Uterine tube evisceration during drainage tube removal - A rare case report.

INTRODUCTION AND IMPORTANCE: Drainage tubes are commonly used to remove unwanted fluid after surgery. However, they are not indicated in all situations, and there is no evidence to support their common utilization. CASE PRESENTATION: A 31-year-old woman at 38 weeks of gestation with a history of five cesarean sections presented with lower abdominal pain following a tonic-clonic epileptic seizure. Emergency surgery was performed due to fetal distress, and the uterus was found to be ruptured. After delivering the baby and closing the uterus, a drainage tube was inserted into the pouch of Douglas. Two days after surgery, the right ampulla and infundibulum were eviscerated from the drain site during the drainage tube removal. A second surgery was performed to reduce the herniated uterine tube. CLINICAL DISCUSSION: Drainage tubes are typically easily removed without complications. Some reported complications related to drainage tube removal include herniation, anchoring and suctioning of the uterine tube to the drainage tube, knotting with the colonic epiploica, and fracturing and retraction of the drainage tube due to adhesions. To the best of our knowledge, this is the first reported case of uterine tube evisceration during drainage tube removal. CONCLUSION: Evisceration after drainage tube removal is very rare. We believe that this is the first report of immediate evisceration after the removal process. Such complications can be avoided with more restricted instructions for the use of drainage tubes and more researches on the reasons for these complications.

Rupture of non-communicating rudimentary horn at 35 weeks ending with a live birth: A case report.

INTRODUCTION AND IMPORTANCE: the rudimentary horn pregnancy frequently ruptured in the second and third trimesters during the normal process of rudimentary horn pregnancy (RHP) which results in a hemoperitoneum that may be fatal, however in very rare cases and under close observation, the pregnancy may continue and end with a live birth. CASE PRESENTATION: A 30 years-old woman gravida 3, para 4 with no symptoms presented to the hospital at 30 weeks gestation for a routine examination and misdiagnosed as an abdominal ectopic pregnancy. The pregnancy continued for approximately 35 weeks, when a ruptured rudimentary horn pregnancy was discovered accidently during an emergency surgery, the left fallopian tube and ovary and the ruptured rudimentary horn were removed. CLINICAL DISCUSSION: Unicornuate uterus is a result of abnormal or failed development of one of the paired müllerian ducts, Spontaneous abortion in women with rudimentary horn pregnancy may occurs in the first and second trimester. Rudimentary horn pregnancies are associated with high maternal morbidity and mortality, And because of the risk of life-threatening complications, early diagnosis before rupture is essential for the successful management and prevention of these complications. CONCLUSION: The diagnosis of most cases of rudimentary horn pregnancy is considered challenging, and could be diagnosed after rupture, during emergency surgery. Although rudimentary horn pregnancy mostly ends in the first and second trimester, in some cases it may continue until term and end with a live healthy child.

A successful bilateral iliac arteries ligation as an emergency management to a life-threatening AVM bleeding: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Uterine arteriovenous malformation (AVM) is a defect due to direct connection between uterine arteries and veins, it has wide range of symptoms and severity, usually causes vaginal bleeding which may be mild or severe and may cause death in some rare cases. Diagnostic methods may include ultrasound, MRI, CT and/or angiography which reveal a high blood flow hypoechoic mass. Many options have been applied as management procedures, including invasive and noninvasive procedures, aiming to save patient life and stop bleeding or preserve fertility in the less severe cases. CASE PRESENTATION: 21 years old primigravida patient developed episodes of severe vaginal bleeding due to AVM after complete molar pregnancy evacuation and chemotherapy, managed successfully by bilateral internal iliac artery ligation and applying compression sutures on the uterus and continuing with compound medical treatment, trying to preserve fertility and ability to get pregnant in the future. CLINICAL DISCUSSION: We point out AVM types, its sings, symptoms and the diagnostic procedures. We discuss the bilateral iliac artery ligation and applying modified compression sutures on uterus as possible emergency managements to AVM when there is a threatening on life due to huge bleeding. We also mentioned the other surgical and medical treatments. CONCLUSION: We confirm the importance of keeping AVM in mind as a possible diagnose when there is unknown cause vaginal bleeding. Consider doing bilateral iliac artery ligation and applying the modified compression sutures as emergency procedures to stop or reduce AVM bleeding.

Fundal partial placenta percreta complicated with postpartum hemoperitoneum: A case report.

INTRODUCTION: The fundus of the uterus is a rare location for abnormally invasive placenta compared with the common site of abnormally invasive placenta in the lower segment of the uterus. PRESENTATION OF CASE: We report a case of a 38-year-old multipara woman who had a fundal partial placenta percreta with no prior cesarean sections, which presented as a retained placenta after preterm labor, and complicated with hemorrhagic shock due to postpartum hemoperitoneum, thus it was diagnosed after surgery and managed by subtotal hysterectomy. DISCUSSION: We discuss the most common risk factors for abnormally invasive placenta and its diagnosis and management. We compare the possibility of leading to invasive placenta resulting from curettage trauma and cesarean delivery scars. CONCLUSION: History of uterine surgical procedures without prior cesarean delivery must raise suspicion of abnormally invasive placenta regardless of its localization, especially when associates with preterm labor or retained placenta.