ABSTRACT
Hydatidosis is a widespread anthropozoonosis. It can affect almost any part of the body, but it occurs most commonly in the liver (75%) and the lungs (15%). Its occurrence in female genital tract, especially the uterus, is very rare. Diagnosing hydatid disease at these unusual locations can be difficult. Hereby, we report two cases of primary hydatid cyst of the uterus. The first case is that of a 62-year-old woman, G7P5A2, who presented with an eight-month history of chronic pelvic pain. Clinical examination and radiological explorations revealed the presence of a uterine fibroid and a serous cystadenoma of the left ovary. She underwent a hysterectomy and a bilateral adnexectomy. Anatomopathological examination concluded that a serous cystadenoma of the left ovary was a calcified subserous hydatid cyst of the uterine fundus. The second case is that of a 69-year-old woman, G6P4A2, who consulted for chronic pelvic pain that had been evolving for 3 months. The clinical examination and radiological explorations doubted a hydatid cyst of the uterus, with a positive hydatid serology. She underwent a resection of the salient dome. The anatomopathological examination was in favor of a hydatid cyst of the uterus. Hydatid disease is endemic in Tunisia. The pelvic region is rarely affected with an incidence ranging from 0.3 to 0.9%, 80% of which involves the genitals. The uterus is more rarely affected than the ovaries. Most often, it is a contamination secondary to the intra-abdominal rupture of a hydatid cyst of the liver. However, primary uterine hydatid cysts have been reported. Surgery is the Gold Standard for the treatment of uterine hydatid cysts. Exploration of the abdominal cavity is essential in the search for other localizations, particularly hepatic. Postoperative medical treatment with Albendazole can be discussed. The ideal approach to deal with this public health concern is to emphasize the need for improved preventive measures. Modern imaging techniques have significantly improved the detection rates of hydatid cysts in atypical localizations. Indeed, the preoperative diagnosis of uterine hydatidosis requires a meticulous approach which is necessary to initiate an adequate treatment and thus guarantee a better management of the patient.
ABSTRACT
INTRODUCTION: in pregnant women, the symptoms of COVID-19 join those of the general population in most cases. However, like any population at risk, more serious symptoms can appear such as pneumonia or ARDS. In our study, we propose to define the clinical, biological and therapeutic characteristics as well as the management of a series of pregnant women suffering from COVID-19. METHODS: this is a prospective and descriptive study which brought together 11 pregnant patients affected by the Coronavirus SARS-CoV-2 in the gynecology-obstetrics department of Mohamed Tlatli hospital, Nabeul, Tunisia between 12th September and 11th November 2020. RESULTS: the average age is 31.18 years. Six patients were followed for a chronic disease. Gestational diabetes was the most common comorbidity. Contact with a suspected or confirmed case of COVID-19 was identified in 6 patients. The average incubation period of the virus was 5.89 days. Average term of pregnancy was 33.36 weeks with amenorrhea. The preferred route of delivery was cesarean section. The most frequently reported symptoms were fever in all patients, dry cough, dyspnea and headache in nine patients. Two patients were subsequently treated in medical intensive care for a picture of acute respiratory distress syndrome (ARDS). Both patients were put on high flow nasal oxygen therapy: Optiflow without the need for mechanical ventilation. In the remaining 9 cases, symptomatic treatment and antibiotic therapy were sufficient and the patients returned to their homes. We have had no mother-to-child transmission and no death. Breastfeeding does not seem to influence this transmission. CONCLUSION: the most frequently reported symptoms were fever in all patients, followed by dry cough, dyspnea and headache. There was no mother-to-child transmission, nor transmission during breastfeeding. In general, symptomatic and antibiotic treatment was sufficient. We are currently facing the second wave of the virus. Our efforts will have to be based on a better clinical knowledge of this new coronavirus and adapt a management function accordingly.
