Case Reports in Obstetrics and Gynecology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Prenatal Diagnosis of a Fetus with Ring Chromosomal 15 by Two- and Three-Dimensional Ultrasonography Mon, 20 Oct 2014 06:31:13 +0000 We report on a prenatal diagnosis of ring chromosome 15 in a fetus with left congenital diaphragmatic hernia (CDH) and severe intrauterine growth restriction (IUGR). A 31-year-old woman, gravida 2 para 1, was referred because of increased nuchal translucency at gestational age of 13 weeks. Comprehensive fetal ultrasound examination was performed at 19 weeks revealing an early onset IUGR, left CDH with liver herniation, and hypoplastic nasal bone. Three-dimensional ultrasound (rendering mode) showed low set ears and depressed nasal bridge. Amniocentesis was performed with a result of a 46,XX,r(15) fetus after a cytogenetic study. A 1,430 g infant (less than third percentile) was born at 36 weeks. The infant presented with respiratory failure and died at 2 h of life. Postnatal karyotype from the umbilical cord confirmed the diagnosis of 15-ring chromosome. We described the main prenatal 2D- and 3D-ultrasound findings associated with ring chromosome 15. The interest in reporting the present case is that CDH can be associated with the diagnosis of 15-ring chromosome because the critical location of the normal diaphragm development is at chromosome 15q26.1-q26.2. Ingrid Schwach Werneck Britto, Sandra Regina Silva Herbest, Giselle Darahem Tedesco, Carolina Leite Drummond, Luiz Claudio Silva Bussamra, Edward Araujo Júnior, Rodrigo Ruano, Simone Hernandez Ruano, and José Mendes Aldrighi Copyright © 2014 Ingrid Schwach Werneck Britto et al. All rights reserved. Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy Tue, 14 Oct 2014 11:53:36 +0000 Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function. Kelly L. Pieh-Holder, Heidi Bell, Tana Hall, and James E. DeVente Copyright © 2014 Kelly L. Pieh-Holder et al. All rights reserved. A Case of Misdiagnosed Cesarean Scar Pregnancy with a Viable Birth at 28 Weeks Tue, 14 Oct 2014 00:00:00 +0000 We report our experience with a case of presumptive cesarean scar pregnancy, based on detection of a gestational sac (GS) in early pregnancy at the site of a previous cesarean scar. The GS grew into the uterine cavity as the pregnancy progressed, showing an ultrasound image similar to that of a normal pregnancy. Thus, the pregnancy continued, resulting in a viable birth at 28 weeks of gestation. Cesarean scar pregnancy is classified as myometrial implantation or implantation growth into the uterine cavity. In the latter type, the gestational sac moves upward with increasing gestational weeks and it shows the same ultrasound image as a normal pregnancy. Therefore, the diagnosis must be made in the early pregnancy. Sakiko Nukaga, Shigeru Aoki, Kentaro Kurasawa, Tsuneo Takahashi, and Fumiki Hirahara Copyright © 2014 Sakiko Nukaga et al. All rights reserved. Surgical Management of Massive Labial Edema in a Gravid Preeclamptic Diabetic Sun, 12 Oct 2014 11:54:36 +0000 Background. Massive labial edema is a rare complication during pregnancy that can jeopardize vaginal delivery, as well as leading to maternal and fetal morbidity. It can be related to systemic pathologies, but has been commonly associated with preeclampsia and diabetes. This increased and sometimes longstanding pressure may result in a “labial compartment syndrome” leading to microvascular damage and tissue necrosis if not resolved in a timely fashion. Case. Massive labial edema was treated first conservatively and then surgically in a gravid diabetic patient with severe preeclampsia. Immediately after Cesarean section, the labial compartment syndrome was relieved surgically and resolved rapidly. Conclusion. When conservative attempts at management of labial edema fail, or rapid resolution is critical to maternal and fetal outcome, surgical alternatives should be considered. Jennifer S. Lindsey and James E. DeVente Copyright © 2014 Jennifer S. Lindsey and James E. DeVente. All rights reserved. Disseminated Cancer in Pregnancy: Krukenberg Tumour Tue, 07 Oct 2014 08:20:00 +0000 Disseminated cancer presenting in pregnancy is extremely rare and its presentation can easily be obscured by pregnancy and physiological changes that occur with it. This case describes a patient who was diagnosed incidentally following investigations