Case Reports in Obstetrics and Gynecology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Delayed Interval Delivery following Early Loss of the Leading Twin Thu, 22 Jan 2015 08:33:46 +0000 This was a case of a nulliparous woman with reduced chance of conception following unilateral salpingectomy and years of infertility. She eventually conceived following ovulation induction resulting in twin pregnancy. She had miscarriage that led to loss of one of the twins at 17 weeks of gestational age. The pregnancy was however continued for 116 days following meticulous management with eventual delivery of a live female baby with good outcome. P. C. Udealor, I. V. Ezeome, F. C. Emegoakor, D. O. Okeke, and P. C. N. Okere Copyright © 2015 P. C. Udealor et al. All rights reserved. Intrapartum Intrauterine Fetal Demise with Normal Umbilical Cord Blood Gas Values at Birth Mon, 19 Jan 2015 09:42:35 +0000 A case is presented in which a fetus was delivered by cesarean section for failure to progress and a “nonreassuring heart rate tracing” in which the Apgar scores were unexpectedly 0 at 1, 5, and 10 minutes. Resuscitation was unsuccessful after 30 minutes. The venous cord gas was normal and the arterial blood gas was not consistent with intrapartum asphyxia. At the time of surgery, the placenta appeared grossly normal. The autopsy was entirely normal. This case raises questions about our understanding of intrauterine fetal demise and suggests an approach to future research. Michael D. Benson Copyright © 2015 Michael D. Benson. All rights reserved. Primary Vaginal Myeloid Sarcoma: A Rare Case Report and Review of the Literature Sun, 18 Jan 2015 13:34:12 +0000 Myeloid sarcoma (chloroma, granulocytic sarcoma, or extramedullary myeloid tumour) is an extramedullary mass forming neoplasm composed of myeloid precursor cells. It is usually associated with myeloproliferative disorders but very rarely may precede the onset of leukemia. Here, we are presenting a rare case of primary vaginal myeloid sarcoma in a geriatric female patient without initial presentation of acute myeloid leukemia (AML). A 68-year-old female patient with ECOG Performance Score of 1 presented with pervaginal bleeding for 20 days. On colposcopic examination, she was found to have mass in the anterior fornix of vagina. A punch biopsy specimen revealed chloromatous infiltration of the vagina. LCA (leukocyte common antigen), MPO (myeloperoxidase), and c-kit were strongly positive on IHC (immunohistochemistry). The patient’s routine blood investigations were normal including peripheral smear, lactose dehydrogenase, uric acid, 2D echocardiography, conventional cytogenetics, bone marrow aspiration, and biopsy. The patient was given 4 cycles of decitabine (Decitex, manufactured by Sun Pharmaceutical Industries Limited, India), 20 mg/m2 for 5 days at an interval of 28 days. There was a partial response to decitabine according to RECIST criteria. As decitabine therapy was well tolerated, we are continuing in the same way until disease progression without any complications. The patient is undergoing regular follow-up at our centre. Gaurang Modi, Irappa Madabhavi, Harsha Panchal, Apurva Patel, Asha Anand, Sonia Parikh, Pritam Jain, Swaroop Revannasiddaiah, and Malay Sarkar Copyright © 2015 Gaurang Modi et al. All rights reserved. Mature Cystic Teratoma of the Fallopian Tube in a Postmenopausal Woman: A Case Report and Review of the Literature Thu, 15 Jan 2015 12:01:33 +0000 Background. Mature cystic teratomas of the fallopian tube are extremely rare and only 54 cases have been reported in the literature. In this paper, we report a mature cystic teratoma of the fallopian tube in a postmenopausal woman and we report the review of literature of tubal cystic teratomas. Case. A 62-year-old, gravida 4 postmenopausal woman presented with pain in the right lower abdominal region for a long time. An 88 × 72 × 95 mm heterogeneous mass which contained calcifications and lipoid components was detected in the right adnexal region by transvaginal ultrasonogram (TV-USG). Serum tumour markers, namely, CA125, CA15-3, and CA19-9, were within normal range. A laparotomy revealed a 9 × 10 cm cystic mass within the fimbrial region in the right fallopian tube, and right salpingoopherectomy was performed consequently. Microscopic examination revealed