A positive urine pregnancy test with haemoperitoneum: misdiagnosed postpartum choriocarcinoma with uterine rupture mimicking ruptured ectopic pregnancy

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shakti Yeoh ◽  
Soon-Leong Yong ◽  
Pak-Inn Teoh ◽  
Marcus Kang
Keyword(s):  
Ectopic Pregnancy ◽  
Uterine Rupture ◽  
Histopathological Examination ◽  
Wedge Resection ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Emergency Laparotomy ◽  
Blood Product Transfusion ◽  
Pregnancy Test ◽  
Urine Pregnancy Test

Abstract Objectives Choriocarcinoma after a term pregnancy is rare and can be life-threatening, especially when it perforates the uterus, resulting in massive haemoperitoneum. As uterine rupture due to choriocarcinoma is uncommonly encountered in the clinical practice, its diagnosis is often missed or delayed. Case presentation We present a case of a 41-year-old para 4 + 1 who had acute abdomen and hypovolaemic shock secondary to haemoperitoneum at three months postpartum period. The urine pregnancy test was positive, and, therefore, a provisional diagnosis of a ruptured ectopic pregnancy was made. She was managed aggressively with fluids and blood product transfusion at the emergency department to achieve haemodynamic stability. Subsequently, she underwent an emergency laparotomy where intraoperatively noted a perforation at the left posterior uterine cornu with purplish tissue spillage. A wedge resection was performed, and the histopathological examination (HPE) was reported as atypical trophoblastic cells, in which choriocarcinoma could not be ruled out. The patient then underwent a total abdominal hysterectomy three weeks later. The final HPE confirmed the diagnosis of choriocarcinoma. Conclusions The clinical presentation of postpartum choriocarcinoma can be indistinguishable from a ruptured ectopic pregnancy. A high index of suspicion is crucial to allow early diagnosis.

scholarly journals Uterine Rupture with Massive Late Postpartum Hemorrhage due to Placenta Percreta Left Partially In Situ

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Mehmet Coskun Salman ◽  
Pinar Calis ◽  
Ozgur Deren
Keyword(s):  
Uterine Rupture ◽  
Bladder Wall ◽  
Placental Tissue ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Wall ◽  
Placenta Percreta ◽  
Emergency Laparotomy ◽  
Life Threatening

Placental adhesive disorders involve the growth of placental tissue into or through the uterine wall. Among these disorders, placenta percreta is the rarest one. However, it may cause significant complications. This report aimed to report a neglected patient with placenta percreta who developed uterine rupture with life-threatening late postpartum intra-abdominal hemorrhage. On admission, the patient had acute abdomen with moderate abdominal distention and was subjected to emergency laparotomy. A full-thickness defect of the anterior uterine wall involving the hysterotomy site was seen. Placental tissues occupied both sides of the incision and posterior bladder wall was also invaded by placenta. Total abdominal hysterectomy with partial resection of the posterior bladder wall was performed.

scholarly journals CAESAREAN SCAR PREGNANCY;

2013 ◽  
Vol 20 (05) ◽  
pp. 849-851
Author(s):  
RAZIA SULTANA ◽  
SAIF-UL- ISLAM ◽  
NURJAHAN -
Keyword(s):  
Uterine Rupture ◽  
Operative Procedure ◽  
Fibrous Tissue ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Massive Hemorrhage ◽  
Emergency Laparotomy ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy ◽  
Profuse Hemorrhage

Caesarean Scar pregnancy (CSP) is a rare form of Ectopic pregnancy where the gestation sac is surrounded bymyometrium and the fibrous tissue of the scar from the previous caesarean section. It is often misdiagnosed as Molar pregnancy orInevitable Abortion and can be associated with massive hemorrhage and pervaginal bleeding leading to uterine rupture. Here we reporteda case of Caesarean scar pregnancy who presented with history of cesarean section and pervaginal bleeding. Dilatation and curettagewas planned but during the operative procedure there was profuse hemorrhage leading to hypovolumic shock which was managed byBlood and venesection then emergency laparotomy followed by Total Abdominal Hysterectomy done as life saving procedure,th postoperative period was uneventful and the patient was discharged on 10 postoperative day. Diagnosis is important as caesarean scarpregnancy is associated with life threatening complications such as uterine rupture, massive hemorrhage and the need for Hysterectomywith subsequent loss of fertility.