for preeclampsia. Despite initially being thought to be of low risk, the final diagnosis was that of metastasis from a primary cancer of an unknown origin, most likely a gastric adenocarcinoma. Although patients are under thorough observation throughout their pregnancy, this case highlights the potential need for additional investigations or adjustment of current practices. It also draws attention to the lack of sufficient reporting of cancer in pregnancy, which, considering its rarity, greatly influences how patients are managed. Sung-Hee Kim, Siti Rahimah Abd Halim, Naila Siddiqui, and Won-Ho Edward Park Copyright © 2014 Sung-Hee Kim et al. All rights reserved. Pregnancy following Radical Resection of Solid Pseudopapillary Tumor of the Pancreas Wed, 01 Oct 2014 11:03:07 +0000 Solid pseudopapillary tumor of the pancreas is a rare tumor seen in predominately young women and carries a low malignant potential. We discuss a patient, who presented to our high risk clinic, with a clinical history of solid pseudopapillary tumor of the pancreas, predating her pregnancy. The patient had undergone previous surgery and imaging which had excluded recurrence of disease; however, increased attention was paid to the patient during her pregnancy secondary to elevated hormonal levels of progesterone, which any residual disease would have a heightened sensitivity to. In cases of pregnant patients with a history of pancreatic tumors, a multidisciplinary approach with maternal fetal medicine, medicine, and general surgery is appropriate and can result in a healthy mother and healthy term infant. James M. O’Brien, Debra Gussman, Ellen Hagopian, and Theodore Matulewicz Copyright © 2014 James M. O’Brien et al. All rights reserved. Isolated Abdominal Wall Metastasis of Endometrial Carcinoma Tue, 30 Sep 2014 11:43:30 +0000 A woman in her mid-60s presented with a bulky mass on the anterior abdominal wall. She had a previous incidental diagnosis of endometrial adenocarcinoma FIGO stage IB following a vaginal hysterectomy. Physical exam and imaging revealed a well circumscribed bulging tumour at the umbilical region, measuring 10 × 9 × 9 cm, with overlying intact skin and subcutaneous tissue. Surgical resection was undertaken, and histological examination showed features of endometrial carcinoma. She began chemotherapy and is alive with no signs of recurrent disease one year after surgery. This case brings up to light an atypical location of a solitary metastasis of endometrial carcinoma. Rita Luz, Rui Leal, Jorge Simões, Matilde Gonçalves, and Isabel Matos Copyright © 2014 Rita Luz et al. All rights reserved. Short and Long Term Outcomes Associated with Fetal Cholelithiasis: A Report of Two Cases with Antenatal Diagnosis and Postnatal Follow-Up Tue, 30 Sep 2014 09:00:58 +0000 The aims of this study were to present and discuss ultrasound findings of prenatal fetal cholelithiasis in two cases with different etiology and evolution. Case 1: a pregnant woman from sub-Saharan Africa, suffering from Lyme disease, was treated with ceftriaxone sodium. Six weeks later, biliary sludge associated with polyhydramnios was detected in the fetus and the fetal growth percentile was 14. Emergency caesarean was performed at 36 weeks of gestation due to fetal distress. Biliary sludge persists in the two-and-a-half-year-old child. Case 2: the fetus of a Caucasian woman with normal pregnancy showed multiple cholelithiasis associated with polyhydramnios at 31 weeks of gestation. At 39 weeks and 4 days, cesarean section was performed due to lack of dilation. The biliary disease resolved spontaneously at seven months of age, with no associated abnormalities. In conclusion, prenatal diagnosis of cholelithiasis is straightforward, but prognosis cannot be defined yet. Serious complications do not arise in 70% of cases, but severe diseases may ensue in 20%. Persistence of cholelithiasis after one year of age results in cholelithiasis in childhood and beyond. Biliary sludge is associated with worse prognosis than cholelithiasis when it appears before 28 weeks of gestation. Juan Troyano-Luque, Ana Padilla-Pérez, Ingrid Martínez-Wallin, Margarita Álvarez de la Rosa, Salvatore Andrea Mastrolia, José Luis Trujillo, and Tirso Pérez-Medina Copyright © 2014 Juan Troyano-Luque et al. All rights reserved. Recurrent Catamenial Pneumothorax Suggestive of Pleural Endometriosis Tue, 30 Sep 2014 00:00:00 +0000 A 42-year-old multiparous patient presented for consultation as a referral for management of recurrent catamenial pneumothorax. Evaluation by a pulmonologist failed to reveal any chest masses. She was treated for endometriosis using Danazol 800 mg daily for 6 months. Pneumothorax did not recur during treatment and during follow-up visits. Shawky Z. A. Badawy and Pujan Shrestha Copyright © 2014 Shawky Z. A. Badawy and Pujan Shrestha. All rights reserved. Obturator Nerve Injury: An Infrequent Complication of TOT Procedure Mon, 29 Sep 2014 11:15:40 +0000 Transvaginal mid-urethral slings have become the most preferred surgical treatment option for female stress urinary incontinence. However, various complications have been reported for these operations occurring especially during penetration of the retropubic space. It can negatively affect patient’s quality of life. Early treatment increases the chance of complete normalization of the functions. In this case report we presented a case of obturator nerve damage that was diagnosed and treated at early stage after TOT operation. S. Aydogmus, S. Kelekci, H. Aydogmus, E. Ekmekci, Y. Secil, and S. Ture Copyright © 2014 S. Aydogmus et al. All rights reserved. The Giant Condyloma (Buschke-Löwenstein Tumor) in the Immunocompromised Patient Thu, 25 Sep 2014 06:46:13 +0000 Since Buschke and Löwenstein first described the giant condyloma in 1925 (which subsequently was named Buschke-Löwenstein tumor), there have been scattered reports over the past 90 years describing presentation and different avenues of treatment for patients with this condition. It is well known that immunocompromised individuals are at an increased risk of anogenital disease caused by human papillomavirus (HPV). In this report, we present the management of two HIV positive patients with giant condylomas. Both patients presented with urinary outflow obstruction and sepsis. Though giant condylomas are a rare phenomenon, these two cases underscore the importance of early treatment intervention, especially in the immunocompromised patient. Andrew L. Atkinson, Nicole Pursell, and Abinet Sisay Copyright © 2014 Andrew L. Atkinson et al. All rights reserved. A Case of Fetal Parvovirus B19 Myocarditis That Caused Terminal Heart Failure Thu, 25 Sep 2014 00:00:00 +0000 Parvovirus B19 is a well-established cause of fetal anemia and nonimmune fetal hydrops in pregnancy. Fetal parvovirus infection can cause severe destruction of erythroid progenitor cells, resulting in fetal anemia, hydrops, and intrauterine death. However, viral myocarditis with subsequent heart failure is another possible mechanism for hydrops formation as viral infection of fetal myocardial cells has been reported in postmortem examinations. We herein report a case of fetal cardiomegaly and massive pericardial effusion secondary to myocarditis as a result of parvovirus B19 infection. The case developed hydrops as consequence of severe anemia and experienced terminal heart failure, which led to the fetus dying an intrauterine death at 22 weeks of gestation. This case demonstrates that there may be an association between myocarditis caused by intrauterine parvovirus B19 infection and a poor outcome. The presence of viral myocarditis may be the determining prognostic factor in that situation. Atsuko Hichijo and Mikio Morine Copyright © 2014 Atsuko Hichijo and Mikio Morine. All rights reserved. HELLP Syndrome and Cerebral Venous Sinus Thrombosis Associated with Factor V Leiden Mutation during Pregnancy Wed, 17 Sep 2014 00:00:00 +0000 Preeclampsia is a leading cause of maternal mortality and morbidity worldwide. The neurological complications of preeclampsia and eclampsia are responsible for a major proportion of the morbidity and mortality for women and their infants alike. Hormonal changes during pregnancy and the puerperium carry an increased risk of venous thromboembolism including cerebral venous sinus thrombosis (CVST). Factor 5 leiden (FVL) is a procoagulant mutation associated primarily with venous thrombosis and pregnancy complications. We report a patient with FVL mutation who presented with CVST at 24th week of pregnancy and was diagnosed as HELLP syndrome at 34th week of pregnancy. Zeynep Ozcan Dag, Yuksel Işik, Yavuz Simsek, Ozlem Banu Tulmac, and Demet Demiray Copyright © 2014 Zeynep Ozcan Dag et al. All rights reserved. An Unusual Gross Appearance of