Case Reports in Obstetrics and Gynecology The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. A Discussion of High-Risk HPV in a 6-Year-Old Female Survivor of Child Sexual Abuse Tue, 23 May 2017 09:54:20 +0000 Background. Human papilloma viruses (HPVs) cause a variety of clinical manifestations in children including skin warts, laryngeal papillomas, and condyloma acuminatum. Whereas the mode of transmission is well understood and management of HPV infection is clearly defined by guidelines in adults, less is known about the mode of transmission, natural history of disease, and appropriate management of high-risk anogenital HPV infections in children. Case. The patient is a previously healthy 6-year-old female who presented with multiple vaginal lesions causing pain and discomfort and was diagnosed with HPV 18 positive CIN I. Summary and Conclusion. Children infected with high-risk HPV subtypes remain a vulnerable patient population, and there is minimal literature on the natural history of disease and effects of overtreatment. Based on a literature review, conservative management, HPV vaccination, and consideration of the cervical cancer screening guidelines for adolescent females are an appropriate treatment course until more studies are reported on cervical cancer screening in survivors of child sexual abuse. Connie D. Cao, Lena Merjanian, Joelle Pierre, and Adrian Balica Copyright © 2017 Connie D. Cao et al. All rights reserved. Epidural Anesthesia for Cesarean Section in a Pregnant Woman with Marfan Syndrome and Dural Ectasia Mon, 22 May 2017 00:00:00 +0000 Marfan syndrome (MFS) is a genetic disorder of connective tissue, characterized by variable clinical features and multisystem complications. The anesthetic management during delivery is debated. Regional anesthesia has been used with success during cesarean delivery, but in some MFS patients there is a probability of erratic and inadequate spread of intrathecal local anesthetics as a result of dural ectasia. In these cases, epidural anesthesia may be a particularly useful technique during cesarean delivery because it allows an adequate spread and action of local anesthetic with a controlled onset of anesthesia, analgesia, and sympathetic block and a low risk of perioperative complications. We report the perioperative management of a patient with MFS and dural ectasia who successfully underwent cesarean section using epidural technique anesthesia. The previous pregnancy of this woman ended with cesarean section with a failed spinal anesthesia that was converted to general anesthesia due to unknown dural ectasia at that time. Franco Pepe, Mariagrazia Stracquadanio, Francesco De Luca, Agata Privitera, Elisabetta Sanalitro, and Puccio Scarpinati Copyright © 2017 Franco Pepe et al. All rights reserved. Malignant Transformation of Mature Cystic Teratoma Diagnosed after a 10-Year Interval Sun, 21 May 2017 06:45:47 +0000 A 67-year-old uniparous woman had undergone surgery for acute perforated gastric ulcer 10 years prior to the current presentation. Although abdominal computed tomography (CT) performed at that point had revealed a mature cystic teratoma measuring 6 cm in diameter in the right ovary, it was left untreated. She visited the department of surgery at our hospital with chief complaints of appetite loss, nausea, and vomiting that had persisted for the prior two weeks. She was admitted with a diagnosis of ileus attributed to an abdominal incisional hernia. CT performed on admission revealed a tumor measuring 21 cm in diameter with mural nodules in the right ovary. Thus, surgery was performed under suspicion of malignant transformation of the previously detected ovarian mature cystic teratoma. While neither lymphadenopathy nor distant metastasis was detected by imaging studies, bilateral adnexectomy and repair of the abdominal incisional hernia were performed. Cytology of ascites was negative. The postoperative pathological diagnosis was squamous cell carcinoma arising from teratoma, and the postoperative clinical diagnosis was stage IA ovarian cancer. It was assumed that the mature cystic teratoma which had been detected in the right ovary 10 years earlier had undergone malignant transformation. Mariko Jitsumori, Satoru Munakata, and Toshiya Yamamoto Copyright © 2017 Mariko Jitsumori et al. All rights reserved. Placental Chorangiosis: Increased Risk for Cesarean Section Sun, 21 May 2017 00:00:00 +0000 We describe a patient with Class C diabetes who presented for nonstress testing at 36 weeks and 4 days of gestation with nonreassuring fetal heart tones (NRFHT) and oligohydramnios. Upon