squamous epithelium with sebaceous glands and hair follicles, and pseudostratified ciliated respiratory epithelium with cartilage and mucous glands. Because the frozen section resulted in a benign dermoid cyst, no further operative procedure was performed. The postoperative follow-up was uneventful and the patient was discharged on the second postoperative day. Conclusion. In cases of undetermined pelvic or abdominal masses, a teratoma of the fallopian tube should be considered. Mustafa Erkan Sari, Ozhan Ozdemir, Pinar Kadirogullari, Funda Arpaci Ertugrul, and Cemal Resat Atalay Copyright © 2015 Mustafa Erkan Sari et al. All rights reserved. The Treatment of Giant Periurethral Condyloma in Pregnancy Using an Ultrasonic Thermal Scalpel: A Case Report and New Single Session Treatment Option Mon, 12 Jan 2015 12:20:28 +0000 Multiple large polypoid lesions with exophytic appearance occurring in anal and perineal region as a result of human papilloma virus (HPV) infection are referred to as giant condyloma acuminatum (GCA). The conventional treatment of these lesions involves the use of surgical excision, laser, electrocautery, and/or application of trichloroacetic acid. A 28-year-old primigravid patient at 22 weeks of pregnancy presented to the hospital complaining of vaginal bleeding and palpable mass in the vulva. The physical examination revealed a 60 × 35 mm broad-based, fragile, and patchy hemorrhagic polypoid lesion originating 1 cm below the clitoris and completely occupying urethral orifice and partially occluding vaginal vestibule. The patient underwent excision of GCA in the midtrimester using an ultrasonic thermal scalpel (Harmonic Scalpel) without any additional treatment and subsequently delivered a single live healthy baby. The excision of GCA occurring during pregnancy using Harmonic Scalpel can be regarded as a new successful method. Prospective, randomized, and controlled studies are warranted in order to provide clear evidence of the efficiency and safety of HS in the treatment of GCA. Ali Yavuzcan, Mete Çağlar, Hakan Turan, Ali Tekin, Seren Topuz, Gizem Yavuzcan, Serdar Dilbaz, Yusuf Üstün, Cihangir Aliağaoğlu, and Selahattin Kumru Copyright © 2015 Ali Yavuzcan et al. All rights reserved. Endometrial Stromal Sarcoma Arising in Colorectal Endometriosis: A Case Report and Review of the Literature Mon, 12 Jan 2015 06:19:24 +0000 Extrauterine endometrial stromal sarcoma (ESS) arising in endometriosis is extremely rare, particularly in the colorectum. It should always be included in the differential diagnosis of primary tumors originating from gastrointestinal tract in females, given that preoperative endoscopical biopsy may reveal no specific changes. We reported a case of ESS arising in colorectal endometriosis and reviewed the previous 7 cases reported in the English literature. Our patient, who was unavailable for tumor resection and refused further adjuvant therapy, played a role in representing the natural history of low-grade extragenital ESS. This case was the only death from ESS arising in colorectal endometriosis. Qiao Wang, Xia Zhao, and Ping Han Copyright © 2015 Qiao Wang et al. All rights reserved. Meckel’s Diverticulitis as a Cause of an Acute Abdomen in the Second Trimester of Pregnancy: Laparoscopic Management Sun, 11 Jan 2015 07:58:47 +0000 Introduction. Meckel’s diverticulitis is an extremely rare cause of an acute abdomen in pregnancy. Its clinical presentation tends to be rather unusual and therefore commonly delaying diagnosis. The surgical method of exploration can be either by laparoscopy or through an open incision. Case Report. We report a case of a 34-year-old, P1 with previous Caesarean section, who presented at 20 weeks with worsening right-sided abdominal pain, distention, and peritonism. Ultrasound scan showed an area of a possibly thickened loop of bowel inconsistent with an appendicitis. The findings at laparoscopy were purulent fluid in the pelvis, a congested appendix, and inflamed Meckel’s diverticulum. An appendectomy and excision of the diverticulum was performed using stapler technique. Discussion. Meckel’s diverticulitis in pregnancy can have nonspecific presentation and poses difficulties for preoperative diagnosis. Delay in diagnosis and management poses significant maternal and fetal risks. The use of laparoscopy