Surgical management of a transverse vaginal septum: About a rare case.

INTRODUCTION: The transverse vaginal septum is a rare anomaly of the müllerian ducts whose pathophysiology is linked to a defect in the resorption of the embryological tissue located between the vaginal dome and the caudal terminal part of the fused müllerian ducts. CASE PRESENTATION: We report a rare case of a permeable transverse vaginal septum in a 41-year-old patient, who consulted for cyclic pelvic pain. DISCUSSION: The vaginal septum is a rare anomaly of the Müllerian ducts whose approximate frequency is around 1/70,000 women. The vaginal septum can be permeable or impermeable and can affect all levels of the vagina. The combination of conventional ultrasound and MRI confirms the diagnosis of these abnormalities. The treatment is surgical and must be implemented quickly. Several surgical techniques have been described, the simplest of which is the "crevice" technique. CONCLUSION: The combination of conventional ultrasound and MRI is useful in confirming the diagnosis of these abnormalities. Surgical treatment should always be well planned. The risks of postoperative stenosis and the impact on the upper genital tract must be taken into account.

Cerebral meningioma during pregnancy mimicking eclampsia: About a rare case.

INTRODUCTION: Pregnancy is a physiological state whose association with any pathology gives it specific characteristics in the management of patients. Meningioma is the most frequent brain tumor but rarely develops during pregnancy. Treatment of the tumor generally follows the same principle as that proposed outside pregnancy, with priority given to the mother's life. PRESENTATION OF CASE: We report a rare case of gestational meningioma that was wrongly attributed to prepartum eclampsia, in a poorly monitored pregnancy estimated at 34 weeks' amenorrhea, which resulted in the termination of the pregnancy by cesarean section for maternal rescue. The patient underwent complete surgical removal of the tumor postpartum. DISCUSSION: Cerebral meningioma in pregnancy is a rare but often fatal disease characterized by unusual behavior compared to meningiomas in non-pregnant women. It is suspected that endocrine and vascular changes play a crucial role in the pathophysiology of rapid tumor growth during pregnancy. The tumor's harmful effect on the fetus is not direct but is mediated by its consequences, such as intracranial hypertension and epileptic seizures, which can be life-threatening for both mother and fetus and in some cases necessitate termination of pregnancy. CONCLUSION: The management of cerebral meningioma during pregnancy must take into account the gestational-fetal pairing, both in diagnosis and treatment. This requires close coordination and collaboration between various experts, including anesthetists, obstetricians, neurosurgeons, and pediatricians.

A rare case of limb body wall complex.

Limb body wall complex (LBWC) is a complex and rare poly-malformative syndrome. We report a case of this syndrome diagnosed antenatally in a 37-year-old primiparous woman, by a first obstetrical ultrasound performed at 22 weeks of amenorrhea and one day. After termination of pregnancy, macroscopic examination revealed a male newborn with all the diagnostic criteria of LBWC.

Acquired uterine arterio-venous malformation post molar pregnancy suction-curettage: 2 case reports.

INTRODUCTION: Acquired uterine AVM is an abnormal and non-functional connection between uterine arteries and veins. It is reported as a consequence of uterine trauma as curettage procedures, pelvic surgery. CASES PRESENTATION: The authors report 2 cases of uterine AVM post suction-curettage procedure on molar pregnancy incidentally discovered in ultrasound screening in the usual follow-up of this disease, diagnosed in the Department of Maternity of Mother and Child University Hospital Abderrahim Harouchi of Casablanca. CLINICAL DISCUSSION: Uterine AVMs are extremely rare and should be considered in cases of heavy and persistent uterine bleeding. Uterine AVMs are either acquired or, more rarely, congenital, due to abnormal differentiation of the primary vascular structures during embryogenesis. The invasive technique allows confirmation of the diagnosis and identification of the major feeding vessels when embolization may be indicated as a treatment option. CONCLUSION: Acquired uterine arteriovenous malformation is the result of uterine trauma; it presents as uterine bleeding through the vagina that can be life threatening, the rarity of the condition makes it difficult to diagnose, however the evolution of investigative techniques helps in the diagnostic process.