delivery, thrombosis of the umbilical cord was grossly noted. Pathological analysis of the placenta revealed chorangiosis, vascular congestion, and 40% occlusion of the umbilical vein. Chorangiosis is a vascular change of the placenta that involves the terminal chorionic villi. It has been proposed to result from longstanding, low-grade hypoxia in the placental tissue and has been associated with such conditions such as diabetes, intrauterine growth restriction (IUGR), and hypertensive conditions in pregnancy. To characterize chorangiosis and its associated obstetric outcomes we identified 61 cases of “chorangiosis” on placental pathology at Henry Ford Hospital from 2010 to 2015. Five of these cases were omitted due to lack of complete records. Among the 56 cases, the cesarean section rate was 51%, indicated in most cases for nonreassuring fetal status. Thus, we suggest that chorangiosis, a marker of chronic hypoxia, is associated with increased rates of cesarean sections for nonreassuring fetal status because of long standing hypoxia coupled with the stress of labor. Shariska S. Petersen, Raminder Khangura, Dmitry Davydov, Ziying Zhang, and Roopina Sangha Copyright © 2017 Shariska S. Petersen et al. All rights reserved. Intramural Hematoma of the Esophagus Complicating Severe Preeclampsia Thu, 18 May 2017 07:12:07 +0000 Intramural hematoma of the esophagus is a rare injury causing esophageal mucosal dissection. Forceful vomiting and coagulopathy are common underlying causes in the elderly population taking antiplatelets or anticoagulation agents. Acute retrosternal pain followed by hematemesis and dysphagia differentiates the hematoma from other cardiac or thoracic emergencies, including acute myocardial infarction or aortic dissection. Direct inspection by endoscopy is useful, but chest computed tomography best assesses the degree of obliteration of the lumen and excludes other differential diagnoses. Intramural hematoma of the esophagus is generally benign and most patients recover fully with conservative treatment. Bleeding can be managed medically unless in hemodynamically unstable patients, for whom surgical or angiographic treatment may be attempted; only rarely esophageal obstruction requires endoscopic decompression. We report an unusual case of esophageal hematoma, presenting in a young preeclamptic woman after surgical delivery of a preterm twin pregnancy, with a favorable outcome following medical management. Simone Garzon, Giovanni Zanconato, Nicoletta Zatti, Giuseppe Chiarioni, and Massimo Franchi Copyright © 2017 Simone Garzon et al. All rights reserved. Fulminating Postcaesarean Necrotising Fasciitis: A Rare and Lethal Condition Successfully Managed in a Resource-Disadvantaged Setting in Sub-Saharan Africa Tue, 16 May 2017 00:00:00 +0000 Necrotising fasciitis is a rare but potentially lethal condition in obstetrics which usually presents with fulminant tissue destruction and a resultant high mortality. We report a 19-year-old Sub-Saharan female diagnosed with a rapidly erosive necrotising fasciitis on day 5 after caesarean section in a resource-limited setting. Timely diagnosis, aggressive antibiotic therapy, and prompt surgical intervention via an extensive abdominal wall debridement were pivotal to her survival. Carlson-Babila Sama, Conrad S. Tankou, and Fru F. Angwafo III Copyright © 2017 Carlson-Babila Sama et al. All rights reserved. A Case of Chronic Ectopic Pregnancy Manifested by Rectal Bleeding Sun, 14 May 2017 07:16:08 +0000 Ectopic pregnancy resulting in perforation of the rectum and rectal bleeding is clinically rare. We report an extremely rare case of chronic ectopic pregnancy with decreasing low levels of serum β-HCG resulting in rectal bleeding. A 31-year-old woman, gravida 3, para 3, with moderate abdominal pain and rectal bleeding was diagnosed with a tubal pregnancy. The tube was adherent to the rectum. Following salpingo-oophorectomy, the perforation of the rectum was sutured. Biopsies from the rectum as well as the tube confirmed chronic ectopic pregnancy. This case illustrates that diagnosing ectopic pregnancy is sometimes extremely challenging and it underlines the importance of follow-up consultations when the final diagnosis has not yet been reached. Nina Vukas Radulovic, Maria Bullarbo, and Erling Ekerhovd Copyright © 2017 Nina Vukas Radulovic et al. All rights reserved. A Case of Sevoflurane Use during Pregnancy in the Management of Persistent Status Asthmaticus Sun, 07 May 2017 06:59:17 +0000 Background. Sevoflurane is rarely used for the treatment of status asthmaticus. We report a case of sevoflurane hepatotoxicity