Vulval Tuberculosis Masquerading as Tumor Sun, 14 Sep 2014 11:42:35 +0000 Tuberculosis of the vulva is very rare. It is found in about 0.2% of the cases of genital tract tuberculosis. It usually presents as small shallow ulcers and multiple sinus tracts or rarely as elephantiasis of vulva. Except for very rare cases of primary tuberculosis in the vulva, it is usually associated with tuberculosis elsewhere in the body leading to secondary tuberculosis. Here, we report a case of secondary vulval tuberculosis which presented as a vulval mass in a 40-year-old female patient. The rarity of this presentation in the female genital tract is emphasized. Surekha U. Arakeri and Prachi Sinkar Copyright © 2014 Surekha U. Arakeri and Prachi Sinkar. All rights reserved. Color Doppler Score: A New Approach for Monitoring a Large Placental Chorioangioma Wed, 10 Sep 2014 05:53:34 +0000 We employed color Doppler score as an innovative approach for the prenatal diagnosis and monitoring of a large placental chorioangioma case diagnosed at 26 weeks and the subjective semiquantitative assessment of the vascularization. The blood flow was assessed by a color Doppler score based on the intensity of the color signal with the following value ranges: (1) no flow, (2) minimal flow, (3) moderate flow, and (4) high vascular flow. Weekly examinations were programmed. Initially, a color Doppler score 3 was assigned, remaining unchanged at the following two exams and decreasing to Score 2 in the following 2 exams and to Score 1 thereafter. The ultrasonographic scan showed an increase of the mass size at the second and third exams and was followed by an arrest of the growth persisting for the rest of the pregnancy. Some hyperechogenic spots inside the mass appeared at the end. Expectant management was opted for, and the delivery was at 39, 2 weeks and maternal and fetal outcomes were favourable. The color Doppler score employed for assessment of vascularization in successive examinations proved to be an important tool for the prediction of the chorioangioma involution, and this new approach of monitoring allowed effective surveillance and successful tailored management. Maria Angelica Zoppi, Alessandra Piras, Ambra Iuculano, Maurizio Arras, Federica Mulas, Maria Carmela Fadda, Sergio Cossu, and Giovanni Monni Copyright © 2014 Maria Angelica Zoppi et al. All rights reserved. Unusually High Levels of CA19-9 Associated with Mature Cystic Teratoma of the Ovary Mon, 08 Sep 2014 00:00:00 +0000 Introduction. Mature cystic teratoma is the benign tumor of the ovary. CA19-9 levels, although a marker of pancreatic malignancy, have been found to be raised in large ovarian mature cystic teratomas. Case Report. We report a case of a young female who had unusually high levels of CA19-9 in the blood associated with large ovarian mature cystic teratoma. The levels returned to normal 12 weeks after cystectomy was performed. Conclusion. This case highlights the fact that although raised tumor marker may be associated with a benign pathology thorough evaluation to rule out malignancy still must be done. Monika Madaan, Manju Puri, Ritu Sharma, Harvinder Kaur, and Shubha Sagar Trivedi Copyright © 2014 Monika Madaan et al. All rights reserved. Intraperitoneal Solitary Fibrous Tumor Sun, 07 Sep 2014 05:53:26 +0000 Solitary fibrous tumors of the pelvis are rare. We report the case of a 32-years-old patient who presented with abdominopelvic mass. The imaging studies showed a right adnexal mass of more than 10 cm. Exploratory laparotomy revealed a 20 cm mass at the Douglas pouch which was adhered to the posterior wall of the uterus. Complete resection of the mass was performed. Histological analysis showed a spindle cell undifferentiated tumor whose morphological and immunohistochemical profile are consistent with solitary fibrous tumor. It is important to know that although these tumors are rare, their evolution can be pejorative. Therefore, long-term followup should be recommended. Youssef Benabdejlil, Jaouad Kouach, Abdellah Babahabib, Moulay Elmehdi Elhassani, Issam Rharassi, Adil Boudhas, Hicham Bakkali, Mohammed Elmarjany, Driss Moussaoui, and Mohamed Dehayni Copyright © 2014 Youssef Benabdejlil et al. All rights reserved. Missing IUD Despite Threads at the Cervix Wed, 27 Aug 2014 06:12:54 +0000 Today, the intrauterine device (IUD) is by far the most popular form of long term reversible