RESUMEN
La inversión uterina es una patología de presentación rara e infrecuente. Se presenta el caso de una paciente con inversión uterina no puerperal con requerimiento de histerectomía abdominal total. Sin antecedentes de importancia asistió al servicio de urgencias por un cuadro clínico de dolor abdominal de 10 días de evolución asociado a sangrado vaginal abundante con inestabilidad hemodinámica y sensación de masa vaginal. Al examen físico se evidenció una masa sobresaliente del canal vaginal de aspecto necrótico, por lo que se sospechó mioma nascens. Durante la estancia hospitalaria presentó inestabilidad hemodinámica, por lo que fue llevada a histerectomía abdominal de urgencia con hallazgo de inversión uterina. La inversión uterina no puerperal es infrecuente. Es importante realizar un buen diagnóstico clínico apoyado de las imágenes si se encuentran disponibles, la intervención quirúrgica es necesaria y proporciona un buen pronóstico. La histerectomía vaginal no es sencilla en estos casos, por lo que se recomienda la histerectomía abdominal total.
Uterine inversion is a rare and infrequent disease. The case of a patient with a non-puerperal uterine inversion that had to be treated with a total abdominal hysterectomy is presented in this study. With no important history of disease, she attended the emergency department presenting abdominal pain in the last 10 days associated with vaginal bleeding and mass sensation. The physical examination revealed a protruding necrotic-like mass through the vagina, hence the suspicion of a myoma nascens. During her hospital ward stay, she presented hemodynamic instability, urgent abdominal hysterectomy had to be done which revealed uterine inversion. Non-puerperal uterine inversion is infrequent. Precise clinical diagnosis is important supported by diagnostic imaging if available. The surgical intervention is necessary, giving a good prognosis. Vaginal hysterectomy is not easy in this type of cases, therefore total abdominal hysterectomy is recommended.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Neoplasias Uterinas/complicaciones , Inversión Uterina/cirugía , Leiomioma/complicaciones , Hemorragia Uterina/etiología , Neoplasias Uterinas/cirugía , Dolor Abdominal/etiología , Inversión Uterina/diagnóstico , Histerectomía/métodos , Leiomioma/cirugíaRESUMEN
RESUMEN La inversión uterina no puerperal es muy rara. Se comunica un caso asociado con leiomiomatosis. Se trató de una multípara de 45 años que manifestó sangrado vaginal grave, dolor pélvico y sensación de cuerpo extraño vaginal. Se diagnosticó mioma uterino en fase abortiva. Se programó para miomectomía con probable histerectomía abdominal y se encontró inversión uterina completa. Este reporte constituye un caso anecdótico de inversión uterina no puerperal, cuyo tratamiento quirúrgico fue exitoso.
ABSTRACT Non-puerperal uterine inversion is very rare. A case associated with leiomyomatosis is reported. The case of a 45-year-old multiparous woman with severe vaginal bleeding, pelvic pain and vaginal foreign body sensation is presented. Uterine leiomyoma in abortive phase was diagnosed. She was scheduled for myomectomy with probable abdominal hysterectomy and complete uterine inversion was found. This report is an anecdotal case of non-puerperal uterine inversion, whose surgical treatment was successful.
RESUMEN
A inversão uterina aguda no pós-parto é uma emergência obstétrica rara e potencialmente fatal, que ocorre nas primeiras 24 horas do puerpério e tem importante associação com hemorragia puerperal. Relata-se um caso de uma primípara de 19 anos, que após indução de parto devido a oligoâmnio, apresentou importante sangramento transvaginal, com instabilidade hemodinâmica. Teve seu reconhecimento e tratamento prontamente realizados, e assim não evoluiu com complicações. O reposicionamento é primeiramente tentado pela manobra de Taxe com uso de relaxantes uterinos, e caso falhe, opta-se por cirurgia. O prognóstico depende justamente da agilidade da intervenção terapêutica, que permite completa recuperação do quadro e ausência de sequelas.