in pregnancy with presentation similar to HELLP syndrome. Case. A G2P1001 at 23 weeks in status asthmaticus presented with pCO2 > 130 and pH < 7. She was nonresponsive to traditional therapy. Sevoflurane was added for a 24 hr period. Respiratory status improved. Extubation occurred on day 12. Workup for preeclampsia spectrum disorders occurred due to maternal hypertension. Given the atypical presentation and hepatotoxicity, a liver biopsy was performed. Histologic features suggested drug induced hepatic injury. Liver function subsequently normalized. She delivered a term neonate without short-term complications. Conclusion. The use of sevoflurane is a treatment option of status asthmaticus during pregnancy. Providers should be aware of the potential for hepatotoxicity. Jessica Parrott, Mitch Tener, Katie Dennis, Matthew Sharpe, and Cecily Clark-Ganheart Copyright © 2017 Jessica Parrott et al. All rights reserved. Endometriosis Nodule Causing Spontaneous Haemoperitoneum in Pregnancy: A Case Report and Literature Review Thu, 27 Apr 2017 06:35:31 +0000 Spontaneous haemoperitoneum in pregnancy (SHiP) due to endometriosis is a very rare condition and this is a case of a 41-year-old primigravida, who presented at 32 weeks with sudden onset of severe lower abdominal pain without any uterine activity. This was a dichorionic-diamniotic twin pregnancy, following in vitro fertilisation for subfertility secondary to severe endometriosis. On admission, pain score was eight, with ten being the maximum of the scale. The vital signs were stable. Abdominal palpation revealed generalised tenderness with no guarding or palpable contraction. There was no evidence of bleeding and the cervical os was closed on speculum examination. The cardiotocograph (CTG) was pathological and a plan was made to deliver the babies with emergency caesarean section. Intraoperatively, there was massive haemoperitoneum which was managed successfully with the involvement of multidisciplinary input from general surgeons and urologists with optimum maternal and fetal outcome. Junaid Rafi, Geetha Mahindrakar, and Debjani Mukhopadhyay Copyright © 2017 Junaid Rafi et al. All rights reserved. Uterine Fibroid Torsion during Pregnancy: A Case of Laparotomic Myomectomy at 18 Weeks’ Gestation with Systematic Review of the Literature Mon, 24 Apr 2017 00:00:00 +0000 Uterine myomas are the most common benign growths affecting female reproductive system, occurring in 20–40% of women, whereas the incidence rate in pregnancy is estimated from 0.1 to 3.9%. The lower incidence in pregnancy is due to the association with infertility and low pregnancy rates and implantation rates after in vitro fertilization treatment. Uterine myomas, usually, are asymptomatic during pregnancy. However, occasionally, pedunculated fibroids torsion or other superimposed complications may cause acute abdominal pain. There are many controversies in performing myomectomy during cesarean section because of the risk of hemorrhage. Nevertheless, the majority of indication arises before labor and delivery due to acute symptoms leading to a discussion regarding the need for intervention during pregnancy. Therefore, we present a case of successful multiple laparotomic myomectomy at 17 + 2 weeks of gestational age and a systematic review of the literature in order to clarify the approach to this pathologic condition and its effect on pregnancy outcome. Annachiara Basso, Mariana Rita Catalano, Giuseppe Loverro, Serena Nocera, Edoardo Di Naro, Matteo Loverro, Mariateresa Natrella, and Salvatore Andrea Mastrolia Copyright © 2017 Annachiara Basso et al. All rights reserved. Peritoneal Keratin Granulomatosis Associated with Endometrioid Adenocarcinoma of the Uterine Corpus in a Woman with Polycystic Ovaries: A Potential Pitfall—A Case Report and Review of the Literature Wed, 19 Apr 2017 08:30:12 +0000 Peritoneal keratin granulomatosis is a rare condition included under granulomatous lesions of the peritoneum. It can be secondary to neoplasms of the female genital tract and can mimic carcinomatosis intraoperatively. A case of a 40-year-old woman with a history of polycystic ovaries and a chief complaint of vaginal bleeding is presented. She was diagnosed with endometrioid adenocarcinoma with squamous differentiation in endometrial curettings. Intraoperatively, many peritoneal nodules were found, interpreted as peritoneal carcinomatosis. The woman underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy, bilateral pelvic lymphadenectomy, and appendicectomy. Multiple biopsies were taken, as well as peritoneal washings. Microscopic examination