Amniotic band syndrome: A case report.

Amniotic band syndrome is a rare disorder, which consists of a combination of malformations in which the main feature is the existence of an amniotic band that can envelop the limbs, the body wall, and/or the viscera. We report a case of an antenatal diagnosis of amniotic band syndrome in a 21-year-old female patient at 20 SA + 1 day, who had a medical abortion.

Tuberculosis of the breast neoplastic-like about two report cases: A rare often unrecognized diagnosis.

Tuberculosis of the breast is a very rare infection; it occurs chiefly in women of childbearing potential, usually as an apparently primary infection and constitutes a diagnosis and therapeutic challenge. Administration of antituberculous agents is the mainstay of therapy. Surgery is required in some cases. We report tow cases of breast tuberculosis. The diagnosis has been established on histology. Outcome was favorable under anti bacillary treatment. Through the literature data we recall the epidemiological, clinical, diagnostic and treatment of this pathology.

Acro-callous syndrome: A case report.

A malformative syndrome of unknown prevalence, the diagnosis is based on morphological ultrasound and magnetic resonance imaging of the fetus. The transmission is genetic and autosomal recessive. Courtnes has established 4 diagnostic criteria to affirm the acrocal syndrome and to eliminate the amalgam with other polymalformative syndrome.

Uterine necrosis simulating a textiloma: A case report.

Uterine necrosis is a rare condition, it is considered a life-threatening complication. A few cases of uterine necrosis are reported in the literature most of them complicating embolizations, occurring after postpartum hemorrhages or severe endometritis. We describe a case of uterine necrosis occurring after a caesarean section, the results of the CT scan simulated a textiloma.

Spontaneous uterine rupture during the first trimester of a partial molar pregnancy in a scar uterus: A rare case report.

INTRODUCTION: Spontaneous uterine rupture in the first trimester is a redoubtable obstetric emergency that carries a high risk for both mother and fetus. CASES PRESENTATION: We present the case of a spontaneous uterine rupture in a patient with a scarred uterus at 9 weeks' gestation treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca; whose histological examination of the removed material found a partial mole. CLINICAL DISCUSSION: Spontaneous uterine rupture in the first trimester is rare and usually occurs in a scarred or malformed uterus. Clinicians should consider this diagnosis in the presence of an acute abdominal pain in early pregnancy with or without first trimester metrorrhagia. CONCLUSION: Since the rate of uterine surgeries is increasing, it is necessary to highlight the risk of uterine rupture occurring early in order to improve their management. Molar pregnancy is a factor of fragility of the uterine wall and uterine rupture must be suspected in any molar pregnancy associated with a hemoperitoneum.

Abdominal pregnancy diagnosed by ultrasonography and treated successfully by laparotomy: Two cases report.

INTRODUCTION: Abdominal pregnancy is one of the rare types of ectopic pregnancies that has a high rate of mortality. Its clinical presentation is similar to those of the other types of ectopic pregnancies. CASES PRESENTATION: we report two cases of abdominal pregnancies whose the diagnosis was made by ultra-sonography and successfully treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. CLINICAL DISCUSSION: the ultra-sonography based on precise criteria represents the fundamental paraclinical examination in the diagnosis of abdominal pregnancies. The treatment of early form is based on surgery; And despite the advent of laparoscopic surgery, laparotomy retains its indications including forms with hemorrhagic shock. CONCLUSION: Due to the high risk of complications and maternal mortality, abdominal pregnancies should be surgically treated as soon as possible when the diagnosis is confirmed.

Unusual primary location of non-Hodgkin lymphoma in the uterine body with compressive form: About case.