scholarly journals A Rare Case of Functional Ectopic Hyperthyroidism: Struma Ovarii

2016 ◽  
Vol 8 (3) ◽  
pp. 212-213
Author(s):  
Indu Lata ◽  
Deepa Kapoor
Keyword(s):  
Rare Case ◽  
Histopathological Examination ◽  
Thyroid Tissue ◽  
Signs And Symptoms ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Cystic Mass ◽  
Surgical Removal ◽  
Struma Ovarii ◽  
Lower Abdomen

ABSTRACT Struma ovarii (SO) is a rare special type of monodermal teratoma of ovary that predominantly consists of thyroid tissue (> 50%). In only 5 to 20% of cases hyperthyroidism is seen due to functional SO. We are reporting here a case of unilateral benign cystic SO in a 50-year-old postmenopausal lady presented with pain and heaviness in lower abdomen without any signs and symptoms of hyperthyroidism. Pelvic ultrasonogram showed right side tubo-ovarian mass and was planned for laparotomy. In preoperative investigation subclinical hyperthyroidism was diagnosed. Abdominal exploration showed cystic mass lesion in right ovary. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathological examination diagnosed the mass as benign cystic SO. Patient became euthyroid after surgical removal of tumor. How to cite this article Lata I, Kapoor D. A Rare Case of Functional Ectopic Hyperthyroidism: Struma Ovarii. World J Endoc Surg 2016;8(3):212-213.

scholarly journals Degenerated fibroid: a diagnostic dilemma

2020 ◽  
Vol 9 (4) ◽  
pp. 1766
Author(s):  
Nayanika Gaur ◽  
Manish Jha
Keyword(s):  
Histopathological Examination ◽  
Exploratory Laparotomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Cystic Degeneration ◽  
Ovarian Malignancy ◽  
Imaging Studies ◽  
Diagnostic Dilemma ◽  
Fibroid Uterus ◽  
Wide Range

Leiomyoma is one of the most commonly encountered benign gynaecological neoplasms. With a wide range of symptoms, sometimes even asymptomatic, these tumors are easy to diagnose and treat, unless there are degenerative changes, which makes them difficult to diagnose and differentiating them from other serious conditions including malignancy, thereby, complicating their management also. Here, the case present to you a case of 48-year-old women with symptoms and clinical examination suggesting fibroid uterus but imaging studies inconclusive to differentiate fibroid uterus with ovarian malignancy, thus, creating a diagnostic dilemma. Ultimately, patient underwent exploratory laparotomy, keeping possibility of ovarian malignancy. Histopathological examination of the specimen of total abdominal hysterectomy with bilateral salpingo-oopherectomy concluded extensive cystic degeneration of leiomyoma and no evidence of malignancy.

Cervical Ectopic Pregnancy: Case Report

1970 ◽  
Vol 25 (2) ◽  
pp. 92-94
Author(s):  
Laila Parveen Banu ◽  
Sameena Chowdhury ◽  
Kohinoor Begum ◽  
Ferdousi Islam ◽  
Saria Tasnim
Keyword(s):  
Case Report ◽  
Ectopic Pregnancy ◽  
Vaginal Bleeding ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Naked Eye ◽  
Life Threatening ◽  
Eye Examination ◽  
Cervical Ectopic Pregnancy