if the gestational age and uterine size permit its use allows a thorough exploration of the abdominal cavity and management of rarer and unexpected pathology. Laparoscopic management of acute abdomen in the midtrimester of pregnancy has been found to be safe and effective. Ivilina Pandeva, Sumit Kumar, Atif Alvi, and Hema Nosib Copyright © 2015 Ivilina Pandeva et al. All rights reserved. Dilemma in Timing of Delivery in a Patient with an Acute Myocardial Infarction Thu, 08 Jan 2015 13:04:25 +0000 Introduction. Acute myocardial infarction (AMI) in a pregnant woman is rare. When occurring, AMI is a major cause of maternal and neonatal death. By presenting the following case we describe the dilemma concerning the timing of delivery. Case. A 36-year-old, multiparous women, at 35 6/7 weeks of gestation, suffered from an AMI due to an acute blockage of the left anterior descending artery (LAD). This was treated by angiographic thrombosuction and biodegradable stent placement. Within 5 hours after this procedure, a cesarean section (CS) was performed because of a nonreassuring fetal condition. A healthy son with an Apgar score of 9/10 was born. The patient’s postoperative course was complicated by a big wound hematoma, a hemoglobin drop, and heart failure. Discussion. In case of AMI during pregnancy, the cardiological management has absolute priority. The obstetrical management is not outlined. In a nonreassuring fetal condition, delivery is indicated after stabilization of the mother. However, delivery after recent AMI and angiography will bring new risks of cardiologic stress and bleeding complications. The limited literature available tends to an expectant obstetrical management, but this case emphasizes the difficulty of waiting in suspected fetal distress. Laura M. Héman, Ingrid E. C. Devies, and Frans J. M. E. Roumen Copyright © 2015 Laura M. Héman et al. All rights reserved. Nonpneumatic Antishock Garment Combined with Bakri Balloon as a Nonoperative “Uterine Sandwich” for Temporization of Massive Postpartum Hemorrhage from Disseminated Intravascular Coagulation Thu, 08 Jan 2015 09:14:58 +0000 Disseminated intravascular coagulation (DIC) is an uncommon but potentially catastrophic complication of postpartum hemorrhage. We describe two cases of massive postpartum hemorrhage complicated by DIC that were successfully temporized with combined use of the Bakri balloon and nonpneumatic antishock garment (NASG) during massive transfusion. In the first case, a healthy, term gravida underwent emergent cesarean for fetal bradycardia during labor induction. 10 minutes after completion of surgery, brisk vaginal hemorrhage of nonclotting blood from fulminant DIC resulted in maternal shock. A Bakri balloon and NASG were placed during massive transfusion, resulting in rapid maternal stabilization. In the second case, a healthy, term gravida suffered an amniotic fluid embolism during labor requiring emergent cesarean delivery and complicated by cardiac arrest with successful resuscitation. Postoperative rapid uterine bleeding from DIC was treated with a Bakri balloon and NASG, stabilizing the patient during massive transfusion. Neither patient required further surgical procedures. NASG combined with Bakri balloon may serve as a valuable nonoperative treatment or temporization option in cases of massive postpartum hemorrhage complicated by coagulopathy such as these. Further study of the utility of NASG in high-resource settings is warranted. Andrea Jelks, Monica Berletti, Liliana Hamlett, and Michele Hugin Copyright © 2015 Andrea Jelks et al. All rights reserved. Severe Acute Pancreatitis in Pregnancy Mon, 05 Jan 2015 10:09:15 +0000 This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen. She was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis. However she then, was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage. This is followed by review of literature on this topic. Acute pancreatitis in pregnancy is not uncommon. The emphasis on high index of suspicion of acute pancreatitis in women who presented with acute abdomen in pregnancy is highlighted. Early diagnosis and good supportive care by multidisciplinary team are crucial to ensure good maternal and fetal outcomes. Bahiyah Abdullah, Thanikasalam Kathiresan Pillai, Lim Huay Cheen, and Ray Joshua Ryan