-threatening intra-abdominal hemorrhage of approximately 4000 mL. The case report details the clinical presentation, diagnostic challenges, and management strategies used in this case, highlighting the critical importance of prompt recognition and intervention in similar scenarios to improve maternal outcomes.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00676"},"PeriodicalIF":0.7,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11720432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969698","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 : 2024-12-13DOI: 10.1016/j.crwh.2024.e00677
Renee T. Sullender, R. Gina Silverstein, Diamond M. Goodwin , Asha B. McClurg, Erin T. Carey
Vulvodynia is a chronic vulvar pain condition that can be challenging to treat and often requires multi-modal interventions for symptom management. Low-dose naltrexone (LDN) is a reversible competitive antagonist at opioid receptors and may have utility in treating chronic pain conditions. In a specialty gynecology clinic at an academic medical center, patients with poorly controlled vulvodynia who had failed standard treatments were offered LDN as an adjunct pain treatment. This case series describes the experience of three patients with chronic vulvodynia who added LDN to their treatment regimen. All patients reported subjective improvement in their symptoms without side-effects. Additional research is needed on the efficacy of LDN for chronic pelvic pain conditions such as vulvodynia as well as the long-term safety profile of such use.
{"title":"Low-dose naltrexone as a treatment for vulvodynia: A case series","authors":"Renee T. Sullender, R. Gina Silverstein, Diamond M. Goodwin , Asha B. McClurg, Erin T. Carey","doi":"10.1016/j.crwh.2024.e00677","DOIUrl":"10.1016/j.crwh.2024.e00677","url":null,"abstract":"<div><div>Vulvodynia is a chronic vulvar pain condition that can be challenging to treat and often requires multi-modal interventions for symptom management. Low-dose naltrexone (LDN) is a reversible competitive antagonist at opioid receptors and may have utility in treating chronic pain conditions. In a specialty gynecology clinic at an academic medical center, patients with poorly controlled vulvodynia who had failed standard treatments were offered LDN as an adjunct pain treatment. This case series describes the experience of three patients with chronic vulvodynia who added LDN to their treatment regimen. All patients reported subjective improvement in their symptoms without side-effects. Additional research is needed on the efficacy of LDN for chronic pelvic pain conditions such as vulvodynia as well as the long-term safety profile of such use.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00677"},"PeriodicalIF":0.7,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969750","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 : 2024-12-11DOI: 10.1016/j.crwh.2024.e00675
Marlon M. Mencia , Pedro Pablo Hernandez Cruz , Shanta Bidaisee , Allan Beharry
Avascular necrosis (AVN) of the hip, a rare cause of pelvic pain in the third trimester of pregnancy, often presents with nonspecific symptoms that resemble common musculoskeletal conditions. This ambiguity, coupled with concerns about the safety of magnetic resonance imaging (MRI) during pregnancy, can hinder timely diagnosis. We report a unique case of a 32-year-old primigravida diagnosed with a hip fracture and bilateral AVN of the femoral head in the immediate postpartum period, a complication seemingly not previously documented in pregnant patients. The initial management involved closed reduction and internal fixation using cannulated screws. However, progressive femoral head collapse necessitated revision to a total hip arthroplasty. This case underscores the importance of early diagnosis and recognition of AVN in pregnancy to prevent severe complications. It highlights the diagnostic challenges and emphasizes the need for heightened awareness and earlier imaging investigations in similar clinical scenarios.
{"title":"Bilateral avascular necrosis leading to hip fracture in pregnancy: A case report","authors":"Marlon M. Mencia , Pedro Pablo Hernandez Cruz , Shanta Bidaisee , Allan Beharry","doi":"10.1016/j.crwh.2024.e00675","DOIUrl":"10.1016/j.crwh.2024.e00675","url":null,"abstract":"<div><div>Avascular necrosis (AVN) of the hip, a rare cause of pelvic pain in the third trimester of pregnancy, often presents with nonspecific symptoms that resemble common musculoskeletal conditions. This ambiguity, coupled with concerns about the safety of magnetic resonance imaging (MRI) during pregnancy, can hinder timely diagnosis. We report a unique case of a 32-year-old primigravida diagnosed with a hip fracture and bilateral AVN of the femoral head in the immediate postpartum period, a complication seemingly not previously documented in pregnant patients. The initial management involved closed reduction and internal fixation using cannulated screws. However, progressive femoral head collapse necessitated revision to a total hip arthroplasty. This case underscores the importance of early diagnosis and recognition of AVN in pregnancy to prevent severe complications. It highlights the diagnostic challenges and emphasizes the need for heightened awareness and earlier imaging investigations in similar clinical scenarios.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"45 ","pages":"Article e00675"},"PeriodicalIF":0.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143098482","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}
A curvature of a finger that bends inwards relative to the other fingers is a common observation during prenatal screening. When the angulation exceeds 10 degrees, it is known as “clinodactyly” and could suggest a variety of underlying issues. Even though it usually remains unnoticed during pregnancy, it may be a sign of serious fetal disease. We report the case of a fetus diagnosed with clinodactyly of the thumb accompanied by tachycardia, abnormal levels of maternal hormones in the first trimester and increased impedance to flow in the uterine arteries. Although non-invasive prenatal testing was normal, amniocentesis was carried out and two deviations at chromosome 20 were identified through molecular karyotyping. Our report aims to raise clinical suspicion regarding the potential association between genetic abnormalities and clinodactyly. A careful clinical and genetic consultation is required in order to achieve the most favorable outcome for both mother and child.
