A 39-Year-Old Woman with Endometriosis Who Developed a Subcapsular Liver Hematoma Following Laparotomic Surgical Left Adnexectomy, Rectosigmoid Anastomosis, and Bilateral Ureteral Reimplantation.

BACKGROUND Endometriosis is a chronic inflammatory disease caused by endometrial tissue that grows outside the uterus. Deep endometriosis surgery is associated with considerable rates of complications, although such rates are lower in surgical procedures carried out by expert surgical teams. This report details a case of a rare but life-threatening complication in the postoperative period following 72 h of endometriosis surgery: a giant subcapsular hepatic hematoma, which was successfully managed conservatively. CASE REPORT Here we describe the case of a 39-year-old woman with deep endometriosis with ureteral, ovarian, and intestinal involvement requiring multidisciplinary surgery. She presented with severe anemia, respiratory distress, and oliguria 72 h postoperatively. A 3-phase computed tomography (CT) scan revealed a giant intrahepatic subcapsular hematoma (180×165×50 mm) lateral to the right hepatic lobe, which was managed conservatively. The patient evolved favorably and the hematoma was reduced (77×16 mm) in a follow-up CT scan performed 5 months later. CONCLUSIONS Giant liver hematoma is a rare, life-threatening complication. The current experience relating to its management remains largely limited owing to the rarity of the condition and paucity of published cases. Actually, we found no articles on hepatic hematoma in the context of endometriosis surgery. Early diagnosis and treatment are essential to reduce the patient's risk of death. Imaging diagnosis plays an essential role.

Role of hysteroscopy during conservative management of atypical endometrial hyperplasia and early-stage endometrial cancer in patients who desire pregnancy.

Twenty-five percent of cases of endometrial cancer appear in women with unfulfilled reproductive desires. An adequate selection of patients and a close hysteroscopic follow-up to monitor the endometrial response to the levonorgestrel-releasing intrauterine system (LNG-IUS) may be a valid and safe option for these patients. This is a case series and review of the literature study. We included eight patients diagnosed of complex endometrial hyperplasia with atypia (CEHA) or stage 1AG1 well-differentiated endometrial cancer without myometrial invasion who desired to get pregnant and opted for a conservative treatment. Follow-up was performed with hysteroscopy and directed biopsy at 3, 6 and 12 months. Of the 854 cases of complex endometrial hyperplasia with atypia (CEHA)/endometrial cancer were diagnosed, 2.3% were candidates for conservative management. We obtained a favourable regression of 71.2% at 6 months and 57% at one year with hormonal treatment. Conservative treatment in complex endometrial hyperplasia with atypia (CEHA)/low-grade endometrial cancer in reproductive age patients with a strong desire for pregnancy is feasible.

Tumores que recuerdan a las células de los cordones sexuales (UTROSCT): exposición de un caso clínico y revisión de la literatura / Uterine tumors resembling ovarian sex cord tumors (UTROSCT): case report and review of the literature

Los tumores uterinos que recuerdan a las células de los cordones sexuales son una entidad clínica rara, clasifica-dos en tipo I (tumores del estroma endometrial con elementos de las células que recuerdan a las células de los cordones sexuales del ovario) y tipo II (tumores uterinos que recuerdan a las células de los cordones sexuales del ovario). Lo más frecuente es el hallazgo casual en una pieza quirúrgica y en el contexto de una metrorragia perimenopáusica. Aunque los tumores uterinos que recuerdan a las células de los cordones sexuales son tumores de baja malignidad y de escasa recurrencia, no hay consenso sobre la radicalidad del tratamiento. Se presenta un caso clínico de un hallazgo anatomopatológico tras una histerectomía compatible con tumores uterinos que recuerdan a las células de los cordones sexuales en el contexto de un útero miomatoso en una paciente de 46 años con historia de hipermenorreas y dolor pélvico

Uterine tumors resembling the sex cord cells are a rare clinical entity, classified as type I (Endometrial stromal tumor with sex-cord-like elements [ESTSCLE]) and type II (Uterine tumors resembling ovarian sex cord tumors [UTROSCT]). Most often it found incidentally in a surgical specimen and in the context of a perimenopausal ute-rine bleeding. Although uterine tumors resembling the sex cord cells are generally low-grade tumors and low recurrence, there is no clinical consensus on how much should be radical treatment. A case of a pathological finding occurs after abdominal hysterectomy compatible with uterine tumors resembling the sex cord cells in the context of a fibroid uterus in a 46-year woman with a history of hipermenorreas and pelvic pain

Perinatal outcomes in twin pregnancies: Association with fetal presentation and mode of delivery / Resultados perinatales en gestaciones gemelares en relación a la presentación de ambos fetos y a la vía del parto

Objective: To analyze perinatal outcomes in twin deliveries considering fetal presentation, delivery mode, and birth order. Material and methods: We performed a retrospective observational study of 639 women with twin pregnancies yielding 1278 newborns. The mode of delivery was chosen according to the presentation of the first twin and the mother's medical and obstetric history. Results: The pregnancy was dichorionic-diamniotic in 82.6% of cases, monochorionic-diamniotic in 14.6% of cases, and monochorionic-monoamniotic in 0.6% of cases. The overall rate of cesarean delivery was 20.7%. Of the 1278 newborns, 0.2% were admitted to the Neonatal Intensive Care Unit (NICU). Presentation at delivery was cephalic in 70.7% of first twins and only 49.9% of second twins. The rate of cesarean delivery was 28.5% for first twins in cephalic presentation and 85.8% for first twins in breech presentation. Analysis of perinatal outcomes for the first and second twins revealed no differences in newborns' weight, 5-minute Apgar score, arterial pH, rate of admission to the NICU, or perinatal mortality. Similarly, no differences were identified in perinatal outcomes according the presentation of both fetuses. Conclusions: There was no evidence of poorer perinatal outcomes related to order of birth, fetal presentation, or mode of delivery. Therefore, attempting vaginal delivery in a twin pregnancy is a reasonable approach

Objetivo: analizar los resultados perinatales en las gestaciones gemelares con respecto a su relación con la presentación y la vía del parto, atendiendo al orden de cada feto. Material y métodos: estudio observacional retrospectivo. Se incluyeron 639 mujeres con embarazos gemelares, con un total de 1278 recién nacidos. El tipo de parto se eligió de acuerdo con la presentación del primer gemelo y el historial médico y obstétrico de la madre. Resultados: el 82,6% fueron BC-BA, el 14,6% MC-BA y el 0,6% MC-MA. Hubo una tasa global de cesáreas del 20,7%. De 1278 recién nacidos, el 0,2% fue ingresado en la Unidad de Cuidados Intensivos Neonatales. El 70,7% de los primeros gemelos se encontraban en una presentación cefálica, lo que sólo ocurrió en un 49,9% de los segundos gemelos. La tasa de cesárea fue del 28,5% en los primeros gemelos con presentación cefálica y del 85,8% en los primeros gemelos con presentación de nalgas. En el análisis de los resultados perinatales (peso de los recién nacidos, la puntuación de Apgar a los 5 minutos, el pH arterial, la tasa de ingreso a la UCIN o la mortalidad perinatal) del primer o segundo gemelo no se encontraron diferencias así como tampoco las hubo en función de la presentación de ambos fetos. Conclusiones: no hubo diferencias estadísticamente significativas en los resultados perinatales atendiendo al orden de cada gemelo, a su presentación y a la vía del parto; por tanto, el intento de parto vaginal en gemelares es una opción razonable