Copyright © 2015 Bahiyah Abdullah et al. All rights reserved. Cholangiocarcinoma Presenting as Uterine Metastasis Wed, 31 Dec 2014 06:27:39 +0000 Metastases to the female genital tract are rare, with metastatic disease restricted to the uterus being even less frequent. The primary tumor is most often intragenital rather than extragenital. The diagnosis is usually made after occurrence of gynecological symptoms. We describe the case of a 26-year-old female, in whom a curettage for menorrhagia revealed a uterine malignancy, at first thought to be a carcinosarcoma. Biochemistry only showed iron deficiency anemia. Imaging showed discrepant results with liver lesions, suspect of neoplastic or inflammatory disease. She underwent an abdominal hysterectomy and, peroperatively, a frozen section of a mass in the liver hilus demonstrated a cholangiocarcinoma. The diagnosis of a uterine metastasized cholangiocarcinoma was made. We emphasize the fact that uterine metastases have to be excluded in every woman with abnormal uterine bleeding and a personal history of malignancy. However, our case also indicates that gynecological metastatic disease may be the first presentation of an extragenital primary neoplasm. W. Dendas, L. Cappelle, J. Verguts, and G. Orye Copyright © 2014 W. Dendas et al. All rights reserved. Endometriosis in a Patient with Mayer-Rokitansky-Küster-Hauser Syndrome Tue, 30 Dec 2014 10:16:44 +0000 Objective. To report a case of Mayer-Rokitansky-Küster-Hauser syndrome (MRKH) in which there were two nonfunctional rudimentary uteruses with the presence of ovarian endometrioma, corroborating that there are valid alternative theories to the existence of endometriosis, rather than Sampson’s theory alone, such as the coelomic metaplasia theory. Design. A case report. Setting. A tertiary referral center, which is also a university hospital. Patient. A fifteen-year-old patient with MRKH syndrome and endometriosis. Intervention. Laparoscopic approach for diagnostic confirmation and treatment of the endometrioma. Results. Evidence of endometriosis in a patient with no functional uterus. Conclusions. This case report and a few others that are available in the literature reinforce the possibility that coelomic metaplasia could be the origin of endometriosis. Patients with müllerian agenesis and pelvic pain should be carefully evaluated, and the presence of pelvic endometriosis should not be excluded. Júlia Kefalás Troncon, Ana Carolina Tagliatti Zani, Andrea Duarte Damasceno Vieira, Omero Benedicto Poli-Neto, Antônio Alberto Nogueira, and Júlio César Rosa-e-Silva Copyright © 2014 Júlia Kefalás Troncon et al. All rights reserved. Tubal Pregnancy Associated with Endometrial Carcinoma after In Vitro Fertilization Attempts Sun, 28 Dec 2014 10:07:27 +0000 Endometrial carcinoma is rarely seen during reproductive ages and commonly related to infertility, polycystic ovarian syndrome (PCOS), and obesity. Pregnancy associated endometrial carcinoma is even rarer and this is the second case reported in the literature concerning tubal pregnancy associated endometrial carcinoma. We present a case of a 36-year-old woman with a history of PCOS, infertility, and several attempts of ovulation induction and in vitro fertilization, who was diagnosed with tubal pregnancy and a well differentiated endometrial carcinoma. We also review the literature about pregnancy associated endometrial carcinoma in the first trimester. Yesim Bayoglu Tekin, Emine Seda Guvendag Guven, Ibrahim Sehitoglu, and Suleyman Guven Copyright © 2014 Yesim Bayoglu Tekin et al. All rights reserved. Unusual Presentation of a Rectovestibular Fistula as Gastrointestinal Hemorrhage in a Postmenopausal Woman Mon, 22 Dec 2014 08:22:14 +0000 Background. Anorectal malformations (ARMs) are extremely rare and are usually identified neonatally. It is unusual for these cases to present in the postmenopausal period. This case report describes a postmenopausal patient with ARM and rectovaginal hemorrhage. Case. An 86-year-old, gravida 11, para 9, presented to the emergency department complaining of profuse postmenopausal vaginal bleeding. Her gynecologic history was significant only for an unclear history of an anal abnormality that was noted at birth. Speculum examination revealed profuse rectal bleeding from a rectovestibular fistula