A thirty year old lady para 3+0 presented with complaints of amenorrhoea for eight weeks and slight per vaginal bleeding for 28 days with frequent bouts of profuse bleeding. Total abdominal hysterectomy was done. Naked eye examination of the specimen was suggestive of cervical ectopic pregnancy (CEP). Histopathology report confirmed cervical implantation of placenta. CEP is an extremely rare life threatening form of ectopic pregnancy. (J Bangladesh Coll Phys Surg 2007; 25 : 92-94)

scholarly journals Endometrial Adenocarcinoma and Mucocele of the Appendix: An Unusual Coexistence

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Ioannis Kalogiannidis ◽  
Amalia Mavrona ◽  
Sophia Grammenou ◽  
Georgios Zacharioudakis ◽  
Stamatia Aggelidou ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Endometrial Adenocarcinoma ◽  
Female Genital Tract ◽  
Mucinous Cystadenoma ◽  
Ct Scanning ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Endometrial Biopsy ◽  
Appendiceal Mucocele ◽  
Preoperative Ct

Appendiceal mucocele is a rare clinical entity, which is however quite often associated with mucinous ovarian tumor. The coexistence of mucinous cystadenoma of the appendix and endometrial adenocarcinoma has not been reported before. A 49-year-old woman presented to our clinic with postmenopausal bleeding and no other symptom. Endometrial biopsy revealed endometrial adenocarcinoma of endometrioid type (grade I). Preoperative CT scanning revealed an appendiceal mucocele, and a colonoscopy confirmed the diagnosis. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and appendectomy. The final histopathological examination showed a mucinous cystadenoma of the appendix and confirmed the diagnosis of endometrioid endometrial adenocarcinoma. The coexistence of appendiceal mucocele and female genital tract pathology is rare. However, gynecologists should keep a high level of suspicion for such possible coexistence. Both the diagnostic approach and the therapeutic management should be multidisciplinary, most importantly with the involvement of general surgeons.

scholarly journals Cornual Pregnancy

2012 ◽  
Vol 13 (2) ◽  
pp. 227-229
Author(s):  
F Wazed ◽  
N Sultana ◽  
S Ahamed ◽  
JH Khan ◽  
S Rouf ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Uterine Rupture ◽  
Abdominal Cavity ◽  
Correct Diagnosis ◽  
Emergency Laparotomy ◽  
Abdominal Pregnancy ◽  
Cornual Pregnancy ◽  
Rare Form ◽  
Therapeutic Challenge ◽  
Uterine Anomaly

Cornual pregnancy is rare form of ectopic pregnancy where implantation occurs in the cavity of a rudimentary horn of the uterus. It is the diagnostic and therapeutic challenge with potential sever consequence if uterine rupture occurs with massive intra abdominal haemorrhage .We report a case of misdiagnosed rupture cornual pregnancy occurring at 12 weeks gestation. First USG revealed intra uterine pregnancy. Repeat USG showed abdominal pregnancy sac but cornual pregnancy was not diagnosed and uterine anomaly was not detected. The correct diagnosis was made at emergency laparotomy. An intact pregnancy sac of 12weeks fetus was seen in abdominal cavity. Placenta and pregnancy sac was adherent to omentum and torn end of left cornu of the bicornuate uterus. Left sided cornu was resected keeping both the ovaries and tubes intact. DOI: http://dx.doi.org/10.3329/jom.v13i2.12763 J Medicine 2012; 13 : 227-229

scholarly journals Ectopic Pregnancy Following Interval Tubal Sterilization

2017 ◽  
Vol 5 (2) ◽  
pp. 77-80
Author(s):  
Deepak Shrestha ◽  
Sebina Baniya ◽  
Sudeep Regmi
Keyword(s):  
Ectopic Pregnancy ◽  
Failure Rate ◽  
Uterine Cavity ◽  
Prior History ◽  
Emergency Laparotomy ◽  
Tubal Sterilization ◽  
Mobile Mass ◽  
History Of ◽  
Permanent Contraception ◽  
Urine Pregnancy Test

