1/54. hematometra and extended vaginal haematoma after laser conization. A case report. A very rare case of haematometra and extended vaginal haematoma in a 53-year-old woman after laser conization is reported. The patient presented with amenorrhea and complete urinary retention. The possible pathogenesis of this complication is discussed. ultrasonography, combined with physical examination were very helpful in determining the diagnosis. Cervical dilation and protection of surrounding tissues from thermal damage is recommended during laser conization to avoid similar complications. ( info) |
2/54. An unusual case of urinary retention due to imperforate hymen. A 15 year old girl presented to the accident and emergency (A&E) department with a 24 hour history of lower abdominal pain, and was found to have acute urinary retention. She was discovered to have an imperforate hymen with associated haematocolpos and haematometrium. This is rare and is hence a very unusual presentation to the A&E department. patients presenting with retention of urine should be carefully assessed for the cause. ( info) |
3/54. Resectoscopic treatment of uterus didelphys with unilateral imperforate vagina complicated by hematocolpos and hematometra: case report. OBJECTIVE: To describe a technique for treating hematocolpos and hematometra in patients with uterus didelphys and unilateral imperforate vagina involving the use of resectoscopy under ultrasonographic control. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 13-year-old girl with uterus didelphys with unilateral hematometra, hematocolpos, and ipsilateral renal agenesis. The girl complained of severe abdominal pain, which appeared with each of her menses. INTERVENTION(S): The intervention was performed by a vaginoscopic approach to preserve the integrity of the hymen. The first incision on the vaginal wall was performed in correspondence with the hematocolpos under continuous ultrasonographic guidance with the use of a straight resectoscopic loop. Resection of the vaginal septum was continued with the use of an angled resectoscopic loop until almost complete excision of the septum was achieved. MAIN OUTCOME MEASURE(S): Clinical, echographic, and vaginoscopic findings before the operation and 2 and 6 months after the operation. RESULT(S): The surgical procedure was easy to perform. Almost complete excision of the septum was achieved with just a few passages of the resectoscope. Complete drainage of both the hematocolpos and the hematometra was confirmed by ultrasonography. The postoperative period was completely uneventful. Clinical and vaginoscopic evaluations 6 months after the operation confirmed the integrity of the hymen, the complete resolution of clinical symptoms, and the persistence of a large communication between the two vaginas. CONCLUSION(S): Resectoscopic excision under ultrasonographic guidance of the vaginal septum in a girl with uterus didelphys with unilateral hematometra and hematocolpos was effective and easy to perform, and it fully respected the integrity of the reproductive system. ( info) |
4/54. Endometrial carcinoma presenting as hematometra mimicking a large pelvic cyst. Large pelvic cysts are commonly seen in gynecologic practice; their heterogeneous origin is reflected in their pleomorphic clinical features. We report the case of a 64-year-old multiparous postmenopausal woman with an unusual manifestation of endometrial adenocarcinoma that presented as hematometra mimicking a large pelvic cyst. In this case, hematometra was well demonstrated by transabdominal sonography, but transvaginal sonography allowed better visualization of the endometrial lining and suggested the correct diagnosis of endometrial cancer. Abnormal vaginal bleeding or hematometra in postmenopausal women should lead to assessment of the endometrial mucosa. Transvaginal sonography can be used to visualize neoplastic lesions in the endometrium when hematometra is detected through transabdominal sonography. ( info) |
5/54. fluorine-18 fluorodeoxyglucose positron emission tomography correlated with computed tomographic scan and magnetic resonance imaging in a case of hematometrocolpos. A 12-year-old girl had intense abdominal pain that had increased in the past 3 months and was accompanied by weight loss. An ultrasound examination revealed large cystic masses in the abdomen. A computed tomographic scan could not conclusively rule out a malignant condition. The hymen was normal on physical examination, but magnetic resonance imaging confirmed that the abnormalities corresponded to dilated cavities of the vagina, uterus, and fallopian tubes, with an appearance suggestive of hematometrocolpos. fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography was requested concurrently with the magnetic resonance image to assess the metabolic activity of the lesions and to exclude the presence of distant metastases. Large defects without FDG accumulation were noted in the areas corresponding to the cystic masses. Vaginal atresia with hematometrocolpos was confirmed at surgery. This rare case involving F-18 FDG positron emission tomographic imaging in hematometrocolpos illustrates that this diagnosis should be considered in the presence of symmetric hypometabolic masses in the pelvis. ( info) |
6/54. hematometra in postmenarchal adolescent girls: a report of two cases. We report two cases of unicornuate uterus with functioning rudimentary horn to highlight that Mullerian duct anomalies should be considered in the differential diagnosis of severe dysmenorrhoea even in normally menstruating girls. ( info) |
| A case of Listeria infection is reported of a 10 year old girl with symptoms of the first menstruation but without the discharge of blood because of the absence of the vaginal duct. The blood retained in the uterus obtained by puncture through the rectum contained listeria monocytogenes 4b. The infection was possibly acquired from a household pet. ( info) |
8/54. hematometra after thermal balloon endometrial ablation in a patient with cervical incompetence. BACKGROUND: Thermal balloon endometrial ablation is a relatively safe nonsurgical treatment for menorrhagia. hematometra follows this procedure in <3 % of patients, but risk factors for this complication are unclear. CASE: A woman with a history of cervical incompetence during pregnancy later developed cervical occlusion and hematometra after thermal balloon endometrial ablation. Cervical occlusion did not recur after cervical dilatation and temporary placement of a catheter as a stent. CONCLUSION: The normal resistance of the internal cervical os may be an important factor in avoiding thermal damage to the cervix during thermal balloon endometrial ablation. This case suggests that a history of cervical incompetence may be a clinical indicator of decreased cervical resistance. ( info) |
| A 30-year-old woman complained of increasing dysmenorrhea and progressive right lower-quadrant pain after cesarean section. A pelvic mass was observed and subsequently a congenital mullerian anomaly was diagnosed upon serial examination. We report the first apparent case of hematometra of the rudimentary horn of a unicornuate uterus resulting from cesarean section. ( info) |
10/54. Does menstrual flow exclude hematometra? A rare case of uterine anomaly presenting with anorectal malformation. hematometra, which is defined as accumulation of menstrual secretions in the uterine cavity, may not be diagnosed until the maturating adolescent fails to menstruate. Clinically, a lower abdominal mass and periodic abdominal pain may develop in these children after puberty. Here, a 13-year-old girl with menstrual flow who presented with symptoms of genital outflow tract obstruction is described. ( info) |