revealed multiple keratin granulomas on the serosal surface of the ovaries, fallopian tubes, appendix, and omentum. Lymph node metastasis was not found. Peritoneal keratin granulomas (PKGs) have been reported in cases of endometrioid adenocarcinoma with squamous differentiation of the uterine corpus, ovary, and atypical adenomyoma. It should be noted that the prognosis of cases of peritoneal keratin granulomas without viable tumor cells is favourable and that the histologic examination is essential for its diagnosis. We report a case of PKG in a patient with endometrial carcinoma with squamous differentiation, being the first in a woman with polycystic ovaries. Helen J. Trihia, Maria Papazian, Natasa Novkovic, John Provatas, Sotiria Tsangouri, and Dimitrios C. Papatheodorou Copyright © 2017 Helen J. Trihia et al. All rights reserved. Hemolysis, Elevated Liver Enzymes, and Low Platelets, Severe Fetal Growth Restriction, Postpartum Subarachnoid Hemorrhage, and Craniotomy: A Rare Case Report and Systematic Review Sun, 16 Apr 2017 00:00:00 +0000 Introduction. Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a relatively uncommon but traumatic condition occurring in the later stage of pregnancy as a complication of severe preeclampsia or eclampsia. Prompt brain computed tomography (CT) or magnetic resonance imaging (MRI) and a multidisciplinary management approach are required to improve perinatal outcome. Case. A 37-year-old, Gravida 6, Para 1-0-4-1, Hispanic female with a history of chronic hypertension presented at 26 weeks and 6 days of gestational age. She was noted to have hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome accompanied by fetal growth restriction (FGR), during ultrasound evaluation, warranting premature delivery. The infant was delivered in stable condition suffering no permanent neurological deficit. Conclusion. HELLP syndrome is an uncommon and traumatic obstetric event which can lead to neurological deficits if not managed in a responsive and rapid manner. The central aggravating factor seems to be hypertension induced preeclamptic or eclamptic episode and complications thereof. The syndrome itself is manifested by hemolytic anemia, increased liver enzymes, and decreasing platelet counts with a majority of neurological defects resulting from hemorrhagic stroke or subarachnoid hemorrhage (SAH). To minimize adverse perinatal outcomes, obstetric management of this medical complication must include rapid clinical assessment, diagnostic examination, and neurosurgery consultation. Shadi Rezai, Justin Faye, Alexander Hughes, Mon-Lai Cheung, Joel R. Cohen, Judy A. Kaia, Paul N. Fuller, and Cassandra E. Henderson Copyright © 2017 Shadi Rezai et al. All rights reserved. Bilateral Breast Metastases from Vulvar Carcinoma: A Case Report and Literature Review Wed, 12 Apr 2017 08:42:51 +0000 Vulvar carcinoma is a rare disease that accounts for 3–5% of all gynecologic malignancies. Breast represents an unusual site of metastasis and only a few cases are reported. We describe the first case of bilateral metastatic breast carcinoma of vulvar origin, at an 80-year-old female patient. Six months after treatment of her primary disease, she presented with bilateral metastatic squamous cell breast carcinoma. Diagnosis was based on clinical, radiological, and histological facts. Breast although rare is another potential site of metastasis in vulvar cancer and thus mammary gland examination should be considered in the follow-up of these patients. Differential diagnosis between primary and metastatic lesions is of utmost importance for appropriate management. D. C. Papatheodorou, C. G Liakou, K. Kalogerakos, Johannes Carl Athanasios Dimopoulos, and N. Kalinoglou Copyright © 2017 D. C. Papatheodorou et al. All rights reserved. Hyperparathyroidism in Pregnancy Leading to Pancreatitis and Preeclampsia with Severe Features Tue, 11 Apr 2017 06:29:49 +0000 Background. Hyperparathyroidism is underdiagnosed in pregnancy, yet early diagnosis is necessary for the potentially severe sequelae of hypercalcemia for both the woman and fetus. Case. A 31-year-old, gravida 3, para 0-0-2-0 at 32 weeks and 3 days of gestation, presented with preeclampsia with severe features concomitant with acute pancreatitis and known diabetes mellitus type 2. She was stabilized and delivered. In the postpartum period, her total calcium level remained elevated. Ionized calcium levels and parathyroid hormone levels were also elevated, and she was diagnosed with hyperparathyroidism. Conclusion. Hyperparathyroidism and hypercalcemia are risk factors for pancreatitis. Women who develop