Acute postpartum uterine inversion is a rare, potentially fatal obstetric emergency occurring within the first 24 hours of the puerperium, and which is closely associated with puerperal hemorrhage. In this case report, a 19-year-old primiparous woman had significant transvaginal bleeding, with hemodynamic instability, after induction of labor due to oligoamnios. The case was diagnosed and treated promptly, thus the patient evolved without complications. The standard treatment protocol usually comprises Taxe maneuver (manual uterine replacement) followed by uterine relaxants; only if it fails, surgery is performed. The prognosis depends precisely on prompt therapeutic intervention, which leads to complete recovery of the condition, as well as absence of sequelae.
RESUMEN
SUMMARY Uterine inversion is an uncommon complication of the puerperium and it is an even rarer complication of the non-puerperal period. In this way, uterine inversions are classified into two groups, being of puerperal origin due to obstetric problems and non-puerperal origin due to gynecological problems. In general, a non-puerperal uterine inversion occurs as a possible complication of a sub mucosal leiomyoma, after an expansive process, a dilation of the cervix occurs and thus its protuberance over the vaginal canal.
RESUMO A inversão uterina é uma complicação incomum do puerpério e é uma complicação ainda mais rara do período não puerperal. Dessa forma, as inversões uterinas são classificadas em dois grupos, sendo as de origem puerperal decorrentes de problemas obstétricos e as inversões de origem não puerperal decorrentes de problemas ginecológicos. Em geral, a inversão uterina não puerperal decorre como uma possível complicação de um leiomioma submucoso — após o processo expansivo, ocorre a dilatação do colo uterino e, dessa forma, a sua protusão sobre o canal vaginal.
Asunto(s)
Humanos , Femenino , Neoplasias Uterinas/complicaciones , Inversión Uterina/etiología , Leiomioma/complicaciones , Neoplasias Uterinas/cirugía , Neoplasias Uterinas/diagnóstico por imagen , Resultado del Tratamiento , Inversión Uterina/cirugía , Inversión Uterina/diagnóstico por imagen , Leiomioma/cirugía , Leiomioma/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
La inversión uterina obstétrica es una entidad rara, y una de las complicaciones más graves del tercer estadio del parto que pone en peligro la vida de la parturienta. La inversión del útero consiste en un cambio de disposición de sus paredes, la cara interna se convierte en externa y el órgano se invagina en forma de dedo de guante. Es un accidente obstétrico que constituye una verdadera emergencia y es causa de muerte materna por choque hemorrágico. Afortunadamente su incidencia en nuestro país es baja, dado por la escasa cantidad de reportes sobre el tema. El objetivo del trabajo es presentar este caso por la atipicidad en la forma clínica que se diagnosticó durante el puerperio. La paciente acudió al hospital a los 22 días de puerperio, se diagnosticó una inversión uterina puerperal subaguda grado II, se realizan maniobras encaminadas a la reducción manual de la inversión con resultados insatisfactorios. Fue necesario realizar histerectomía total abdominal; se logró conservar ambos anejos y la vida de la paciente. Su tratamiento habitualmente es quirúrgico, sobre todo si no se diagnostica en el tercer estadio del parto(AU)
Obstetric uterine inversion is a rare entity, and one of the most serious complications of the third stage of labor that endangers the life of the mother. The inversion of the uterus is a change of arrangement of its walls, it pulls on the inside surface, and turns the organ inside out shaping a glove finger. It is an obstetric accident which constitutes a true emergency and causes of maternal death from hemorrhagic shock. Fortunately its incidence in our country is low, given the low number of reports on the subject. The aim of this paper is to present this case by its unusualness in clinical form which was diagnosed during the postpartum period. The patient came to the hospital at 22 days postpartum. Sub-acute puerperal uterine inversion grade II was diagnosed. Manual maneuvers were made aiming to reduce the inversion. The results were unsatisfactory. It was required total abdominal hysterectomy; we managed to keep both adnexae and the life of the patient. Treatment is usually surgical, especially if not diagnosed in the labor third stage(AU)
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Inversión Uterina/cirugía , Inversión Uterina/epidemiología , Complicaciones del Embarazo/prevención & controlRESUMEN
A intussuscepção uterina é condição rara em pequenos animais. No presente relato descreve-se um caso de intussuscepção uterina em um canino, fêmea Yorkshire Terrier no pós-parto imediato, diagnosticada por meio de laparotomia exploratória e pela avaliação anatomopatológica. Realizou-se a ovariossalpingo-histerectomia (OSH) como tratamento definitivo para a alteração. Conclui-se, portanto, que a intussuscepção uterina pode ocorrer em cadelas, de forma espontânea no pós-parto imediato.
