Pelvic organ prolapse is rarely associated with severe bilateral ureteral hydronephrosis and renal dysfunction. The etiopathogenetic mechanism has not been fully elucidated. Contemporary imaging methods of the urinary tract play a decisive role in assessing the morphological function of the kidneys. In cases of moderate and severe pelvic organ prolapse, surgery appears to be the main choice of treatment. Our case concerns a post-menopausal patient with three vaginal deliveries in her obstetric history and with a history of bilateral hydronephrosis and impaired renal function who was referred to the outpatient clinic for a gynecological examination due to complete uterine prolapse. Bilateral hydroureteronephrosis due to prolapse was assessed as the main cause of renal dysfunction. A surgical intervention was decided to the pelvic floor and a vaginal hysterectomy was performed with simultaneous correction of the cystocele and rectocele. The postoperative course was uneventful. Three months later, re-examination of the urinary tract showed complete remediation of kidney morphology and function. The present case report emphasizes the significant degree of bilateral hydroureteronephrosis and deterioration of renal function rarely seen in patients with complete uterine prolapse. At the same time, it is pointed out that the exclusion of renal dysfunction related to complete uterine prolapse should be the main concern of the modern gynecologist even for complex cases with coexisting etiological factors for renal disease, in order to avoid permanent renal parenchymal damage and ensure the best health and quality of life of these patients.
Amniotic fluid embolism is a rare, unpredictable and often catastrophic obstetric complication that usually occurs during labor or caesarean section. The pathogenetic mechanism has not been fully elucidated to date. Amniotic fluid embolism is believed to happen due to an anaphylactic reaction to embryonic antigens that enter the mother's circulation and trigger a variety of immune processes that produce an anaphylactic-like response. The diagnosis remains clinical. The disease manifests abruptly with cardiovascular shock, encephalopathy, fetal discomfort and disseminated intravascular coagulation. There is no special treatment. The treatment is supportive and focuses on rapid stabilization of the cardiopulmonary system, adequate oxygenation of the vital organs and correction of coagulation, ensuring the best possible perinatal outcome. In this article, based on current data, a literature review of this rare obstetric complication is attempted, particularly with regard to diagnosis and the basic treatment principles, the timely and correct application of which can provide the best possible outcome for the mother and the newborn.
Paratubal cyst torsion accompanied by secondary isolated fallopian tube torsion without involvement of the ipsilateral ovary is rare. A similar case occurring in the postpartum period has not been reported to date in the English literature. Our case report concerns a pregnant multiparous woman in the 40th gestational week, without regular antenatal care attendance, who was urgently admitted to the maternity ward with pushing labour pains and gave birth with vaginal delivery. A few hours later, puerperant complained of worsening severe lower abdominal pain, accompanied by nausea, dizziness and vomiting, unresponsive to analgesic medication. Based on the clinical and ultrasound findings, the diagnosis of an ovarian cyst torsion was established, and it was decided to treat the patient with surgery and in particular with laparotomy. Intraoperatively, in the left parametrium, the presence of an ovoid mass with a brownish-red hue and a smooth outer surface was detected, along which the ipsilateral fallopian tube ran, without the involvement of the ovary. Histological examination of the surgical specimen confirmed the diagnosis of isolated fallopian tubal torsion with paratubal cyst. The postoperative course was uneventful. In this paper, based on modern data, a brief literature review of this rare nosological entity is attempted, regarding the diagnostic and therapeutic approach, the immediate application of which can ensure the best prognosis.
This case report is about the successful treatment of a patient with acute kidney injury during pregnancy. Primigravida at 37 weeks gestational age presented at the emergency department of our hospital with tonic – clonic muscle spasms. After performing immediate clinical examination and the appropriate lab investigation we reached to the diagnosis of HELLP syndrome and performed an emergency cesarean section, due to eclampsia during HELLP syndrome. Right after surgery, kidney dysfunction and rising creatinine levels led nephrologists to start dialysis sessions, because of the acute kidney injury. Postoperative period was without complications. On the sixth postoperative day the patient’s clinical status was significantly improved, thus she got discharged from the clinic. It was considered necessary by the nephrologists to continue the dialysis sessions until full rehabilitation of the renal function is succeeded. In this paper, apart from the presentation of the case, a literature review is attempted of the acute kidney injury during pregnancy, in relation to current available therapeutic options, which performed in – time contributes to the best possible prognostic outcome.
Acute myocardial infarction in pregnant women is an uncommon but potentially devastating complication with significantly increased rates of maternal and perinatal morbidity and mortality. The treatment of acute coronary syndrome in pregnancy is a unique clinical challenge. Published data on the use of thrombolytic drugs, percutaneous coronary intervention, coronary artery bypass grafting and optimal medical management of ischemic heart disease in pregnancy are limited. This article attempts to review acute myocardial infarction in pregnancy, regarding the basic treatment principles, the timely and correct application of which can yield the best possible result for the mother and the fetus and the newborn.
Endometriosis of the rectus abdominis muscle is an extremely rare form of extrapelvic localization of the disease. It is usually iatrogenic and develops after caesarean section or gynecological surgery. Preoperative diagnosis is very difficult and a challenge for gynecologists and surgeons; thus, the diagnosis is histological. The treatment of choice consists of wide local excision of the lesion on healthy margins. We cite a case of isolated endometriosis in the rectus abdominis muscles in a 46-year-old patient with a previous caesarean section, the diagnosis of which was made randomly when performing abdominal total hysterectomy for the treatment of chronic pelvic pain. Histological examination of the surgical specimen confirmed the diagnosis. Simultaneously, the surgical specimen of the uterus and ovaries was free of endometriosis. Postoperatively, the patient mentioned discharge of her symptoms. No further therapeutic intervention was deemed necessary, as it was considered that a complete resection of the endometrial tissue implantation from the muscles of abdominal wall was performed. The present case report lay emphasis on the significant difficulties involved in the preoperative diagnosis of endometriosis of the rectus abdominis muscle. Concurrently, it is pointed out that, despite its rarity, individual extrapelvic endometriosis located in the rectus abdominis muscle should be included among other pathological entities in the differential diagnosis of chronic pelvic pain in women of reproductive age, who gave birth by caesarean section or underwent gynecological surgery with abdominal or laparoscopic access.
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