INTRODUCTION: Primary non-Hodgkin's malignant lymphoma (NHML) of the uterine body is an extremely rare localization since only eleven cases have been reported in the literature. CASE PRESENTATION: We report a case of primary NHML of the uterine body discovered during a hysterectomy performed for a uterine mass. The primary character of NHML of the uterine body was retained in view of the absence of extra-genital localization in the clinical, biological and radiological workup (Ann Arbor stage IE) and there were no signs of recurrence during follow-up. The patient received anti-CD20 immunochemotherapy (rituximab-CHOP and rituximab-VCAP combinations) and at 12 months follow-up, she is in complete remission. DISCUSSION: The diagnosis of primary and isolated NHML of the uterine body is based on a clinical and further examination and regular follow-up for several months. The treatment is not codified; surgery, poly-chemotherapy and radiotherapy are the different therapeutic modalities. Rituximab-CHOP immunochemotherapy is currently the reference treatment for primary malignant lymphomas of the uterine body particularly in young patients who wish to become pregnant. The prognosis depends mainly on two factors: age and Ann Arbor stage. CONCLUSION: Primary uterine lymphomas are rare tumors of unknown etiopathogeny and of non-specific clinical presentation, the role of the various treatments remains difficult to evaluate due to the small number of published cases.

[Pelvic hydatid yst: apropos of 8 cases]. / Kystes hydatiques pelviens: à propos de huit cas.

The hydatidosis fisues in the endemic state in Morocco, its pelvigenital localization is rare and doubtful. The objective of this study is to examine the epidemio-clinic appearance, the diagnosis means and the therapeutic flow of the pelvigenital hydatid cyst in Morocco. This retrospective study is about eight patients hospitalized and cured for pelvigenital hydatid cyst in lalla Meryem maternity of Casablanca during a period of six years (1992-1997). The hydatid cyst diagnosis was confirmed by anatomopathology. This affection represented 0.80% of the pelvic mass operated during the same periode. The majority of our patients was from rural origin, their age varies between 22 and 70 years old. The discovery circumstances were dominated by abdomino-pelvic mass. The diagnosis was nearly certain prior to the surgery for half of the cases. The genital organs were the most reached by the pelvic hydatidosis (75%). The treatment was purely surgical, adapted to each case in according to the localization, the volume and the contribution of the cyst. The medical treatment has been prescribed in one case in post surgery. The evolution was good in all the cases. The hydatidos cyst must always be present in mind when dealing with cyst pelvic formation in an endemic country like Morocco. The prophylaxia preserves its important value and must constitute a hinder against this disease in endemic countries.

[Heterotopic pregnancies: 8 cases]. / Grossesses hétérotopiques: à propos de huit cas.

Heterotopic pregnancy is the combination of intra-uterine pregnancy and ectopic pregnancy in the same patient whatever is the localization of the ectopic pregnancy. The aim of this work was to summarize the epidemics and clinical factors, the diagnostic means and the therapeutic methods for the spontaneous heterotopic pregnancy in Moroccan context. In a period of 6 years (1993-1998), 8 patients were treated for heterotopic pregnancy in Lalla Meryem Maternity of Casablanca, with a rate of 0.2/1000. Patients' ages ranged from 19 to 37. The backgrounds were: abortions (4 cases), secondary sterility (2 cases) and genital infection (2 cases). Five patients consulted for metrorrhagia associated with pelvic pain. Two for pelvic pain and one for metrorrhagia. The diagnosis was confirmed before echography in 5 cases. All patients were operated on, 3 in a condition of haemorrhagic shock. Ectopic pregnancy lay at the level of the fallopian tube in 7 cases and at the level of the ovary in one. The treatment consisted of a salpingectomy in the 7 patients with tubal localisations, the ovary pregnancy benefited from ovariectomy. Evolution has been marked by expulsion of intra-uterine pregnancy in 6 cases. Two women were able to carry out their pregnancy. Heterotopic pregnancy is more and more frequent because of genital infection increase and especially the wide diffusion of the assisted medical procreation.

