Complete labia majora fusion after obliterative surgical procedure: a video case report.

Obliterative surgical procedures have been classically used as a method to reduce pelvic organ prolapse in elderly women who do not wish to preserve the vagina for sexual intercourse. The aim of this video is to demonstrate a surgical technique of repairing complete labia majora fusion in a woman who had previously undergone one of these procedures. We present the case of an 80 year-old woman with a history of progressive difficulty on voiding onset and sensation of incomplete bladder emptying. She reported an obliterative procedure to correct her pelvic organ prolapse (POP) 10 years earlier. On physical examination, complete fusion of labia majora was observed, causing abnormal urinary drainage. Perineal reconstructive surgery was performed without complications and the application of topical Promestriene was prescribed. Optimal genital re-epithelization was observed during follow-up. As observed, patients undergoing obliterative surgery who present with genital atrophy are at increased risk of developing vulvar adherences. Applying vaginal moisturizers or local topical estrogens can prevent this condition. In severe vulvar fusions, early surgical treatment is recommended to prevent potentially serious complications.

Edema mamario unilateral en contexto de insuficiencia cardíaca: presentación de un caso y revisión de la literatura / Unilateral breast edema in context of heart failure: A case report and literature review

El edema mamario unilateral puede aparecer como sintomatología atípica de la insuficiencia cardíaca. Presenta un amplio diagnóstico diferencial, entre el que se incluyen causas benignas, como la mastitis o las enfermedades sistémicas que cursan con edema generalizado; y causas malignas como el carcinoma inflamatorio de mama. Esta última entidad, aunque poco frecuente, presenta mayor agresividad que otros tipos de tumores mamarios y se deberá sospechar su diagnóstico ante la presencia de cambios mamarios unilaterales. En este artículo se presenta un caso de edema mamario unilateral en una paciente con fallo cardíaco congestivo en el que se sopesaron la mastitis y el carcinoma inflamatorio como diagnósticos iniciales. También se incluye una revisión de la literatura de los pocos casos publicados sobre el tema. (AU)

Unilateral breast edema might appear as an infrequent symptom of congestive heart failure. It has a wide range of diagnostic possibilities including benign causes, such as mastitis or systemic diseases causing general edema, and malign causes such as inflammatory breast cancer. This kind of tumor, although uncommon, is more aggressive than other breast tumors. Therefore, it is mandatory to rule it out whenever changes in breast skin occur. We report a case of unilateral breast edema in a patient with congestive heart failure for whom mastitis and inflammatory breast cancer were considered as first diagnostic possibilities. A literature review of the few articles published on the subject is also included. (AU)

Pelvic inflammatory disease presenting 16 months after vaginal hysterectomy: A case report and literature review.

Pelvic inflammatory disease after hysterectomy is rare and the underlying route of infection is highly heterogeneous. We report the case of a 52-year-old woman with a history of vaginal hysterectomy for uterine prolapse admitted to the emergency department with acute abdominal pain and fever. Vaginal discharge and pelvic tenderness were evident in the clinical examination. Ultrasound and computed tomography scans showed a cystic pelvic mass in contact with the vaginal cuff, suggesting the diagnosis of pelvic inflammatory disease. Laparoscopic examination revealed a bilateral tubo-ovarian abscess firmly attached and fistulized to the vaginal cuff, and after tubal removal and antibiotic coverage the patient had an optimal recovery. We performed a review of the case reports published on this subject, and concluded that pelvic inflammatory disease should not be excluded in patients with a history of hysterectomy when symptoms and findings are compatible.