ABSTRACT
Although a uterine leiomyomectomy or adenomyomectomy is an accepted procedure to treat symptoms such as dysmenorrhea or hypermenorrhea to enhance fertility, the risk of future uterine rupture is a major concern for patients who become pregnant following these surgery. Although uterine rupture very rarely occurs, this is the most feared complication in pregnancy and is associated with a high rate of maternal and fetal morbidity and mortality. A 37-year-old nulliparous woman had a 2-year history of infertility. A transvaginal ultrasound revealed multiple uterine tumors that resembled leiomyomas on the posterior and fundal walls of the uterine body. After the patient had three failed in vitro fertilization and embryo transfer treatments, the uterine tumor was enucleated, and pathologically diagnosed as an adenomatoid tumor. Five months after the operation, the patient became pregnant as a result of a fourth in vitro fertilization and embryo transfer. At the 33rd week of gestation, she complained of a sudden onset of abdominal pain. The patient was diagnosed with a ruptured uterus based on an ultrasound, and an emergency cesarean section was performed. The rupture occurred at the site of the operation scar on the posterior wall of the uterine body. The fetal legs extruded into the abdominal cavity from the uterine cavity but were enclosed within the unruptured chorioamniotic membrane. A male neonate (1956 g) was delivered without asphyxia and had Apgar scores of 8 and 9. The ruptured uterine wall could be repaired by suturing. To our knowledge, this is the first case report of uterine rupture during pregnancy after resection of an adenomatoid tumor in the uterine body.
Subject(s)
Prenatal Diagnosis , Uterine Rupture/diagnosis , Adenomatoid Tumor/diagnosis , Adenomatoid Tumor/pathology , Adenomatoid Tumor/surgery , Adult , Cesarean Section , Diagnosis, Differential , Female , Fertilization in Vitro , Humans , Infant, Newborn , Laparoscopy , Male , Pregnancy , Pregnancy Trimester, Third , Rupture, Spontaneous/diagnosis , Rupture, Spontaneous/pathology , Uterine Neoplasms/diagnosis , Uterine Neoplasms/pathology , Uterine Neoplasms/surgery , Uterine Rupture/pathologyABSTRACT
Congenital partial absence of a fallopian tube has rarely been reported in the literature. A 29-year-old nulligravida woman presented with a two-year history of infertility. Hysterosalpingography revealed an obstructed left fallopian tube with a normal uterine cavity and right fallopian tube. After several AIH treatments, diagnostic laparoscopy was performed, revealing segmental absence of the mid portion of the left fallopian tube. Only a 1-cm stump of the left fallopian tube remained, the majority of the isthmic portion was absent. A 3-cm distal ampullary portion with normal-appearing fimbria was attached to the left pelvic sidewall near the pelvic brim. No other abnormal findings were observed for the uterus, right fallopian tube, and ligaments surrounding the uterus. There are two possible etiologies of partial absence of the fallopian tube:congenital absence associated with developmental alterations of the Müllerian ducts or asymptomatic torsion followed by autoamputation and reabsorption.