[Trial of labor after 2 cesarean sections. Prospective study of 130 cases]. / Epreuve du travail sur utérus bicicatriciel. Etude prospective à propos de 130 cas.

The mode of delivery in the parturient women with two prior cesarean is controversial. Based on a prospective analysis of 130 cases, we tried to assess the outcome of trial of labor after two cesarean sections. Among 167 patients with two uterine scars, 130 (77.8%) were selected for a trial of labor that was successful in 65 cases (50%). The overall rate of vaginal birth and cesarean section was 39% and 61%, respectively. There were 4 scar dehiscences and 2 uterine ruptures among the women who underwent trial of labor, but no case of perinatal death or morbidity related to these complications was observed. In the majority of the cases, these scar separations were due to poor obstetrical conditions. Trial of vaginal delivery after two prior cesarean sections seems to us a reasonable attitude if it is well indicated and supervised correctly.

[Vaginal birth after cesarean delivery: can the trial of labor be extended]. / Accouchement des utérus cicatriciels: peut-on élargir l'épreuve utérine?

Based on a retrospective analysis of 1000 cases of scared uteri following cesarean section(s) (one cesarean, n = 857, 85.7%); two n = 129, 12.9%; three n = 14, 1.4%), we tried to answer two questions. Is trial of labor in case of low segment uterine-scar (excepting pelvic abnormalities, corporeal scar and more than two scars) free of risk for the mother and child? Can trial of labor be extended to cases of breech presentation, two previous cesarean sections, twin pregnancy and suspected macrosomia? In this series, the cesarean was indicated before labor in 138 cases (13.8%). Trial of labor was conducted in 862 cases (86.2%), and led to vaginal birth in 728 (84.5%). Successful trial of labor was observed in 75% of twin pregnancies, in 100% of breech presentations and in 69.6% of macrosomic infants. Uterine rupture occurred in 23 cases (2.7%), especially in cases with unknown corporeal scars (15 cases). No case of perinatal death related to uterine rupture was observed in this series.

[Granulomatous recurrent mastitis during pregnancy]. / Mastite granulomateuse récurrente et grossesse.

We report a case of granulomatous mastitis during pregnancy which raised important diagnostic and therapeutic problems. Several diagnoses were suspected and subsequently different therapeutic regimen were tried (antibiotic therapy associated with nonsteroidal antiinflammatory drugs, progestogens, vein tonicity drugs and bromocriptine). All were ineffective and the patients status worsened. Histology confirmed the diagnosis of granulomatous recurrent mastitis. Corticosteroid therapy and interruption of pregnancy successfully controlled the disease process.

[Hydatic cyst of the fallopian tube: a case report]. / Kyste hydatique tubaire: à propos d'un cas.

A 37-year-old woman was seen for pelvic pain. Ultrasonography and laparoscopy led to the diagnosis of bilateral hydrosalpinx. Analgesics and antibiotics were given several times but the clinical picture worsened. Laparotomy was performed and disclosed bilateral hydatidosis of the fallopian tubes requiring bilateral salpingectomy. Postoperatively, hydatic serology was strongly positive and a calcified hydatic splenic cyst was identified. Medical treatment with albendazole was prescribed for these multiple localizations of hydatid cysts.

[Pelvic tuberculosis mimicking bilateral ovarian tumor. A case report]. / Tuberculose pelvienne simulant une tumeur ovarienne bilatérale: à propos d'un cas.

Tuberculosis is a curable infectious disease which can mimic ovarian cancer. This case report illustrates that the association of a pelvic mass with elevated CA125 is not necessarily suggestive of ovarian malignancy. A 22-Year-old woman presenting with bilateral ovarian masses and an elevated CA 125 underwent an exploratory laparotomy to search for ovarian tumor. The final pathology diagnosis was ovarian tuberculosis without pulmonary involvement. Tuberculosis is a differential diagnosis to consider in patients with a pelvic mass because of the lack of pathognomonic clinical and biological signs.