{"title":"Prenatal diagnosis of clinodactyly and its association with genetic syndromes: A case report","authors":"Themistoklis Loukopoulos , Athanasios Zikopoulos , Nikolaos Vlassis , Emmanouil Manolakos , Sotirios Sotiriou , Anastasia Vatopoulou , Fani Gkrozou , Anastasios Potiris , Sofoklis Stavros , Charikleia Skentou","doi":"10.1016/j.crwh.2024.e00674","DOIUrl":"10.1016/j.crwh.2024.e00674","url":null,"abstract":"<div><div>A curvature of a finger that bends inwards relative to the other fingers is a common observation during prenatal screening. When the angulation exceeds 10 degrees, it is known as “clinodactyly” and could suggest a variety of underlying issues. Even though it usually remains unnoticed during pregnancy, it may be a sign of serious fetal disease. We report the case of a fetus diagnosed with clinodactyly of the thumb accompanied by tachycardia, abnormal levels of maternal hormones in the first trimester and increased impedance to flow in the uterine arteries. Although non-invasive prenatal testing was normal, amniocentesis was carried out and two deviations at chromosome 20 were identified through molecular karyotyping. Our report aims to raise clinical suspicion regarding the potential association between genetic abnormalities and clinodactyly. A careful clinical and genetic consultation is required in order to achieve the most favorable outcome for both mother and child.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00674"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142884989","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 : 2024-12-01DOI: 10.1016/j.crwh.2024.e00670
Sana Mushtaq , Muhammad Arslan Ul Hassan , Yan Li , Ikran Abdi , Aqsa Ahmad , HaiNing Li
Liposarcoma of the uterine corpus represents an exceptionally rare tumor, with few cases documented in the literature, underscoring its unique histopathologic characteristics and management challenges. This case describes the clinical management of a 57-year-old patient with well-differentiated liposarcoma of the uterine corpus who presented with a three-month history of abdominal pain and distension. She underwent an abdominal hysterectomy followed by chemotherapy but experienced local recurrence in the mesentery and retroperitoneum after 21 months. Tumor resection was performed again, followed by chemotherapy, but the patient experienced a second recurrence 15 months later, involving the small intestine, vaginal stump, and ureter, with evidence of dedifferentiated liposarcoma. A third surgical resection was carried out without administering chemotherapy and the patient remained asymptomatic at follow-up appointments every 3 months for a year. This case highlights the importance of acknowledging the aggressive nature of recurrent liposarcoma, especially its transition into dedifferentiated liposarcoma, and the need for tailored management strategies.
