Cases reported "Uterine Prolapse"

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1/35. uterine prolapse in pregnancy caused by a very large mucinous cyst.

    The literature review and a case report of a 25 years old patient who started to suffer from an extemely large abdomen, sever oedema, dyspnea, and uterine prolapse from the 30th week in her third pregnancy because of a very large mucinous cyst. The prolapsed uterus improved with bed rest. She delivered at term with no complication. The cyst was removed three weeks after the delivery with about ten litres of mucoid secretion in it. The patient left hospital on the tenth post operative day.
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2/35. The relationship of the in-situ advancing vaginal wall sling to vaginal epithelial inclusion cyst.

    Epithelial inclusion cyst is an under recognized complication of the in-situ advancing vaginal wall sling. A 63-year-old woman with stage I pelvic organ prolapse and mixed incontinence underwent in-situ sling placement in November 1997. In February 1998 she presented with a painful recurrent inflammatory anterior vaginal wall mass. The mass was cystic and drained spontaneously four times over the period of conservative management. The patient underwent resection of a clinical and pathological vaginal epithelial inclusion cyst in September 1998. At 6-month follow-up the patient remains continent and the cyst has not reformed. The vaginal surgeon should be aware of the potential for epithelial inclusion cyst formation after in-situ sling placement, and actively search for them at postoperative examination.
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3/35. rupture of the rectosigmoid colon with evisceration of the small bowel through the anus.

    Spontaneous rupture of the rectosigmoid colon and herniation of the small intestine through the rupture site and eventual evisceration through the anus is a very rare event. In the literature, only 42 cases have been reported. The majority of them occurred in patients with rectal prolapse and one case was reported in association with a third-degree uterine prolapse. We experienced an 81-year-old female patient with rectal prolapse and second-degree uterine prolapse complicated by spontaneous perforation of the rectosigmoid colon and anal evisceration of the small intestine. Segmental resection of the nonviable small intestine, primary repair of the ruptured rectosigmoid colon, and sigmoid loop colostomy were performed, and the patient recovered well. In our patient, both rectal and uterine prolapses cooperatively damaged the anterior wall of the rectosigmoid colon and resulted in perforation. So, rectal and uterine prolapses should be treated before the complication develops. In this patient, uterine prolapse should be treated because of the recurrence of this rare episode.
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4/35. Sprengels deformity: anaesthesia management.

    A 28 years old lady presented with Sprengels deformity and hemivertebrae for Fothergills surgery. Clinically there were no anomalies of the nervous, renal or the cardiovascular systems. She had a short neck and score on modified Mallapati test was grade 2. She was successfully anaesthetised using injection propofol as a total intravenous anaesthetic agent after adequate premedication with injection midazolam and injection pentazocine. Patient had an uneventful intraoperative and postoperative course.
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keywords = operative
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5/35. Vaginal leiomyoma--an imitator of prolapse.

    Vaginal leiomyoma is a rare tumor with a variable clinical presentation and broad differential diagnosis that can lead to preoperative misdiagnosis. We present a case of vaginal leiomyoma with a symptom complex of prolapse, urinary urgency and urge incontinence. A 50-year-old woman presented with a 4-year history of deteriorating sensation of prolapse, significant complex urinary complaints and prolonged vaginal bleeding. Clinical examination revealed a mobile 6 x 8 cm mass arising from the anterior vaginal wall. She underwent hysteroscopy, curettage, urethrocystoscopy (normal findings) and mass enucleation through a vertical incision. histology showed a benign leiomyoma. ultrasonography, MRI, positive-pressure urethrography and urethrocystoscopy should be considered in the evaluation of an anterior wall vaginal mass. Surgical enucleation via a vaginal approach is the treatment of choice. If this surgical procedure results in skeletonization of the urethral and bladder support, a colporrhaphy/pubourethral ligament plication is required.
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6/35. Acute puerperal inversion of the uterus--treatment by a new abdominal uterus preserving approach.

    OBJECTIVE: Inversion of the uterus is still a rare (1, 2) but serious and life-threatening obstetric complication. It is said to be complete when the fundus uteri protrudes through the cervix and into the vagina. Within minutes a state of shock is reached due to pulling forces on the peritoneum as well as blood loss. methods: The vagina was entered by a longitudinal incision (3 m) below the contraction ring. Through this opening it was possible to advance two fingers (second and third finger of the left hand) into the vagina above the invaginated corpus uteri. The invaginated cavum uteri was loaded on these two fingers and, exerting counterpressure with the right hand, the inside was turned out. CONCLUSION: The present operative method guarantees easy reposition of the uterus in cases of failed vaginal manual repositioning. Furthermore, the cavum uteri remains intact and hysterectomy can be avoided.
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7/35. Sacral osteomyelitis: an unusual complication of abdominal sacral colpopexy.

    BACKGROUND: Abdominal sacral colpopexy using permanent mesh is an established technique for repair of vaginal vault prolapse. infection is not a frequent complication. We report two cases of lumbosacral osteomyelitis treated with intravenous antibiotics without mesh removal. CASES: The first patient had known advanced degenerative arthritis. Unremitting severe low back pain 5 years after abdominal sacral colpopexy prompted magnetic resonance imaging (MRI), revealing osteomyelitis and diskitis. The second patient developed symptoms 2 months postoperatively, and MRI indicated osteomyelitis with epidural abscess. Both patients received intravenous antibiotics, and neither required surgical debridement or mesh removal. CONCLUSION: osteomyelitis can present remote from the operation and can be difficult to diagnose. Protracted parenteral antibiotic therapy can be definitive treatment without mesh removal.
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8/35. Translevator gluteal hernia.

    The authors report a case of a posterior translevator gluteal hernia in a woman with recurrent prolapse. This case illustrates the need to be aware of extravaginal perineal hernias. MRI proved useful in diagnosing this case preoperatively. This case highlights the need to exclude any associated pelvic hernias in women with complex prolapse preoperatively.
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keywords = operative
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9/35. Bilateral hydroureter and hydronephrosis causing renal failure due to a procidentia uteri: a case report.

    We report a case of complete uterine prolapse that resulted in bilateral hydroureter, hydronephrosis, and renal dysfunction. The nonoperative reduction of the prolapse with a vaginal pessary reversed the obstructive uropathy and ameliorated renal function. The lower urinary tract should be imaged in patients with complete uterine prolapse. If present, obstructive uropathy should be relieved by the reduction of the prolapse before irreversible renal damage occurs.
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10/35. Low incidence of post-TVT genital prolapse.

    Tension-free vaginal tape (TVT) is a well established surgical procedure for the treatment of female urinary stress incontinence. The operation, described by Ulmsten in 1995, is based on a midurethral Prolene tape support. TVT is accepted as an easy-to-learn and safe, minimally invasive surgical technique. Postoperative genital prolapse has been described following the Burch technique, as well as other surgical methods for the correction of female stress urinary incontinence. The aim of this analysis was to evaluate the occurrence of this specific complication in relation to TVT. Of 314 patients undergoing TVT and followed for up to 50 months only 1 suffered genital prolapse, with de novo grade 2 cystocele, rectocele and uterine prolapse, diagnosed 3 months after the operation. This is the first reported case of genital prolapse following TVT.
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