pancreatitis during pregnancy are at increased risk of developing preeclampsia. If elevated serum calcium is noted, it should be confirmed with ionized calcium level and parathyroid hormones as ionized calcium levels are unaffected by pregnancy. Andrew G. Dale, Bradley D. Holbrook, Lauren Sobel, and Valerie J. Rappaport Copyright © 2017 Andrew G. Dale et al. All rights reserved. Sequence and Timing of Intracranial Changes in Cytomegalovirus in Pregnancy: A Case Report and Literature Review Mon, 10 Apr 2017 06:52:33 +0000 Cytomegalovirus (CMV) is the most common cause of intrauterine infection, occurring in up to 2% of all live births. Most women are asymptomatic or experience nonspecific symptoms, which can lead to long-term sequelae in newborns including neurological impairment, hearing loss, and mental retardation. A 41-year-old woman (G6 P2), with a medical history of epilepsy, presented for her routine anomaly scan at 20 + 4/40. A single finding of echogenic bowel was noted on ultrasound which prompted a full investigation. A repeat ultrasound only five days later demonstrated progressive changes, which included bilateral ventriculomegaly with oedema of the posterior ventricular wall, periventricular hyperechogenicity, and enlargement of the cisterna magna. CMV DNA was detected at amniocentesis. Ultrasound findings are not diagnostic for CMV with only 11–15% of at-risk fetuses being identified. Unfortunately, these findings may be the only indication of an abnormality. There is a well-documented lack of awareness surrounding CMV and screening is not routinely offered. Given the risk to the pregnancy of CMV and to subsequent pregnancies, simple education at the start of a pregnancy could significantly reduce the incidence of maternal CMV. Cynthia O’Sullivan, Shankari Arulkumaran, Lorin Lakasing, Eric Jauniaux, and Karl Murphy Copyright © 2017 Cynthia O’Sullivan et al. All rights reserved. Galactocele in the Axillary Accessory Breast Mimicking Suspicious Solid Mass on Ultrasound Sun, 09 Apr 2017 09:58:42 +0000 Galactoceles are the most common benign breast lesions during breastfeeding period that can mimic carcinomas. We report a galactocele with malignant appearance on ultrasound in the accessory breast. The patient was a 32-year-old lactating woman presented to our hospital for considerable swelling in the left axilla. Ultrasound examination revealed a hypoechoic mass with heterogeneous echogenicity and irregular shape and margins. Sonography-guided aspiration was performed. Aspiration of milky fluid and resolution of the axillary lump after aspiration confirmed the diagnosis of galactocele. Galactocele can present as a suspicious tumoral lesion in the axillary accessory breast and diagnostic aspiration can help in correct diagnosis of this rare lesion in the accessory breast. Donya Farrokh, Ali Alamdaran, Farhad Yousefi, and Bita Abbasi Copyright © 2017 Donya Farrokh et al. All rights reserved. Tumors Sharply Increased after Ceasing Pazopanib Therapy for a Patient with Advanced Uterine Leiomyosarcoma: Experience of Tumor Flare Thu, 06 Apr 2017 00:00:00 +0000 Pazopanib has activity in patients with soft-tissue sarcoma. We report an advanced uterine leiomyosarcoma case that suddenly worsened after cessation of pazopanib therapy. A 47-year-old woman had a primary uterine leiomyosarcoma tumor and multiple lung metastases, which progressed during her initial treatment. In subsequent treatment with pazopanib for 3 months, the sum of her tumor diameters after cessation sharply increased for two weeks. Symptoms such as dyspnea suddenly worsened also. She died of the disease one month after cessation of pazopanib therapy. Given the poor prognosis of recurrent uterine leiomyosarcoma and the rapid tumor enlargement after ending pazopanib therapy, control of this disease is especially important. Therefore, the decision to discontinue pazopanib therapy requires careful consideration. Terumi Tanigawa, Shintaro Morisaki, Hisanobu Fukuda, Shuichiro Yoshimura, Hisayoshi Nakajima, and Kohei Kotera Copyright © 2017 Terumi Tanigawa et al. All rights reserved. Spontaneous Adrenal Hemorrhage in Pregnancy: A Case Series Wed, 22 Mar 2017 06:20:50 +0000 Background. Abdominal pain during pregnancy has a broad differential diagnosis which includes spontaneous adrenal hemorrhage (SAH). There is scant literature available on optimal mode of delivery in stable patients. Cases. Patient 1 was a 35-year-old nullipara who presented at 36 weeks of gestation with left flank pain. Patient 2 was a 27-year-old multipara at 38 weeks who presented with left upper quadrant pain. Diagnosis