exterior to her hymenal ring. Colonoscopic examination revealed severe diverticular disease. Conclusion. This patient was born with an imperforate anus which resolved as rectovestibular fistula and ectopic anus. This case presents a rare clinical circumstance which integrates the fields of obstetrics, gynecology, gastroenterology, and embryology alike. Olga Grechukhina, Gregory M. Gressel, Graham Taylor, Jeremy I. Schwartz, and Regan J. Welsh Copyright © 2014 Olga Grechukhina et al. All rights reserved. Genital Schistosomiasis: A Report on Two Cases of Ovarian Carcinomas Containing Viable Eggs of Schistosoma mansoni Mon, 22 Dec 2014 08:07:25 +0000 Schistosomiasis is a parasitic infection that is highly prevalent worldwide, with a variety of species being responsible for causing the disease. In Brazil, however, the only identified species is Schistosoma mansoni. The adult parasites inhabit the blood vessels of the hepatic portal system of the main host. The disease may range from being asymptomatic to provoking liver damage or portal hypertension. Furthermore, ectopic schistosomiasis may develop, and several hypotheses have been raised to explain the occurrence of the disease. This paper describes two cases, one in a 39-year-old woman and the other in a 47-year-old woman. Both had similar symptoms of pain and abdominal distension caused by a large abdominal/pelvic mass. Histopathology of the ovary showed a mucinous cystadenocarcinoma of the intestinal type in the first patient and a papillary serous carcinoma in the second, with both tumors containing viable eggs of Schistosoma mansoni. The neoplasms probably serve as a migratory route for the adult parasites and the embolization of eggs. Nevertheless, there is insufficient evidence to confirm the malignization of a benign lesion due to the presence of Schistosoma mansoni. Few cases have been reported in the international literature on the association between ovarian schistosomiasis and neoplasms. Andressa Gonçalves Amorim, Fernanda Alves Barbosa Pagio, Rodrigo Neves Ferreira, and Antônio Chambô Filho Copyright © 2014 Andressa Gonçalves Amorim et al. All rights reserved. Sudden Death by Pulmonary Thromboembolism due to a Large Uterine Leiomyoma with a Parasitic Vein to the Mesentery Sun, 21 Dec 2014 11:40:35 +0000 The pathophysiology of venous thrombosis is classically attributed to alterations in one or more components of Virchow’s triad: hypercoagulability, stasis, and damage to the vascular endothelium. Deep vein thrombosis (DVT) may lead to pulmonary thromboembolism (PE), and the latter is culpable for many deaths annually in the United States; however, DVT as a complication of uterine leiomyoma has rarely been reported. We report a case of a 57-year-old woman whose death was due to a large pedunculated subserosal leiomyoma externally compressing the pelvic veins resulting in stasis and venous thrombosis leading to fatal PE. The association of large pelvic masses with venous thrombosis has clinical implications, since prophylactic surgery could be life-saving. Varsha Podduturi, Danielle R. Armstrong-Briley, and Joseph M. Guileyardo Copyright © 2014 Varsha Podduturi et al. All rights reserved. Fetal Circulatory Variation in an Acute Incident Causing Bradycardia Thu, 18 Dec 2014 00:10:50 +0000 Umbilical artery\vein, middle cerebral artery, and ductus venosus Doppler velocimetry were performed at 33 weeks of gestation in the settings of an intrauterine growth restricted fetus during a heart rate deceleration. Interestingly, we recorded a sudden onset redistribution of fetal blood flow with fetal bradycardia. Spontaneous normalization of waveforms was observed once fetal heart rate returned to normal. Our case provides evidence to circulatory variation of a human fetus resulting from an acute incident causing bradycardia. Safak Olgan, Mehmet Sakinci, Murat Ozekinci, Nasuh Utku Dogan, Erkan Cagliyan, and Sabahattin Altunyurt Copyright © 2014 Safak Olgan et al. All rights reserved. Bilateral Tubal Gestation Associated with Schistosomiasis in an African Woman Sun, 14 Dec 2014 06:25:32 +0000 Background. The incidence of tubal ectopic gestation caused by schistosomiasis induced tubal pathology is undocumented in this environment, which may be due to rarity of this pathology. Bilateral tubal gestation is common in patients