contraception in the world. Side effects from the IUD are minimal and complications are rare. Uterine perforation and migration of the IUD outside the uterine cavity are the most serious complications. Physician visualization and/or the patient feeling retrieval threads at the cervical os are confirmation that the IUD has not been expelled or migrated. We present a case of a perforated, intraperitoneal IUD with threads noted at the cervical os. Office removal was not possible using gentle traction on the threads. Multiple imaging and endoscopic modalities were used to try and locate the IUD including pelvic ultrasound, diagnostic hysteroscopy, cystoscopy, and pelvic magnetic resonance imaging (MRI). The studies gave conflicting results on location of the IUD. Ultimately, the missing IUD was removed via laparoscopy. Andrew L. Atkinson and Jonathan D. Baum Copyright © 2014 Andrew L. Atkinson and Jonathan D. Baum. All rights reserved. Coronary Arteriovenous Fistula Causing Hydrops Fetalis Tue, 26 Aug 2014 11:46:36 +0000 Fetal heart failure and hydrops fetalis may occur due to systemic arteriovenous fistula because of increased cardiac output. Arteriovenous fistula of the central nervous system, liver, bone or vascular tumors such as sacrococcygeal teratoma were previously reported to be causes of intrauterine heart failure. However, coronary arteriovenous fistula was not reported as a cause of fetal heart failure previously. It is a rare pathology comprising 0.2–0.4% of all congenital heart diseases even during postnatal life. Some may remain asymptomatic for many years and diagnosed by auscultation of a continuous murmur during a routine examination, while a larger fistulous coronary artery opening to a low pressure cardiac chamber may cause ischemia of the affected myocardial region due to steal phenomenon and may present with cardiomyopathy or congestive heart failure during childhood. We herein report a neonate with coronary arteriovenous fistula between the left main coronary artery and the right ventricular apex, who presented with hydrops fetalis during the third trimester of pregnancy. Nilüfer Çetiner, Sinem Altunyuva Usta, and Figen Akalın Copyright © 2014 Nilüfer Çetiner et al. All rights reserved. Huge Benign Ovarian Cystic Teratoma in a Patient with a History of Hansen’s Disease Tue, 26 Aug 2014 00:00:00 +0000 Mature ovarian cystic teratomas are common benign ovarian neoplasm derived from germ cells. With increasing availability of ultrasound services even in developing countries, the diagnosis of benign ovarian tumour is made earlier and the size of the ovarian tumour at diagnosis is relatively small. It is unusual to find an ovarian cystic teratoma larger than 10 cm. We report a huge mature ovarian cystic teratoma in a multipara with a history of Hansen’s disease. We conclude that, in circumstances where women have restricted access to health care, the unusual finding of mature ovarian cystic teratoma larger than 10 cm is possible due to delayed presentation for diagnosis and treatment. Patrick I. Okonta and Chukwuemeke Mofon Copyright © 2014 Patrick I. Okonta and Chukwuemeke Mofon. All rights reserved. A Therapeutic Challenge: Liddle’s Syndrome Managed with Amiloride during Pregnancy Mon, 25 Aug 2014 05:55:53 +0000 Liddle’s syndrome (LS) is a rare heritable form of hypertension that often affects young patients. It is caused by gain-of-function mutations of the kidney epithelial sodium channel (ENaC) and it is classically associated with hypokalemia and suppression of renin and aldosterone. LS is characterized by responsiveness to ENaC inhibitors but not to mineralocorticoid receptor inhibitors. Consequently the most effective treatment is amiloride. This drug is not used in pregnancy, as it has not been sufficiently studied during gestation. However for pregnant LS patient amiloride is the most effective drug in decreasing blood pressure. Herein we report the case of a LS patient, who has been followed up by a multidisciplinary teamwork during her first pregnancy. Hypertension worsened after the 25th week of gestation and amiloride was safely administered, firstly in combination with hydrochlorothiazide (the only formulation commercially available in Italy) and, thereafter, as a single drug. Genetic testing was performed in the patient’s family in order to support diagnosis and clinical management. Amelia Caretto, Liviana