of SAH was made by CT scan and both were managed with pain control, serial hemoglobin assessments, and abdominal exams resulting in uncomplicated vaginal deliveries. Conclusion. SAH, although rare, is an important consideration when evaluating abdominal and flank pain in pregnancy. Management options vary from conservative management to surgical intervention depending on the stability of the patient. Ankita Gupta, Ruby Minhas, and Hayley S. Quant Copyright © 2017 Ankita Gupta et al. All rights reserved. Management of Liddle Syndrome in Pregnancy: A Case Report and Literature Review Wed, 15 Mar 2017 07:54:12 +0000 Liddle syndrome is an autosomal dominant genetic condition that causes hypertension and hypokalemia due to a gain-of-function mutation in the SCNN1B or SCNN1G genes which code for the epithelial sodium channel in the kidney. This leads to increased sodium and water reabsorption causing hypertension. We report a case of a 27-year-old pregnant woman who was admitted for hypertension and hypokalemia and later diagnosed and treated for Liddle syndrome using amiloride. Maintaining a high suspicion of Liddle syndrome in pregnancy is essential in such cases to be able to adequately and effectively treat the hypertension. Due to physiological effects of pregnancy, the dose of amiloride may need to be increased as gestational age progresses up to a maximum dose of 30 mg orally per day. Michael Awadalla, Manasi Patwardhan, Adham Alsamsam, and Nashat Imran Copyright © 2017 Michael Awadalla et al. All rights reserved. Bilateral Sertoli Cell Tumors in a Patient with Androgen Insensitivity Syndrome Mon, 13 Mar 2017 00:00:00 +0000 Androgen insensitivity syndrome is the most common cause of male pseudohermaphroditism and the third most common cause of primary amenorrhea. This genetic alteration is a consequence of inherited defects on the X chromosome causing total or partial damage to the intrauterine virilization process due to functional abnormalities in the androgen receptors. The present report describes a 22-year-old patient with a female phenotype and a 46, XY karyotype, presenting with bilateral inguinal tumors. The tumors were surgically removed at the Santa Casa de Misericórdia Hospital in Vitória, Espírito Santo, Brazil. Pathology revealed bilateral testicles with Sertoli cell tumors. According to the international literature, prophylactic gonadectomy following puberty is recommended due to the progressive risk of neoplastic transformation in the residual gonads. Roberta Fonseca de Souza, Janaina Pereira da Silva, Bruno Vieira Balla, Rodrigo Neves Ferreira, and Antônio Chambô Filho Copyright © 2017 Roberta Fonseca de Souza et al. All rights reserved. Pneumoperitoneum Secondary to Spontaneously Perforated Pyometra Sun, 05 Mar 2017 00:00:00 +0000 Pyometra, by definition, is a collection of purulent fluid within the uterine cavity. Incidence has been estimated to range from 0.1% to 0.5%. Typically, this is linked to postmenopausal women; however, it has been linked to premenopausal women with concordant use of intrauterine devices. Based on our knowledge, there have been less than 50 recorded cases reported in the English literature regarding perforation of pyometra resulting in acute abdomen and fewer than 25 resulting in pneumoperitoneum. We report a patient who was evaluated for diffuse peritonitis caused by perforated pyometra who was successfully treated with surgical intervention. Benjamin A. Raymond and Christopher Esper Copyright © 2017 Benjamin A. Raymond and Christopher Esper. All rights reserved. Ultrasound, Echocardiography, MRI, and Genetic Analysis of a Fetus with Congenital Diaphragmatic Hernia and Partial 11q Trisomy Thu, 02 Mar 2017 07:30:44 +0000 Congenital diaphragmatic hernia (CDH) is a serious birth defect with a significant mortality and morbidity. The current and constant progress in ultrasound techniques has led to the improvement of the prenatal diagnosis of this malformation. CDH is a developmental defect whose etiology is heterogeneous and takes place when the pleuroperitoneal folds and septum transversum fail to converge and fuse. Survival depends on the extent of pulmonary hypoplasia and the disease may be potentially worsened by the presence of added congenital defects. 