Uterine tamponade for a case of gestational choriocarcinoma with heavy vaginal bleeding.
In: International Journal of Gynecological Cancer, Jg. 28 (2018-10-02), S. 236-237
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Zugriff:
Introduction Choriocarcinoma is a highly invasive tumor derived from trophoblast cells, which has a high chance of bleeding due to high vascularity and affinity of trophoblast for blood vessels. We are presenting a case of gestational choriocarcinoma with life-threatening haemorrhage. She was successfully treated in our hospital, which provides a clinical reference for this difficulty. Case review 23 years old Para 1 LMP 4 months back, with very heavy vaginal bleeding, non painful 3 months with lower back pain 2-3 weeks had gynecological procedure one month back in Afghanistan with laparotomy. No histopathology or notes were available. On Admission BP 90/50mmHg, pulse 110 bpm, Hemoglobin of 4.7gm/dl and Bhcg 54623 mIU/ML, coagulation profile and A mass was felt protruding through the cervix, which was soft and friable and extending on to posterior and left vaginal wall . She was managed in the Emergency room with fluid and blood product replacement, and uterine and vaginal packing with ribbon gauze was performed. She was managed supportively and subsequently CT Chest + Abdomen/Pelvis scans were done which showed: A Heterogeneously enhancing soft tissue density lesion identified within the cul de sac which is inseparable from the uterus, measuring 12.1 x 5.6 cm. It is compressing the mid ureters resulting in mild proximal hydroureter and hydronephrosis bilaterally. Multiple areas of patchy infiltrates identified in both lungs with surrounding ground glass haze and subtle soft tissue density nodules. The differentials included Metastatic deposits vs alveolitis. Intervention The vaginal pack was removed after 12 hours and a tissue biopsies were taken from the polypoid growth. Torrential bleeding occurred resulting in hypovolemeic shock at which the patient was packed again with ribbon gauze and nasal Packing forceps were used to pack the uterus and vagina Biopsies from the mass were consistent with GTD in the backdrop of beta-HCG levels >50,000. Her care was subsequently taken over by the Oncology Service and she was started on Chemotherapy (EMA-CO). The vaginal and uterine packing was kept in place for 72 hours. She was kept on ceftriaxone and metronidazole for 5 days. She remained well, and vaginal bleeding stabilized. Outcome She received chemo 7 cycles of EMACO and remained stable and returned home in stable condition. Follow-up at 3 years post EMACO showed that the patient was in remission. It has been difficult follow-up the patient due to the political situation in Afghanistan. This precludes her fertility status, but the intervention allowed her condition to remain stable while chemotherapy was delivered for a favorable outcome. Lesson learnt The diagnosis of choriocarcinoma may be difficult, especially in the setting with the limit of medical resources. While some studies have looked at uterine artery embolization, our study looked at uterine packing to accomplish this. this may be useful in low resource settings. [ABSTRACT FROM AUTHOR]
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Titel: |
Uterine tamponade for a case of gestational choriocarcinoma with heavy vaginal bleeding.
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Autor/in / Beteiligte Person: | Khan, Rozilla ; Abbasi, Huda Saleem |
Zeitschrift: | International Journal of Gynecological Cancer, Jg. 28 (2018-10-02), S. 236-237 |
Veröffentlichung: | 2018 |
Medientyp: | academicJournal |
ISSN: | 1048-891X (print) |
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