that have undergone in vitro fertilization. We report a hitherto undocumented case of spontaneous bilateral ectopic gestation following tubal schistosomiasis. Case Report. Mrs. OB was a 32-year-old G4P3+0 (3 alive) woman who complained of abdominal pain and bleeding per vaginam of 4 and 2 days’ duration respectively following 8 weeks of amenorrhea. A clinical impression of ruptured ectopic gestation was confirmed by ultrasound scanning. She had bilateral salpingectomy with histology of specimens showing bilateral ectopic gestation with Schistosoma haematobium induced salpingitis (findings of Schistosoma haematobium ova noted on slide). Conclusion. Schistosoma induced salpingitis is a rare but possible cause of bilateral tubal gestation. K. H. Odubamowo, O. M. Akinpelu, O. O. Lawal, C. A. Okolo, A. A. Odukogbe, and A. O. Adekunle Copyright © 2014 K. H. Odubamowo et al. All rights reserved. Response to: Comment on “Complete Androgen Insensitivity Syndrome: Optimizing Diagnosis and Management” Thu, 11 Dec 2014 00:10:34 +0000 Antonio Simone Laganà and Alfonsa Pizzo Copyright © 2014 Antonio Simone Laganà and Alfonsa Pizzo. All rights reserved. A Case of Ruptured Splenic Artery Aneurysm in Pregnancy Tue, 09 Dec 2014 07:51:03 +0000 Background. Rupture of a splenic artery aneurysm is rare complication of pregnancy that is associated with a significant maternal and fetal mortality. Case. A multiparous female presented in the third trimester with hypotension, tachycardia, and altered mental status. A ruptured splenic artery aneurysm was discovered at the time of laparotomy and cesarean delivery. The patient made a full recovery following resection of the aneurysm. The neonate survived but suffered severe neurologic impairment. Conclusion. The diagnosis of ruptured splenic artery aneurysm should be considered in a pregnant woman presenting with signs of intra-abdominal hemorrhage. Early intervention by a multidisciplinary surgical team is key to preserving the life of the mother and fetus. Elizabeth K. Corey, Scott A. Harvey, Lynnae M. Sauvage, and Justin C. Bohrer Copyright © 2014 Elizabeth K. Corey et al. All rights reserved. Radical Abdominal Trachelectomy for IB1 Cervical Cancer at 17 Weeks of Gestation: A Case Report and Literature Review Mon, 08 Dec 2014 08:10:08 +0000 Background. With regard to the therapy for early invasive cervical carcinoma during pregnancy, radical trachelectomy is also a treatment of choice, along with its advantages and disadvantages. Case Report. A 28-year-old woman, para 1-0-0-1, was diagnosed with FIGO stage IB1 squamous cell carcinoma of the cervix at 12 weeks of gestation. The patient underwent radical abdominal trachelectomy with pelvic lymphadenectomy at 17 weeks of gestation. Her pregnancy was successfully maintained after the surgery. The patient underwent a planned cesarean section at 38 weeks of gestation. A healthy baby girl weighing 2970 g was born with an Apgar score of 8/9. The mother and child in overall good health were discharged. Ten months after the delivery, there was no clinical evidence of recurrence. Conclusions. We believe that it is appropriate to perform radical abdominal trachelectomy in the early second trimester with preserving uterine arteries, although it is a technically challenging approach. It may be possible that radical abdominal trachelectomy during pregnancy can help women avoid the triple losses of a desired pregnancy, fertility, and motherhood. Yoichi Aoki, Morihiko Inamine, Sugiko Ohishi, Yutaka Nagai, and Hitoshi Masamoto Copyright © 2014 Yoichi Aoki et al. All rights reserved. A Case of Placenta Increta Mimicking Submucous Leiomyoma Sun, 07 Dec 2014 08:51:55 +0000 In recent years with the increase in cesarean section rates, the frequency of placenta accreta cases rises. It causes 33–50% of all emergency peripartum hysterectomies. We present a 42-year-old case who was caught with early postpartum hemorrhage due to retained placental products. The ultrasonography showed a 65 × 84 mm mass in the uterine cavity after the delivery. Due to presence of early postpartum hemorrhage which needs transfusion, an intervention decision was made. The patient underwent curettage but the mass could not be removed so that placental retention was ruled out. Submucous leiomyoma was made as first-prediagnosis. Hysterectomy