40% of CDH cases are associated with at least one additional anomaly. The ultrasound diagnosis is established with essential signs: loss of uniform echogenicity of lungs and marked mediastinal shift. We report the case of a fetus with isolated CDH diagnosed at 21 weeks of gestation by ultrasound and confirmed by RMI, whose genetic analysis of amniotic fluid cells identified a de novo partial trisomy of the long arm of chromosome 11. Different genetic causes have been associated with CDH. Moreover, it is expectable that the use of new techniques for prenatal diagnosis will reveal novel CNVs associated with CDH and will help us to estimate the recurrence risk for this defect as well as for other associated anomalies. Yolanda Fernández-Perea, Lutgardo García-Díaz, Javier Sánchez, Guillermo Antiñolo, and Salud Borrego Copyright © 2017 Yolanda Fernández-Perea et al. All rights reserved. Treatment of Endometrial Cancer in Association with Pelvic Organ Prolapse Tue, 28 Feb 2017 00:00:00 +0000 Background. Uterine malignancy coexistent with pelvic organ prolapse (POP) is uncommon and standardized treatment is not established. The objective of this case study was to highlight the management of endometrial cancer in association with pelvic organ prolapse. Case Report. An 87-year-old woman presented with POP Stage IV combined with endometrioid adenocarcinoma of the uterus: clinical Stage IV B. She had multiple medical conditions including stroke, deep vein thrombosis, and pulmonary embolism. She was treated with radiotherapy and pessary was placed. Conclusion. Genital prolapse with abnormal uterine bleeding requires proper evaluation and management. Concurrent adenocarcinoma and POP can be a difficult clinical situation to treat, and optimum management is controversial. Asama Vanichtantikul, Ekkasit Tharavichitkul, Imjai Chitapanarux, and Orawee Chinthakanan Copyright © 2017 Asama Vanichtantikul et al. All rights reserved. Rare Epithelioid Leiomyoma of the Vagina Exhibiting a Pelvic Mass Tue, 28 Feb 2017 00:00:00 +0000 Epithelioid leiomyoma of the vagina is extremely rare. Smooth muscle tumors of the vagina usually present with a submucosal growth pattern or a pedunculated growth pattern from the anterior vaginal wall into the vaginal cavity. Here we report a case of a 43-year-old woman with a solid epithelioid leiomyoma and a palpable mass in the pouch of Douglas. Transvaginal biopsy and angiography showed the epithelioid leiomyoma feeding from the vaginal artery behind the posterior vagina. An abdominal wide excision of the tumor with a partial vaginectomy was performed. Our use of ultrasound-guided needle biopsy and angiography was useful for preoperative diagnosis of a vaginal epithelioid leiomyoma exhibiting a pelvic mass. Yuji Tanaka, Mayuko Nagasaka, Mariko Takahashi, and Masashi Kobayashi Copyright © 2017 Yuji Tanaka et al. All rights reserved. Term Abdominal Pregnancy Revealed by Amnioperitoneum in Rural Area Sun, 26 Feb 2017 12:45:59 +0000 Abdominal pregnancy (AP) accounts for 1% of ectopic implantations. In sub-Saharan Africa, the high prevalence of sexually transmitted infections explains the increasing frequency of this pathology. In Cameroon it rose from 1/10000 deliveries (1995) to 3.3/10000 (2015). Authors herein report a case of a viable abdominal pregnancy discovered at term during emergency laparotomy for suspected uterine rupture. The 24-year-old G2P0 patient was HIV-positive, under antiretrovirals, though AP exceptionally occurs in HIV patients. She did only two antenatal consultations: her main complaint was abdominal pain but five echographies concluded to normal intrauterine pregnancy. Findings at laparotomy were as follows: amnioperitoneum, a live female baby weighing 3.4 kilogrammes without deformities and a placenta deeply inserted on the uterine fundus. Removal of the placenta triggered massive bleeding (2400 milliliters) with shock managed with a tourniquet on the lower uterine segment and fluid resuscitation. Outcome was favourable for the mother and child. Prevention of vertical transmission of HIV was successful with antiretroviral therapy. Henri Donald Mutarambirwa, Bruno Kenfack, and Jovanny Tsuala Fouogue Copyright © 2017 Henri Donald Mutarambirwa et al. All rights reserved. Cesarean Scar Endometriosis: An Uncommon Surgical Complication on the Rise? Case Report and Literature Review Thu, 23 Feb 2017 07:30:05 +0000 Endometriosis is defined by the presence and growth of ectopic functional endometrial tissue outside the uterus. Scar endometriosis has been described following obstetrical and gynecological surgery. It is a rare condition, though probably on the rise, due to the considerable increase of cesarean sections performed worldwide. Its physiopathology is complex; its symptomatology is rich and diverse but thorough clinical examination along with ultrasound imaging and potentially pretherapeutic cytologic evaluation are usually efficient in diagnosing the condition. Treatment