RESUMO
Postmenopausal abnormal uterine bleeding is a common clinical problem addressed in gynaecological practice and should prompt clinical investigation due to the significant prevalence of malignant and premalignant lesions of the endometrium in this age group. Nevertheless, other causes should be considered, since its diagnostic and therapeutic management may differ considerably. Here, we present a case of a colouterine fistula due to chronic diverticulitis presenting with postmenopausal abnormal uterine bleeding. This is an infrequent occurrence and is caused by the rupture of a diverticular abscess into the uterine wall, resulting in an inflammatory adhesion of the colon and uterus, with necrosis and subsequent fistula formation. The clinical presentation is variable and may include abdominal pain, gastrointestinal tract symptoms, vaginal discharge, and abnormal uterine bleeding. The laboratory and imaging techniques may be not completely conclusive and definitive diagnosis can be made intraoperatively. There are different treatment options, with en bloc resection and primary anastomosis being used most often, allowing complete treatment. The prognosis for a colouterine fistula secondary to diverticulitis is excellent after surgery. This case highlights the importance of clinical suspicion of an unusual cause of uterine bleeding and an effective and multidisciplinary approach that allowed complete surgical treatment and patient recovery.
RESUMO
Adnexal torsion is usually diagnosed in pre-menopausal women and is less common in post-menopausal patients. Symptoms are nonspecific and the risk of torsion in post-menopausal women presenting with an adnexal mass is often undervalued. Because the clinical presentation of adnexal torsion can mimic other causes of abdominal pain, the diagnosis is often delayed, and post-menopausal women are taken to surgery later than pre-menopausal ones. We report a case of adnexal torsion in a post-menopausal woman presenting with pain and an adnexal mass (AU)
La torsión anexial se diagnostica más frequentemente en mujeres premenopáusicas. Los síntomas son inespecíficos y el riesgo de torsión en las mujeres postmenopáusicas que se presentan con una masa anexial es a menudo infravalorado. Debido a que la presentación clínica puede simular otras causas de dolor abdominal, el diagnóstico a menudo se retrasa y las mujeres postmenopáusicas son llevadas a cirugía más tarde que las premenopáusicas. Presentamos un caso de torsión anexial en una mujer postmenopáusica que presenta dolor y una masa anexia (AU)