Introduction:  Tubal sterilization is a highly effective method of permanent contraception. However, pregnancy can still occur following a successful procedure. Published literatures report a failure rate of 0.13-1.3% and 15-33% of such pregnancies are likely to be ectopic. Case report: A 33 years para three lady with prior history of tubal ligation presented with generalized abdominal pain and several episodes of vomiting. Bimanual examination revealed a soft and mobile mass of 2 x 3 cm in right adnexa. Urine pregnancy test was positive and ultrasonogram showed a heterogeneous mass of 3.4 x 3.3 cm in right adnexa with empty uterine cavity. Culdocentesis resulted in aspiration of frank non-clotting blood. She then underwent emergency laparotomy with bilateral salpingectomy for ruptured ectopic pregnancy. Conclusion: Ectopic pregnancy after tubal sterilization though rare is not entirely impossible. All women who are offered this procedure should always be educated about its failure rate. And in women presenting with acute abdomen, a prior history of tubal sterilization doesn't preclude the possibility of ectopic pregnancy.

scholarly journals Ovarian Lymphangioma with Mature Cystic Teratoma

2019 ◽  
Vol 17 (01) ◽  
pp. 128-130
Author(s):  
Karishma Malla Vaidya ◽  
Bigya Shrestha
Keyword(s):  
Benign Tumor ◽  
Histological Analysis ◽  
Adnexal Mass ◽  
Histopathological Examination ◽  
Cystic Teratoma ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Mature Cystic Teratoma ◽  
Long Time ◽  
Slow Growing

Lymphangiomas are slow-growing tumors that remain asymptomatic for a long time, with the tumor being identified incidentally during histopathological examination after excision. Mature cystic teratoma is benign tumor consisting of mature tissue derived from two or three germ layers. We have 47-year-old woman who underwent total abdominal hysterectomy for right adnexal mass. As her ultrasound report revealed a right adnexal mass with solid and cystic components. The histological analysis along with immunohistochemistry (D2-40) maker confirmed the diagnosis of lymphangioma of the ovary coexisting with mature cystic teratoma. There is paucity of reported case of co-existing these two tumors in same tissue.Keywords: D2-40; lymphangioma; mature cystic teratoma; ovary.

scholarly journals Mullerian Adenosarcoma of the Uterus with Sarcomatous Overgrowth

2010 ◽  
Vol 3 ◽  
pp. CCRep.S5082 ◽  
Author(s):  
Reecha Singh ◽  
S. Shameema ◽  
Koothan Vijaya ◽  
Pradeep Kumar
Keyword(s):  
Histopathological Examination ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Polypoid Mass ◽  
Histologic Diagnosis ◽  
Surgical Specimen ◽  
Stromal Component ◽  
Poorly Differentiated ◽  
Post Menopausal ◽  
Formalin Fixed

Background and objectives Mullerian adenosarcoma is an uncommon variant of mixed mesodermal tumour of the uterus. This is a case report of a 65 year old post-menopausal lady who presented with complaints of passing tissue fragments per vaginum for 2 days followed by spotting. On examination, a polypoid mass protruding through the cervix was seen which was biopsied. Following a preliminary histologic diagnosis of poorly differentiated sarcoma on the biopsy; the patient underwent total abdominal hysterectomy with bilateral salpingo-oopherectomy. Method The surgical specimen was formalin fixed and paraffin embedded. Haematoxylin and eosin stained sections were studied. Result and conclusion Histopathological examination of the polypoid mass revealed a tumour comprising of an admixture of benign endometrial glandular component with overgrowth of sarcomatous stromal component and heterologous elements. This may pose a problem in diagnosis due to its rarity, and hence its distinctive morphological features merit attention as described here. In view of the rarity of this tumor, it is mandatory to do extensive histologic sampling to identify areas of sarcomatous overgrowth before arriving at a diagnosis of mullerian adenosarcoma as the clinical course and management vary.

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