Spontaneous heterotopic pregnancy: Diagnosis and surgical management.

INTRODUCTION: Heterotopic pregnancy is a rare form of pregnancy, defined by the coexistence of an ectopic and an intrauterine pregnancy. The diagnosis of heterotopic pregnancy remains one of the greatest challenges of the gynecological-obstetrical emergencies. CASE PRESENTATION: We report a rare case of spontaneous heterotopic pregnancy of a 28-year-old woman, diagnosed with a heterotopic pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. DISCUSSION: Heterotopic pregnancy is a rare form of pregnancy, defined by the coexistence of an ectopic and an intrauterine pregnancy. The most common functional signs are abdominal pain, vaginal bleeding, pelvic mass and peritoneal irritation. The first-line paraclinical examination is suprapubic and transvaginal pelvic ultrasound. Therapeutic management of heterotopic pregnancies involves rapid intervention on the ectopic pregnancy, while respecting the intrauterine pregnancy if it has progressed, in order to preserve the patient's fertility. CONCLUSION: Diagnosis of heterotopic pregnancy is often difficult and management should be initiated as soon as possible given the risk of maternal mortality.

Collodion baby: A rare case report.

INTRODUCTION: Collodion baby "CB" is an extremely rare dermatological condition. Approximately 1 in 100,000 births are identified as infants with CB syndrome, including stillbirths (Dyer et al., 2013). A cornified substance replaces the newborn's skin, giving the body a varnished or parchment-like appearance. CASE PRESENTATION: Patient aged 30 years, third gesture, third pare, admitted for premature delivery of 8 months. After labor management, she gave birth 2 h after admission to the maternity ward of a living newborn female weighing 2400 g. The initial physical examination revealed large, thick scales all over the body. Examination of the head and neck revealed an abnormal parchment-like membrane covering the head and sparse hairs. Excessive scaling around the mouth gives a typical fish-like appearance. No other obvious abnormalities were observed. CLINICAL DISCUSSION: CB is an extremely rare dermatological condition. This is a disorder secondary to cornification. These children are generally born prematurely, and are not diagnosed until after birth. Due to the presence of a tight membrane, these babies develop numerous complications such as eclabium, ectropion, limited movement of the extremities and fingers. Treatment consists mainly of support, such as the use of intravenous fluids, incubators, tube feeding and emollients. CONCLUSION: The collodion baby is a newborn characterized by an altered skin barrier, exposing him or her to numerous complications. Fortunately, the mortality rate has fallen thanks to improved neonatal care.

Massive vulvar edema during pregnancy: A case report.

INTRODUCTION: Massive vulvar edema is an unusual complication of pregnancy that may be due to underlying systemic pathology but has also been associated with preeclampsia. It is likely to interfere with vaginal delivery. It has been associated with maternal mortality in the postpartum period. OBSERVATION: A 34 years old female patient, having already delivered a child by vaginal route, without any other particular pathological history, admitted for severe pre-eclampsia on an unattended pregnancy estimated at 36 weeks of amenorrhea. The examination on admission showed a blood pressure of 170/110 mmHg, a proteinuria of three crosses on the urine dipstick. Examination of the vulva showed massive vulvar edema. The massive vulvar edema was explained by hypoprotidemia secondary to renal damage in the context of severe pre-eclampsia. The evolution was marked by the rapid normalization of the tentional figures and a spectacular regression of the vulvar edema, and its complete disappearance in fifteen days. DISCUSSION: Edema may be seen in 80 % of pregnant women, but isolated massive vulvar edema is rare in pregnancy. Massive vulvar edema has been reported in the literature after tocolysis, vulvovaginitis, Crohn's disease and pre-eclampsia. Treatment of vulvar edema is necessary because it can be alarming to the patient and may lead to occlusion of the vulvar orifices. The patient with vulvar edema deserves special attention, and identification and treatment of the associated factors are essential to its management. CONCLUSION: Massive vulvar edema is rare in pregnancy but requires special attention because it can be associated with maternal and fetal complications. Treatment is symptomatic and etiologic whenever an underlying cause is found and the evolution is often favorable with proper treatment.

Uterine rupture with massive hemoperitoneum due to placenta percreta in a second trimester: A case report.

INTRODUCTION: Uterine rupture due to placenta percreta is very rare. It often occurs in patients with a history of Cesarean section. Quick diagnosis, management and intervention improves survival rate and decreases maternal and foetal morbidity. OBSERVATION: Patient, 36 years old, mother of three children delivered by cesarean section, admitted for acute abdominal pain in the context of a poorly monitored pregnancy estimated at 25 weeks of amenorrhea. Pelvic ultrasound showed a large peritoneal effusion with the presence of an evolving intrauterine pregnancy with cardiac activity present, the placenta was with anterior coverage. An emergency laparotomy revealed uterine rupture with active hemorrhage localized on the anterior uterine scar with placental protrusion was noted. A cesarean section was quickly performed to save the fetus. The placenta was left in place and a difficult hysterectomy was then undertaken. DISCUSSION: Uterine rupture in second trimester caused by placental percreta is a rare event that can be life threatening for both mother and fetus. Placenta percreta should be considered when diagnosing internal bleeding in a patient during the first trimester of pregnancy. CONCLUSION: Placenta percreta is a rare but severe obstetric complication that is potentially life threatening for both the mother and fetus. It is important to maintain a high level of clinical suspicion for this disease in pregnant women with acute abdomen, especially those with specific risk factors.

Desmoid fibromatosis of the breast occurring after breast reduction surgery mimicking a carcinoma: A rare case report.