is mostly surgical. We report the case of a cesarean section scar endometriosis, managed at a tertiary level center and emphasize the diagnosis and treatment options. Imane Khachani, Abdelhai Filali Adib, and Rachid Bezad Copyright © 2017 Imane Khachani et al. All rights reserved. Spontaneous Pneumomediastinum in Labor Tue, 21 Feb 2017 00:00:00 +0000 Spontaneous pneumomediastinum and subcutaneous emphysema also known as Hamman’s syndrome is a very rare complication of labor that is often related to the valsalva maneuver during the labor. In most case, Hamman’s syndrome is a self-limiting condition, rarely complicated unless there are underlying respiratory diseases. Chest X-ray can be a useful early diagnostic technique in severe clinical presentation. We report an uneventful pregnancy in a primigravid parturient, which was complicated in the late second stage of labor by the development of subcutaneous emphysema, pneumomediastinum, and mild pneumothorax. Spontaneous recovery occurred after four days of conservative management. This condition shows the major interest of labor analgesia especially locoregional techniques. Mohamed Adnane Berdai, Said Benlamkadem, Smael Labib, and Mustapha Harandou Copyright © 2017 Mohamed Adnane Berdai et al. All rights reserved. Pure Primary Ovarian Squamous Cell Carcinoma Perforating the Rectum Mon, 20 Feb 2017 07:12:34 +0000 Rectal perforation is uncommon in ovarian cancer, even in advanced stages. Pure primary ovarian squamous cell carcinoma is a very rare subtype of ovarian cancer and has not been reported to cause rectal perforation. A 50-year-old woman presented with rectal bleeding. Rectosigmoidoscopy suggested perforation of a pelvic tumor into the rectum. Abdominopelvic magnetic resonance imaging revealed a 9 cm heterogeneous mass in the pouch of Douglas. We performed complete cytoreduction, including an en-bloc resection of the tumor and rectosigmoid colon. Histopathology showed squamous cell carcinoma of the left ovary penetrating the rectal wall. A common symptom of rectal bleeding was caused by a very rare entity of ovarian cancer penetrating the rectal wall, but thorough evaluation led to its accurate diagnosis and appropriate treatment. Kazuya Mimura, Aiko Okada, Naotsugu Haraguchi, Kenjiro Sawada, Takuji Tomimatsu, and Tadashi Kimura Copyright © 2017 Kazuya Mimura et al. All rights reserved. Management of Retained Genital Piercings: A Case Report and Review Sun, 19 Feb 2017 07:00:42 +0000 The prevalence of genital piercing among women is increasing. As the popularity increases, the number of complications from infection, injury, and retained jewelry is likely to rise. Techniques to remove embedded jewelry are not well described in the literature. The purpose of this report was to describe a case of a patient with a retained clitoral glans piercing, discuss a simple technique for outpatient removal, and review current evidence regarding associated risks of clitoral piercings. A 24-year-old female presented to the emergency department with an embedded clitoral glans piercing. Local anesthetic was injected into the periclitoral skin and a small superficial vertical incision was made to remove the ball of the retained barbell safely. In conclusion, among patients with retained genital piercing, outpatient removal of embedded jewelry is feasible. While the practice of female genital piercing is not regulated, piercing of the glans of the clitoris is associated with increased injury to the nerves and blood supply of the clitoris structures leading to future fibrosis and diminished function compared to piercing of the clitoral hood. Laura J. Moulton and Amelia M. Jernigan Copyright © 2017 Laura J. Moulton and Amelia M. Jernigan. All rights reserved. Spontaneous Rupture of Pyometra in a Nonpregnant Young Woman Sun, 19 Feb 2017 00:00:00 +0000 A 40-year-old woman presented with severe vaginal bleeding. Initial workup with an abdominal sonography revealed endometrium for about 3 mm and free fluid in the abdomen. Hemodynamic instability with abdominal pain and free fluid in the abdomen prompted blood transfusion and laparotomy. There were about 1000 cc blood and clots in the abdomen at laparotomy. There was a longitudinal rupture from fundus up to cervix at the left side of the uterus. Tearing was in full thickness from serosa to endometrium. Scar of previous cesarean was transvers and not associated with this tearing. There was not any myomectomy scar. Parvin Mostafa-Gharabaghi, Shima Bordbar, Shabnam Vazifekhah, and Mohammad Naghavi-Behzad Copyright © 2017 Parvin Mostafa-Gharabaghi et al. All rights reserved.