operation was performed as a curative treatment. Placenta increta diagnosis was made as a final diagnosis with pathological examination. As a result, placental attachment disorders may be overlooked if it is not a placenta previa case. Ali Ekiz, Ibrahim Polat, Sezcan Mumusoglu, Burchan Aydiner, Cagdas Ozdemir, and Hilal Serap Arslan Copyright © 2014 Ali Ekiz et al. All rights reserved. A Case of Abruptio Placentae due to the Torsion of Gravid Uterus Thu, 04 Dec 2014 12:06:54 +0000 Torsion of a gravid uterus is a rare obstetric emergency potentially lethal for the fetus and the mother. Some of the cases described in literature are associated with preexisting gynecologic conditions related to pelvic and uterine anatomy, even if most of cases remain unexplained. We report a case of acute 180-degree torsion of uterus at 33 weeks of gestation associated with abruptio placentae in a young Asian woman without apparent risk factors. S. Zullino, S. Faiola, A. M. Paganelli, and E. Ferrazzi Copyright © 2014 S. Zullino et al. All rights reserved. Malouf Syndrome with Hypergonadotropic Hypogonadism and Cardiomyopathy: Two-Case Report and Literature Review Wed, 03 Dec 2014 07:16:53 +0000 Malouf syndrome is a very rarely encountered syndrome which was first diagnosed in 1985 upon the examination of two sisters, with findings of hypergonadotropic hypogonadism, dilated cardiomyopathy, blepharoptosis, and broad nasal base. Later on, Narahara diagnosed another sporadic case with the same findings. A survey of relevant literature leads us to three women cases in total. Here we present two cases of Malouf syndrome and literature review. Dilek Benk Şilfeler, Atilla Karateke, Raziye Keskin Kurt, Özgür Aldemir, Alper Buğra Nacar, and Ali Baloğlu Copyright © 2014 Dilek Benk Şilfeler et al. All rights reserved. Management of Pregnancy in a Chilean Patient with Congenital Deficiency of Factor VII and Glanzmann’s Thrombasthenia Variant Mon, 01 Dec 2014 00:10:10 +0000 Patients with inherited bleeding disorders are rare in obstetric practice but present with prolonged bleeding even after minor invasive procedures. They require a combined approach with obstetric and hematological management of each case, including the neonatal management of a possibly affected fetus. We present the case of a pregnancy in a patient with combined Factor VII deficiency and Glanzmann’s thrombasthenia, the successful obstetric and hematological management of the case, and a review of the literature. Nigel P. Murray, Claudio Garcia, Javier Ilabaca, and Nestor Lagos Copyright © 2014 Nigel P. Murray et al. All rights reserved. Gynecologic Malignancies Post-LeFort Colpocleisis Mon, 01 Dec 2014 00:10:08 +0000 Introduction. LeFort colpocleisis (LFC) is a safe and effective obliterative surgical option for older women with advanced pelvic organ prolapse who no longer desire coital activity. A major disadvantage is the limited ability to evaluate for post-LFC gynecologic malignancies. Methods. We present the first case of endometrioid ovarian cancer diagnosed after LFC and review all reported gynecologic malignancies post-LFC in the English medical literature. Results. This is the second reported ovarian cancer post-LFC and the first of the endometrioid subtype. A total of nine other gynecologic malignancies post-LFC have been reported in the English medical literature. Conclusions. Gynecologic malignancies post-LFC are rare. We propose a simple 3-step strategy in evaluating post-LFC malignancies. Rayan Elkattah, Alicia Brooks, and R. Keith Huffaker Copyright © 2014 Rayan Elkattah et al. All rights reserved. Clinical Manifestation of a Calyceal Diverticular Abscess in a Pregnant Woman Sun, 30 Nov 2014 06:40:49 +0000 Calyceal diverticula are congenital, nonsecretory abnormalities in which the transitional cell-lined cavity communicates with the renal collecting system. Here we present the case of a calyceal diverticular abscess during pregnancy. A 40-year-old primiparous woman developed the abscess at 23 weeks of gestation, with right flank pain and a 37.8°C fever. A transabdominal ultrasound revealed a  cm cystic mass in the right kidney. She was initially diagnosed with a simple renal cyst infection, and intravenous antibiotics were initiated. Percutaneous drainage was started at 26 weeks of gestation. When urine excretion