Mullerian anomaly - Uterus didelphys

 A 15 years girl presented with pain abdomen, MRI showed Mullerian anomaly - Uterus didelphys with normal vagina. Had right side hematometra and hematosalpinx due to blind end cervix. 

For more details : https://youtu.be/R5G4YxRtstM

Different types of fibroids

Intramural, Cervical and anterior wall fibroids respectively

Tubo-ovarian mass

Fibroid before menarche

A 13 year old female who has not yet attained menarche came with complaints of pain abdomen. In ultrasound ovarian cyst of 10.9 x 5.5 cm along with uterine fibroid of 3.2 x 2.8 cm diagnosed.

Broad ligament fibroid

A 42 years old woman presented with pain abdomen for 3 days surprisingly diagnosed to have a very large broad ligament fibroid.

Pregnancy with intrauterine contraceptive device in situ.

Recently have seen a woman with 6 weeks pregnancy with intrauterine contraceptive device in situ. She is G3P2L2 with one and half months of amenorrhea with previous normal deliveries.

Twin Gestation

A 27 year old patient with an Obstetric history of G3D2L0 with twin gestation with preeclampsia delivered vaginally at 36 weeks. 

Both babies were in breech position and delivered by assisted breech delivery. First one male with 2.15 kgs and second one female with 1.75 kgs.

The placenta was monochorionic and diamniotic.

Mass in adnexa, not Ovaraian or Fallopian or Paraovarian

A 31 years female presented with pain abdomen ultrasound and CT scan showed a mass in the pelvis between the uterus and bladder with around 10 cms diameter.
At laparotomy around 10 * 10 cms irregular mass found which was not arising from either the ovary or fallopian tube.

Suspected tubercular pathology, uterus also was showing tubercles like structures on the surface.
So, mass removed by clamping and cutting the pedicle  and sent for hystopathological examination.
Montoux test gave positive result and specimen report awaited.  No previous history of tuberculosis, according to the patient.

The histopathology report is:

Water from uterus not liquor

A 40 yrs old lady presented with mass per abdomen with around 22 weeks size.

Ultrasound report was like this.              

CA 125 and CEA were :                    

 

 Went for CECT abdomen and pelvis:

When  abdomeno and uterus holded with instrument clear water like fluid came out.🙄

Indicating degenerated fibroid😅. 

Diagnosis may change during surgery!

A 45 years old lady presented with abdominal mass with loss of weight. According to history and MRI

Ovarian mass suspected.
But surgical findings were different, it was a degenerated broad ligament fibroid.

Happy New Year

Huge dermoid cyst

A 55 yrs old postmenopausal lady presented with distension of abdomen since 6 months.

CECT report was

In laparotomy there was huge cystic mass with multiple lobes.

The histopathology report is          

       

Uterine didelphys with right side hematometra, right hematosalpinx and right endometriotic cyst

A 23 years old woman presented with dysmenorrhoea which is gradually increasing severe since 5 to 6 months.
MRI was like this

Case was posted for laparotomy. During surgery uterine didelphys with blind right side uterus with hematometra, right hematosalpinx and right endometriotic cyst were noted.

Right side uterus with hematometra right hematosalpinx and right endometriotic cyst

The left side uterus, fallopian tube and ovary were normal.

Right side uterus had blind end cervix.

Right side uterus with hematometra, hematosalpinx and endometriotic cyst were removed.

Giant fibroid uterus

Posthysterectomy ovarian cyst with adhesions

A 38 yrs old lady who underwent hysterotomy in a town around 10 yrs back due to abnormal uterine bleeding, prented with ovarian cyst.
While doing laparoscopy, there was plenty of adhesions. Due to which total removal of cyst was not possible. So, fluid drained from the cyst, part of cyst wall removed and drain kept.

Bicornuate uterus

Bicornuate uterus or heart shaped uterus is a condition wherein the uterus consists of two-horn shaped projections. Partitioned by a septum, which separates these two horns.
Cesarean section was done to a woman with bicornuate uterus by our colleague.