Primerano, Francesca Novara, Orsetta Zuffardi, Stefano Genovese, and Maurizio Rondinelli Copyright © 2014 Amelia Caretto et al. All rights reserved. An Unusual Case of Fulminant Type 1 Diabetes during the Second Trimester of Pregnancy Mon, 11 Aug 2014 08:31:04 +0000 Fulminant type 1 diabetes is a new subtype of rapid-onset type 1 diabetes, with pancreatic exocrine dysfunction, that usually develops during the third trimester of pregnancy. We describe a patient with fulminant type 1 diabetes onset during her second trimester, resulting in premature delivery. The 34-year-old woman, without any known risk factors for diabetes mellitus, experienced a sudden stillbirth at 24-weeks gestation. Her blood glucose level was 950 mg/dL and she was positive for urine ketone bodies. The condition met all the diagnostic criteria for fulminant type 1 diabetes, and was diagnosed as such. Although this disease is rare, its progression is rapid, and its clinical course is severe and occasionally leads to death; therefore, a full knowledge of the disease is important to facilitate an accurate diagnosis. Tomohiro Okuda, Sadao Yamashita, Yoshio Ogino, Hisashi Kataoka, and Jo Kitawaki Copyright © 2014 Tomohiro Okuda et al. All rights reserved. An Uncommon Case of Bilateral Peroneal Nerve Palsy following Delivery: A Case Report and Review of the Literature Mon, 11 Aug 2014 00:00:00 +0000 Peroneal nerve palsy is an infrequent but potential complication of childbirth. Bilateral peroneal palsy is particularly rare following delivery with few reported cases. A 38-year-old gravida 1, para 0 underwent a prolonged second stage of labor, was diagnosed with an arrest of descent, and subsequently underwent an uncomplicated primary cesarean section. The patient was diagnosed with bilateral peroneal neuropathy four days after delivery. By two months postpartum, her foot drop had improved by 85% and the remainder of her symptoms resolved. Awareness of the risks of a peroneal neuropathy as well as implementation of preventive measures is important for members of the delivery team. Regional anesthesia during labor is a risk factor for the development of a peroneal neuropathy. Kristen Bunch and Erica Hope Copyright © 2014 Kristen Bunch and Erica Hope. All rights reserved. 18 F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography-Positive Lymph Node Endometriosis Masquerading as Lymph Node Metastasis of a Malignant Tumor Sun, 10 Aug 2014 08:28:36 +0000 Endometriosis is defined as the presence of endometrium-like tissues at extrauterine sites, most commonly in the abdominal cavity. Lymph node endometriosis is a rare but clinically important type of endometriosis that can mimic lymph node metastasis of a malignant tumor. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is a useful tool for diagnosing malignant tumors, although it occasionally shows false positive results in tissues with high metabolic activity caused by severe inflammation. In the present report, we describe a case of lymph node endometriosis that mimicked lymph node metastasis of a malignant tumor and showed a positive result on 18F-FDG PET/CT. The findings of the present case suggest that lymph node endometriosis could present as swollen lymph nodes with 18F-FDG PET/CT-positive results and provide important information for determining an appropriate treatment strategy. Makoto Akiyama, Izumi Suganuma, Taisuke Mori, Izumi Kusuki, Haruo Kuroboshi, Fumitake Ito, Hiroshi Matsushima, Morio Sawada, and Jo Kitawaki Copyright © 2014 Makoto Akiyama et al. All rights reserved. Deep Endometriosis Induced Spontaneous Colon Rectal Perforation in Pregnancy: Laparoscopy Is Advanced Tool to Confirm Diagnosis Tue, 05 Aug 2014 09:48:14 +0000 Endometriosis causes rare complications in pregnancy, such as obstetrical bleeding, preterm birth, spontaneous haemoperitoneum, and intestinal perforation. The prevalence of spontaneous perforation due to intestinal endometriosis is unknown in pregnancy. A recent review of the literature indicated 15 bowel complications caused by endometriosis during pregnancy or at the immediate postpartum period. The diagnosis of a bowel perforation can be difficult and in all of the cases reported necessitates an exploratory laparotomy. Anyway, in the majority of cases bowel perforation is not diagnosed during this laparotomy, and a repeat laparotomy is needed. Laparoscopy is being used increasingly