from the cyst was confirmed by dye test using indigotindisulfonate sodium, the patient was diagnosed with a calyceal diverticular abscess. She gave birth to a 2,870 g healthy male at 38 weeks of gestation. Percutaneous drainage with low-dose antimicrobial therapy could thus allow for the continued pregnancy of women with a calyceal diverticular abscess until full term. Masaki Sekiguchi, Yuichi Hasegawa, Satoko Kinomoto, and Haruhiko Sago Copyright © 2014 Masaki Sekiguchi et al. All rights reserved. Vaginal Treatment of Vaginal Cuff Dehiscence with Visceral Loop Prolapse: A New Challenge in Reparative Vaginal Surgery? Mon, 24 Nov 2014 08:20:55 +0000 Vaginal cuff dehiscence is a rare, but potentially morbid, complication of total hysterectomy and refers to separation of the vaginal cuff closure. The term vaginal cuff dehiscence is frequently interchanged with the terms of cuff separation or cuff rupture. All denote the separation of a vaginal incision that was previously closed at time of total hysterectomy. After dehiscence of the vaginal cuff, abdominal or pelvic contents may prolapse through the vaginal opening. Bowel evisceration, outside the vulvar introitus, can lead to serious sequelae, including peritonitis, bowel injury and necrosis, or sepsis. Therefore, although prompt surgical and medical intervention is required to replace prolapsed structures, the main problem remains the reconstruction of vaginal vault. In case of recent hysterectomy, vaginal reparation only requires the approximation of vaginal walls, including their fascia, while if dehiscence occurs after a long time from hysterectomy, the adequate suspension of the vaginal vault has to be taken into consideration. In this report we describe the case of a postmenopausal patient, undergoing surgical emergency because of the evisceration of an intestinal loop through a dehiscence of vaginal vault, after numerous reconstructive vaginal surgeries for vaginal prolapse. This paper analyzes clinical circumstances, risk factors, comorbidity, and clinical and surgical management of this complication. Salvatore Andrea Mastrolia, Edoardo Di Naro, Luca Maria Schonauer, Maria Teresa Loverro, Beatrice Indellicati, Mario Barnaba, and Giuseppe Loverro Copyright © 2014 Salvatore Andrea Mastrolia et al. All rights reserved. Management of Posterior Reversible Syndrome in Preeclamptic Women Wed, 19 Nov 2014 09:44:54 +0000 Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome associated with a number of conditions including preeclampsia. It is characterized by seizures, alteration of consciousness, visual disturbances, and symmetric white matter abnormalities, typically in the posterior parietooccipital regions of the cerebral hemispheres, at computed tomography (CT) and magnetic resonance (MRI). We report three new cases of PRES in preeclamptic patients and describe the management of these patients. We present a brief review of other cases in the literature, with particular attention to the anesthetic management. S. Poma, M. P. Delmonte, C. Gigliuto, R. Imberti, M. Delmonte, A. Arossa, and G. A. Iotti Copyright © 2014 S. Poma et al. All rights reserved. Vaginal Evisceration: An Unexpected Complication of Conization Wed, 19 Nov 2014 06:57:18 +0000 Background. Large loop excision of the transformation zone (LLETZ) is routinely performed for the management of high grade intracervical neoplasia (CIN). Several uncommon complications have been described, including postoperative peritonitis, pseudoaneurysm of uterine artery, and bowel fistula. We report a unique case of postoperative vaginal evisceration and the subsequent management. Case. A 73-years-old woman underwent LLETZ for high grade CIN. On postoperative day 3, she was admitted for small bowel evisceration through the vagina. Surgical management was based on combined laparoscopic and transvaginal approach and consisted in bowel inspection and reinstatement, peritoneal washing, and dehiscence repair. Conclusions. Vaginal evisceration is a rare but potentially serious complication of pelvic surgery. This case report is to make clinicians aware of such complication following LLETZ and its management. Ali Ghassani, Benoit Andre, Caroline Simon-Toulza, Yann Tanguy le Gac, Alejandra Martinez, and Fabien Vidal Copyright © 2014 Ali Ghassani et al. All rights reserved.