Ovarian cyst with torsion got ruptured

A 20 yrs unmarried woman presented with abdominal pain since two days which became severe since 8 hrs.
Ultrasound releaved large ovarian cyst of 7.8*5.6cm with possibility of torsion with minimal free fluid in abdomen. She was giving the history of fever with vomitings also with raised total WBC count.
She was immediately takenup for laparoscopy, in which ruptured ovarian cyst found, which might have ruptured after torsion.

Ovarian cyst with twisted pedicle

Hemorrhagic fluid collection due to rupture 

https://srsree.blogspot.com/2013/11/ovarian-tumors-management-of-ovarian.html?m=1

Intrauterine fetal demise

A 22 yrs old woman presented with intrauterine fetal demise at 17 to 18 weeks.
Death of the fetus diagnosed on routine ultrasound examination.

Ultrasound showing cardiac standstill 

Marriage was consaguinous  otherwise no factors noted relating to fetal demise.
Delivery of dead fetus required induction with foley's bulb, followed by misoprostol tablets then oxytocin drip in around 38 to 40 hours. Fetus expelled but removal of placenta needed anesthesia.

Macerated fetus indicating intrauterine death 

Cervical fibroid and broad ligament fibroid

Cervical fibroid

Broad ligament fibroid 

https://srsree.blogspot.com/2013/11/fibroids-part-1.html?m=1

Holt-Oram syndrome

A 23 years old primi presented with baby with Holt-Oram syndrome, also called as heart hand syndrome.
Which is an autosomal dominant syndrome with almost 50% recurrence rate.
This disease usually occurs due to mutations in the transcription factor TBX5, which is important in the development of both the heart and upper limbs.
This baby was around 20 weeks with absence of radius of right upper limb and hypo plastic heart.

Ovarian ectopic pregnancy at 34 weeks

This is a very very rare and interesting

case where fetus grown upto 34 weeks in ovarian ectopic pregnancy
Delivered an alive baby by laparotomy
This happened in Davanagere Government hospital, Karnataka, INDIA.

https://srsree.blogspot.com/2012/02/ectopic-pregnancy-types-diagnosis-and.html?m=1

Case of threatened abortion , part 2

The ultrasound has given an indication that the pregnancy may not be continued with the findings that the gestational sac is irregular and it is moved to the lower body of the uterus and the Heartbeat was also decreasing.
Even after taking all the medical measures the patient aborted within 1 hour after taking the ultrasound.
The possible causes of abortion here are:
Mild elevation of TSH was noted compared with first trimester pregnancy.
Not maintaining abstinence.

So, once process of abortion is started, sometimes we can not save even after taking all precautions.
The measures that can help to some extent are:
Undergoing all necessary investigations in the first visit itself and taking necessary treatment.
Staring Folic acid supplements at least one month before the pregnancy.
If spotting noted, taking beta hcg and progesterone supplementation.
Strict abstinence and being in rest.
In case of vaginal infection, swab for culture and sensitivity and treating accordingly may help.

Case of threatened abortion , part 1

This about a case of threatened abortion.
A 22 years old female conceived spontaneously, presented to gynec op at around 6 weeks 3 days.
Ultrasound was done and pregnancy was confirmed. All blood investigations came normal  thyroid report was awaited.
Then after 4 days she came with complaint of spotting per vaginum, ultrasound was repeated, minimum amount of subchorionic hemorrhage was found. 
For which injection of micronized progesterone and tablet forms of micronized progesterone were advised and strict bed rest, abstinence, avoid to lift weights etc were advised
But the bleeding was persistent associated with pain abdomen and the scan was repeated the report was

Multiple fibroids

A P1D1A1 woman presented with multiple fibroids, underwent open myomectomy.

Small to large size fibroids removed during myomectomy.
https://srsree.blogspot.com/2013/11/fibroids-part-1.html?m=1

Broad ligament fibroid

A case of large broad ligament fibroid.