Uterine intussusception has rarely been described in small animals. In this report we describe a case of uterine intussusception in a female Yorkshire terrier immediately postpartum, diagnosed by exploratory laparotomy and anatomopathologic evaluation. Ovariosalpingohisterectomy (OSH) was performed as definitive treatment. It is concluded that the intussusception of the uterus may occur spontaneously in dogs immediately postpartum.
Asunto(s)
Animales , Femenino , Perros , Intususcepción/diagnóstico , Intususcepción/veterinaria , Laparotomía/estadística & datos numéricos , Laparotomía/veterinariaRESUMEN
A intussuscepção uterina é condição rara em pequenos animais. No presente relato descreve-se um caso de intussuscepção uterina em um canino, fêmea Yorkshire Terrier no pós-parto imediato, diagnosticada por meio de laparotomia exploratória e pela avaliação anatomopatológica. Realizou-se a ovariossalpingo-histerectomia (OSH) como tratamento definitivo para a alteração. Conclui-se, portanto, que a intussuscepção uterina pode ocorrer em cadelas, de forma espontânea no pós-parto imediato.(AU)
Uterine intussusception has rarely been described in small animals. In this report we describe a case of uterine intussusception in a female Yorkshire terrier immediately postpartum, diagnosed by exploratory laparotomy and anatomopathologic evaluation. Ovariosalpingohisterectomy (OSH) was performed as definitive treatment. It is concluded that the intussusception of the uterus may occur spontaneously in dogs immediately postpartum.(AU)
Asunto(s)
Animales , Femenino , Perros , Intususcepción/diagnóstico , Intususcepción/veterinaria , Laparotomía , Laparotomía/veterinariaRESUMEN
Teratomas are the most commonly diagnosed germ cell tumors and occur primarily in testes and ovaries. Platinum-based therapy followed by surgical resection of the residual lesion is generally the recommended treatment. In contrast, immature uterine teratomas are rare, with few cases reported in the literature. Moreover, there is no standard treatment for these tumors. Non-puerperal uterine inversion is also rare in women younger than 45 years of age, and neoplastic lesions are responsible for this condition. Here, we report a case of an immature uterine teratoma associated with uterine inversion. The patient underwent surgery followed by adjuvant chemotherapy and continues to be monitored.
RESUMEN
La inversión uterina es una entidad clínica poco frecuente y grave, descrita como una emergencia obstétrica relacionada con las complicaciones del tercer estadio del parto que necesita tratamiento inmediato, habitualmente quirúrgico. Con este artículo se pretende demostrar a la comunidad científica algunos elementos relacionados con esta, pues es probable que por su baja incidencia, generaciones actuales de obstetras no alcancen asistir una paciente con esta complicación, además por la ausencia de reportes nacionales relacionados con esta entidad. Se presenta una paciente que acudió al hospital, a los 2 meses después del parto, se diagnosticó una inversión uterina puerperal crónica grado II, fue necesario realizar la histerectomía total como tratamiento definitivo, lograron conservarse ambos anejos. La forma de presentación atípica en el cuadro clínico de esta paciente y la posibilidad de mostrar una evidencia gráfica de su presentación clínica y tratamiento quirúrgico, motivaron la presentación de este trabajo.
Uterine inversion is a rare and severe clinical entity described related to obstetric emergency in labor third stage complications, which needs immediate treatment, usually surgery. This article aims to show the scientific community some elements related to this, since it is likely that due to its low incidence, current generations of obstetricians do not assist patients with this complication, apart from the absence of national reports related to this entity. A patient came to the hospital 2 months after delivery, A chronic puerperal uterine inversion grade II was diagnosed. Total hysterectomy was necessary to perform as definitive treatment, achieving to retain both ovaries. The atypical presentation in this patient clinical condition and the ability to display graphic evidence of its clinical presentation and surgical treatment led to the presentation of this paper.