in the diagnosis and operative management of acute abdomen. Laparoscopy can be a useful means of diagnosis and in addition a therapeutic tool in selected pregnant patients with abdominal pain. We report the first case of a pregnant woman with spontaneous double sigmoid and rectal perforation from decidualized endometriosis diagnosed by laparoscopy. Aurelio Costa, Annalisa Sartini, Silvia Garibaldi, and Marco Cencini Copyright © 2014 Aurelio Costa et al. All rights reserved. Management and Follow-Up of a Case of Gestational Gigantomastia in a Brazilian Hospital Mon, 04 Aug 2014 13:29:30 +0000 Gigantomastia is a breast disorder that is associated with an exaggerated, rapid growth of the breasts, generally bilaterally. Since the pathology is rare and has seldom been described, its etiology has yet to be fully established, although there are speculations that a hormonal component may play an important role. Treatment is aimed at improving the clinical and psychological symptoms; however, the best therapeutic option varies from case to case. The present report describes a case of gestational gigantomastia seen at the Department of Obstetrics and Gynecology of the Hospital da Santa Casa de Misericórdia, Vitória, Espírito Santo, Brazil, in a primigravida in the second trimester of pregnancy. The report follows this patient from her diagnosis until the completion of treatment with a third and final surgical procedure. Pollyana Eler dos Reis, Natalia Quarto Blunck Santos, Fernanda Alves Barbosa Pagio, Fabio Chambô, Danielle Chambô, and Antônio Chambô Filho Copyright © 2014 Pollyana Eler dos Reis et al. All rights reserved. Delayed Recognition of a Rare Mediastinal Lymphoma Presenting as Postpartum Circulatory Collapse Mon, 04 Aug 2014 06:46:01 +0000 We report a case of a 29-year-old primigravida at 36 weeks of gestation following an emergency caesarean section, complicated by respiratory distress and multiorgan failure secondary to superior vena cava (SVC) obstruction, requiring intubation and prolonged ventilatory support. The presented case highlights the consequences of delayed recognition of SVC obstruction due to a reluctance to undertake appropriate radiological imaging during pregnancy. Jasmina Kevric, Sanil Nair, and David Ernest Copyright © 2014 Jasmina Kevric et al. All rights reserved. Retracted: Intravenous Leiomyoma with Extension to the Heart: A Case Report and Review of the Literature Sun, 03 Aug 2014 00:00:00 +0000 Case Reports in Obstetrics and Gynecology Copyright © 2014 Case Reports in Obstetrics and Gynecology. All rights reserved. Splenic Metastasis of Squamous Cell Carcinoma of the Uterine Cervix: A Case Report and Review of the Literature Thu, 24 Jul 2014 00:00:00 +0000 Metastasis from various neoplasms to the spleen is very rare and most of the cases are found at autopsy. We report a patient presenting with uterine cervical cancer with splenic metastases. A 49-year-old woman presenting with genital bleeding was referred to our hospital and diagnosed with stage IIB cervical cancer. She underwent concomitant chemoradiotherapy (CCRT) consisting of 50 Gy whole pelvis irradiation, high-dose-rate intracavitary brachytherapy 24 Gy/4 fractions and six weeks of paclitaxel and carboplatin administration. Ten months after the initial therapy, CT revealed recurrence at spleen. Although she received 5 courses of nedaplatin, enlargement of the tumor was noticed. She underwent a splenectomy and the result of histology was compatible with metastasis of cervical cancer. Shigeki Taga, Mari Sawada, Aya Nagai, Dan Yamamoto, and Ryoji Hayase Copyright © 2014 Shigeki Taga et al. All rights reserved. Vesicoovarian Fistula on an Endometriosis Abscessed Cyst Thu, 24 Jul 2014 00:00:00 +0000 We report the case of a patient who developed a vesicoovarian fistula on an endometriosis abscessed cyst. The patient presented with an advanced endometriosis stage IV complicated with a right ovarian abscessed cyst of 10 cm. A first coelioscopy with cystectomy was realized. After surgery, a voiding cystography highlighted a fistula between the ovarian abscess and the bladder. A second surgery by median laparotomy was realized with the resection of the right ovarian abscess and the resection of vesical fistula. C. Tran, M. Even, M. Carbonnel, F. Preaux, F. Isnard, A. Rault, M. Rouanne, and J. M. Ayoubi Copyright © 2014 C. Tran et al. All rights reserved.