Introduction: Desmoid tumors are benign mesenchymal tumors developed at the expense of muscular fasciae and aponeuroses. The mammary localization is a rare entity, representing less than 0.2% of all breast tumors. It is characterized by a strictly local evolution and its tendency to recur without giving metastases. Its clinical and radiological presentation is similar to a breast carcinoma which is the main differential diagnosis. Case presentation: Patient aged 51 years, primigravida primiparous, followed for right breast cancer diagnosed at the age of 49 years for which she received a right mastectomy and axillary lymphnode dissection and contralateral breast reduction. It was a 4 cm infiltrating ductal carcinoma, SBR III Luminal B, 0 N+/20 N with presence of fibrous mastopathy without sign of malignancy at the left breast reduction specimen.The patient received adjuvant chemotherapy, external radiotherapy and hormone therapy.One year after surgery, the patient returned for a four x 2 cm left breast nodule in the upper medial quadrant. The biopsy confirmed the diagnosis of fibromatosis of the breast. A wide local excision was performed. Discussion: The etiology of this tumor is unknown, however, physical, hormonal and genetic factors play an important role in the development of desmoid tumor.The clinical presentation is similar to breast carcinoma, making it difficult to differentiate this tumor from breast carcinoma. Breast imaging techniques are not specific for desmoid fibromatosis. Treatment is based primarily on complete surgical excision. Conclusion: Breast fibromatosis is a rare entity, clinically and radiologically mimicking breast cancer. Only histology will provide the diagnosis. The treatment of choice is based on complete surgical excision with healthy safety margins.

Rare association of the ovarian adenocarcinoma with pregnancy: A case report.

The association of ovarian malignancy with pregnancy is rare; accounting for 3-6% of ovarian masses of which malignant germ cell tumors represent the type most frequently associated with pregnancy, whereas the incidence of epithelial ovarian cancer is only 1/12,000 to 1/50,000 of pregnancies. The diagnosis and management of ovarian cancer in pregnancy remain poorly codified because of the rarity of cases and the limited data available on this pathology. We report here the case of a 45-year-old woman with a large ovarian mucinous adenocarcinoma diagnosed during pregnancy, identified by ultrasound and magnetic resonance imaging. The patient was treated by surgical resection followed by adjuvant chemotherapy with carboplatin and paclitaxel with a follow-up of 36 months, she is in complete remission.

Primary ovarian fibroma in a postmenopausal woman: A case report.

INTRODUCTION: Primary ovarian leiomyoma is a rare benign tumor of the ovary seen in women between 20 and 65 years old. Clinical, ultasonographic and tumor marker data remain the best preoperative approach currently available for ovarian tumours. Only pathological examination can establish the diagnosis. CASE PRESENTATION: We describe a case of unilateral, ovarian leiomyoma. The abdomino-pelvic Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a left adnexial mass. A hysterectomy without adnexal preservation was performed, and histological examination revealed a leiomyoma arising primarily in the ovary. The diagnosis was confirmed immunohistochemically. DISCUSSION: The tumor may be asymptomatic or may manifest with lower abdominal pain associated to metrorrhagia like in our case. The definitive diagnosis of these lesions is difficult prior to surgical removal. Because there is no pathognomonic symptoms or characteristic imaging findings. The correct diagnosis of an ovarian leiomyoma is confirmed immunohistochemically. CONCLUSION: This rare tumor of the ovary should be considered in the differential diagnosis of solid ovarian masses. An immunohistochemical analysis is recommended for definitive diagnosis.

Diagnosis and management of ectopic ovarian pregnancy: a rare case report.

INTRODUCTION: Ovarian pregnancy is a rare form of ectopic pregnancy. Its incidence is 0.5% to 1% of all ectopic gestations, or 1 in 7000 to 40,000 live births. The diagnosis is intricate and based on surgical and histopathological observations. Traditional risk factors for ovarian ectopic pregnancy are similar to those for tubal pregnancy, but use of an IUD seems to be disproportionately associated. CASE REPORT: We report a rare case of spontaneous ectopic ovarian pregnancy of a 40-year-old woman, diagnosed with a ovarian pregnancy by ultrasound and treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca. CLINICAL DISCUSSION: Ovarian ectopic pregnancies occur through fertilization of an egg retained in the peritoneal cavity leading to implantation on the surface of the ovary. The increased incidence of ovarian ectopic pregnancies is associated with the increased use of artificial reproductive technologies (ART) and intrauterine contraceptive devices (IUCDs). The diagnosis is difficult and a constant challenge for the gynecologist. Its management remains surgical therapy despite the progress in medical treatment. CONCLUSION: Ovarian pregnancy is a rare entity that has some special features. Its diagnosis is difficult and relies on criteria based on intraoperative findings. Its management remains surgical therapy despite the progress in medical treatment.

Spontaneous bladder rupture following non traumatic vaginal delivery in a multiparous woman: A rare case report.

INTRODUCTION: Spontaneous bladder rupture SBR is a rare condition and often missed diagnosis, especially after a nontraumatic vaginal delivery. CASE PRESENTATION: A 34-year-old patient who had a nontraumatic vaginal delivery presented to the emergency room 7 days later with acute abdomen and anuria. Computed tomography showed free fluid in the peritoneal cavity. An intraperitoneal rupture of the bladder dome was detected, showing extravasation of contrast into the peritoneal cavity. An exploratory laparotomy revealed a perforation on the bladder dome that was sutured. CLINICAL DISCUSSION: SBR following vaginal delivery is an extremely rare condition. It represents a surgical emergency. Due to the low incidence and the presence of non-specific symptoms, diagnosis was usually delayed with an increased morbidity and mortality. Clinicians should consider this diagnosis in the presence of an acute abdominal pain associated to anuria or dysuria. We therefore recommend that the bladder be catheterized or drained before labour. CONCLUSION: SBR is a rare and life-threatening condition in post-partum. Abdominal pain with elevated serum creatinine should be suspicious of urinary bladder rupture.