Primary non-clear-cell adenocarcinoma of the vagina in a diethylstilbestrol exposed woman.

A 54-year-old woman with a history of in-utero diethylstilbestrol (DES) exposure, who had a prior hysterectomy for symptomatic leiomyomata and dysmenorrhea, presented for vaginal bleeding. Vaginal biopsies showed a non-clear-cell adenocarcinoma, and the patient was subsequently treated with radiation therapy. We present a case of primary vaginal non-clear-cell adenocarcinoma in a patient with in-utero DES exposure. Continued monitoring of older DES-exposed women for vaginal lesions is warranted because of reported cases of non-clear-cell adenocarcinoma and persistent risk of clear cell adenocarcinoma.

Endometrial adenocarcinoma following supracervical hysterectomy managed with radiation due to dabigatran etexilate.

BACKGROUND: Dabigatran etexilate, a new oral anticoagulant, has been developed for use in atrial fibrillation. This medication does not require therapeutic monitoring and there is no reversal agent in the event of life-threatening bleeding. We present a case of vaginal hemorrhage because of endometrial adenocarcinoma after a supracervical hysterectomy in a patient using dabigatran. CASE: 74-year-old woman status after supracervical hysterectomy presented with profuse vaginal bleeding. Biopsy confirmed high-grade adenocarcinoma, suggesting endometrial origin. Because of recent use of dabigatran and vaginal bleeding she underwent treatment with full-dose radiation and brachytherapy. CONCLUSION: Adenocarcinoma following supracervical hysterectomy is a rare occurrence. In the presence of profuse bleeding because of an anticoagulant with no reversal agents and extended activity, alternate modalities may be used.

Vaginal hemorrhage from transobturator sling controlled with QuikClot combat gauze.

A 42-year-old woman underwent an outside-in transobturator sling procedure, with subsequent venous hemorrhage. Two rolls of Combat Gauze were placed intravaginally and taken out on postoperative day 2 with good hemostasis. Despite careful technique, hemorrhage is a known complication of midurethral slings. Advanced hemostatic dressings may provide hemorrhage control and avoid the need for surgical intervention. After an extensive literature review, we present the first case of QuikClot Combat Gauze used as a hemostatic agent due to vaginal hemorrhage.

Transversus abdominis plane block for postoperative analgesia after cesarean delivery.

OBJECTIVE: The transversus abdominis plane (TAP) block is the ultrasound-guided placement of a peripheral nerve block in the abdominal wall for pain control. Our objective was to compare postoperative adjunctive oral narcotic use in women who underwent cesarean delivery and received the TAP block vs. those who received neuraxial narcotics. We hypothesize a decrease in narcotic use in women who received the TAP block. METHODS: Retrospective cohort study of women who received a TAP block for postoperative analgesia after cesarean compared to women who did not. The primary outcome was the total number of oral narcotic tablets administered between 24 and 48 h after surgery. An independent t-test and an analysis of covariance were employed to determine significant differences (P < 0.05) between the cohorts and to adjust for confounders. RESULTS: The TAP block cohort utilized 30% less oral narcotic analgesia than the control cohort (3.8 ± 0.5 tablets, P < 0.001). After adjusting for confounders and the presence of antecedent labor, there remained a significant reduction in the total oral narcotic doses given to women who underwent a TAP block compared to other forms of analgesia. CONCLUSION: The TAP block is associated with decreased oral narcotic usage 24-48 h following cesarean delivery.