{"title":"Dedifferentiated recurrent liposarcoma of the uterine corpus: A case report and literature review","authors":"Sana Mushtaq , Muhammad Arslan Ul Hassan , Yan Li , Ikran Abdi , Aqsa Ahmad , HaiNing Li","doi":"10.1016/j.crwh.2024.e00670","DOIUrl":"10.1016/j.crwh.2024.e00670","url":null,"abstract":"<div><div>Liposarcoma of the uterine corpus represents an exceptionally rare tumor, with few cases documented in the literature, underscoring its unique histopathologic characteristics and management challenges. This case describes the clinical management of a 57-year-old patient with well-differentiated liposarcoma of the uterine corpus who presented with a three-month history of abdominal pain and distension. She underwent an abdominal hysterectomy followed by chemotherapy but experienced local recurrence in the mesentery and retroperitoneum after 21 months. Tumor resection was performed again, followed by chemotherapy, but the patient experienced a second recurrence 15 months later, involving the small intestine, vaginal stump, and ureter, with evidence of dedifferentiated liposarcoma. A third surgical resection was carried out without administering chemotherapy and the patient remained asymptomatic at follow-up appointments every 3 months for a year. This case highlights the importance of acknowledging the aggressive nature of recurrent liposarcoma, especially its transition into dedifferentiated liposarcoma, and the need for tailored management strategies.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00670"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743488","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 : 2024-12-01DOI: 10.1016/j.crwh.2024.e00671
Akiko Yamamoto, Patrick Jn-Charles
Uterine rupture is a well-known, life-threatening complication of misoprostol use; the incidence is remarkably low. Herein, we report what seems to be the first documented case of uterine rupture following induction of labour for intrauterine foetal death in the second trimester without a uterine scar. A 40-year-old woman with no history of caesarean section or uterine surgery presented with mild lower abdominal pain and mild genital bleeding. Transabdominal ultrasonography revealed intrauterine foetal death, at presumed gestational age of 20 weeks. Two hours after three doses of 400 μg 3-hourly of misoprostol, the patient complained of abdominal pain; however, the foetus was not expelled. Repeat sonography revealed the foetus in the abdominal cavity and fluid collection in the pelvis. Based on the probable diagnosis of uterine rupture, a laparotomy was performed. The intra-abdominal haemorrhage volume was approximately 250–300 ml. There was a linear rupture approximately 10 cm long on the posterior wall of the uterus, and as a consequence, a macerated and foetid foetus and part of the placenta were found in the abdominal cavity. A total hysterectomy was performed, and the patient was discharged three days after the intervention without any postoperative complications. In conclusion, while misoprostol is generally safe for second-trimester pregnancy termination, its use should be approached with caution and close monitoring in cases of uterine inflammation.
{"title":"Uterine rupture with induction using misoprostol for intrauterine foetal death in the second trimester: A case report","authors":"Akiko Yamamoto, Patrick Jn-Charles","doi":"10.1016/j.crwh.2024.e00671","DOIUrl":"10.1016/j.crwh.2024.e00671","url":null,"abstract":"<div><div>Uterine rupture is a well-known, life-threatening complication of misoprostol use; the incidence is remarkably low. Herein, we report what seems to be the first documented case of uterine rupture following induction of labour for intrauterine foetal death in the second trimester without a uterine scar. A 40-year-old woman with no history of caesarean section or uterine surgery presented with mild lower abdominal pain and mild genital bleeding. Transabdominal ultrasonography revealed intrauterine foetal death, at presumed gestational age of 20 weeks. Two hours after three doses of 400 μg 3-hourly of misoprostol, the patient complained of abdominal pain; however, the foetus was not expelled. Repeat sonography revealed the foetus in the abdominal cavity and fluid collection in the pelvis. Based on the probable diagnosis of uterine rupture, a laparotomy was performed. The intra-abdominal haemorrhage volume was approximately 250–300 ml. There was a linear rupture approximately 10 cm long on the posterior wall of the uterus, and as a consequence, a macerated and foetid foetus and part of the placenta were found in the abdominal cavity. A total hysterectomy was performed, and the patient was discharged three days after the intervention without any postoperative complications. In conclusion, while misoprostol is generally safe for second-trimester pregnancy termination, its use should be approached with caution and close monitoring in cases of uterine inflammation.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00671"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881379","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 : 2024-12-01DOI: 10.1016/j.crwh.2024.e00668
Yusuf Mohammed Yusuf , Gulilat Tigiye Endeshaw , Berhanu Mohammed Shifa , Biniyam Afework Abate , Ashenafi Aberra Buser , Mohammednur Ali Mohammed , Shimelis Ayalew Yimer , Yabets Tesfaye Kebede , Bekri Delil Mohammed
Hepatic pregnancy, an exceedingly rare subtype of abdominal ectopic pregnancy, remains clinically challenging due to its infrequency, diverse presentations, and diagnostic difficulties. We report the clinical course, diagnostic journey and treatment of a woman with a primary hepatic pregnancy.
The patient presented with acute pain in the right hypochondrium and vomiting. Imaging revealed a peripheral hypodense gestational sac within the right hepatic lobe containing a fetus with heart pulsations, as well as peritoneal fluid and pelvic collection. Following administration of mifepristone, the patient underwent a laparotomy, and expelled a developed fetus. Hepatic resection utilizing the Pringle maneuver was performed, and methotrexate was administered postoperatively. The patient had a stable recovery and vital signs and was discharged two days after surgery.
This case highlights the diagnostic and management challenges of hepatic pregnancy, and emphasizes the need for heightened clinical suspicion and thorough evaluation. By sharing the experience, we aim to contribute insights to guide the diagnosis and management of similar cases.
