RESUMO
BACKGROUND: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a serious, drug-induced, life-threatening condition characterized by an epidermal blistering rash with necrosis, desquamation and mucosal surface involvement. This patient represents the youngest and most significant case report in the literature of gynecologic damage due to TEN. CASE: A 31/2-year-old girl developed TEN involving 90% of her body surface area after exposure to pediatric ibuprofen. After onset of puberty she required surgery to treat vulvar, vaginal and cervical adhesions, stenosis and hematometra. CONCLUSION: While delaying evaluation and treatment of the extremely young child with this disorder until puberty has been the standard, consideration should be given to earlier evaluation and intervention.
Assuntos
Doenças dos Genitais Femininos/etiologia , Ibuprofeno/efeitos adversos , Síndrome de Stevens-Johnson/induzido quimicamente , Síndrome de Stevens-Johnson/etiologia , Pré-Escolar , Constrição Patológica , Feminino , Doenças dos Genitais Femininos/cirurgia , Hematometra/etiologia , Hematometra/cirurgia , Humanos , Puberdade , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/patologia , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Doenças do Colo do Útero/etiologia , Doenças do Colo do Útero/cirurgia , Vagina/patologia , Doenças Vaginais/etiologia , Doenças Vaginais/patologia , Doenças Vaginais/cirurgia , Doenças da Vulva/etiologia , Doenças da Vulva/cirurgiaRESUMO
BACKGROUND: Placenta accreta is often diagnosed at the time of delivery and is a cause of postpartum hemorrhage, morbidity and mortality. The standard treatment for placenta accreta is hysterectomy to avoid acute blood loss and shock. A conservative surgical approach to the treatment of placenta accreta will allow immediate cure while preserving the patient's future fertility. CASES: A 39-year-old woman with placenta accreta diagnosed at the time of vaginal delivery was successfully treated with resection of the placental implantation site. A 33-year-old woman and a 35-year-old woman with placenta accreta/increta diagnosed at the time of cesarean section were successfully treated with resection of the placental implantation site. One patient has since conceived and given birth. CONCLUSION: Placenta accreta and placenta increta can be safely and successfully treated, in some well-selected cases, by resection of the placental implantation site and uterine repair. This conservative surgical management provides immediate therapy, reduces blood loss and preserves fertility.