{"title":"Management of primary hepatic pregnancy: A case report","authors":"Yusuf Mohammed Yusuf , Gulilat Tigiye Endeshaw , Berhanu Mohammed Shifa , Biniyam Afework Abate , Ashenafi Aberra Buser , Mohammednur Ali Mohammed , Shimelis Ayalew Yimer , Yabets Tesfaye Kebede , Bekri Delil Mohammed","doi":"10.1016/j.crwh.2024.e00668","DOIUrl":"10.1016/j.crwh.2024.e00668","url":null,"abstract":"<div><div>Hepatic pregnancy, an exceedingly rare subtype of abdominal ectopic pregnancy, remains clinically challenging due to its infrequency, diverse presentations, and diagnostic difficulties. We report the clinical course, diagnostic journey and treatment of a woman with a primary hepatic pregnancy.</div><div>The patient presented with acute pain in the right hypochondrium and vomiting. Imaging revealed a peripheral hypodense gestational sac within the right hepatic lobe containing a fetus with heart pulsations, as well as peritoneal fluid and pelvic collection. Following administration of mifepristone, the patient underwent a laparotomy, and expelled a developed fetus. Hepatic resection utilizing the Pringle maneuver was performed, and methotrexate was administered postoperatively. The patient had a stable recovery and vital signs and was discharged two days after surgery.</div><div>This case highlights the diagnostic and management challenges of hepatic pregnancy, and emphasizes the need for heightened clinical suspicion and thorough evaluation. By sharing the experience, we aim to contribute insights to guide the diagnosis and management of similar cases.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00668"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743483","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 : 2024-12-01DOI: 10.1016/j.crwh.2024.e00673
Greta Lisa Carlin , Sören Lange , Werner Haslik , Harun Fajkovic , Engelbert Hanzal
Anterior exenteration is a radical surgical option for treating locally advanced pelvic malignancies when alternative treatments are deemed ineffective or inappropriate. Due to its nature as an ablative treatment, interference with supportive structures of the pelvic floor can result in pelvic organ prolapse.
A 70-year-old woman presented with prolapse after radical cystectomy and following two unsuccessful attempts at Le Fort colpocleisis, the second of which was further complicated by rupture of the vaginal cuff. After exploratory laparotomy to evaluate pelvic adhesions and potential tumor recurrence, the necrotic vaginal apex was excised via the vaginal route, and a musculus gracilis flap was created to cover the levator hiatus in a Z-shaped pattern. The introitus was then narrowed by partial colpocleisis of Kahr. The postoperative course was uneventful and high patient satisfaction and an adequate anatomic result were found at one-year follow-up.
There is a scarcity of literature regarding the optimal treatment for pelvic organ prolapse after anterior exenteration, and to our knowledge this is the first published report of the use of a gracilis flap combined with partial colpocleisis of Kahr with a satisfactory outcome in this complicated situation. This case underscores the importance of a multidisciplinary approach in managing prolapse after radical cystectomy, showcasing the successful integration of expertise across gynecology, urology, and reconstructive surgery.
{"title":"Gracilis flap and partial colpocleisis of Kahr for pelvic organ prolapse after anterior exenteration: A case report","authors":"Greta Lisa Carlin , Sören Lange , Werner Haslik , Harun Fajkovic , Engelbert Hanzal","doi":"10.1016/j.crwh.2024.e00673","DOIUrl":"10.1016/j.crwh.2024.e00673","url":null,"abstract":"<div><div>Anterior exenteration is a radical surgical option for treating locally advanced pelvic malignancies when alternative treatments are deemed ineffective or inappropriate. Due to its nature as an ablative treatment, interference with supportive structures of the pelvic floor can result in pelvic organ prolapse.</div><div>A 70-year-old woman presented with prolapse after radical cystectomy and following two unsuccessful attempts at Le Fort colpocleisis, the second of which was further complicated by rupture of the vaginal cuff. After exploratory laparotomy to evaluate pelvic adhesions and potential tumor recurrence, the necrotic vaginal apex was excised via the vaginal route, and a musculus gracilis flap was created to cover the levator hiatus in a <em>Z</em>-shaped pattern. The introitus was then narrowed by partial colpocleisis of Kahr. The postoperative course was uneventful and high patient satisfaction and an adequate anatomic result were found at one-year follow-up.</div><div>There is a scarcity of literature regarding the optimal treatment for pelvic organ prolapse after anterior exenteration, and to our knowledge this is the first published report of the use of a gracilis flap combined with partial colpocleisis of Kahr with a satisfactory outcome in this complicated situation. This case underscores the importance of a multidisciplinary approach in managing prolapse after radical cystectomy, showcasing the successful integration of expertise across gynecology, urology, and reconstructive surgery.</div></div>","PeriodicalId":9657,"journal":{"name":"Case Reports in Women's Health","volume":"44 ","pages":"Article e00673"},"PeriodicalIF":0.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142884988","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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