Útero incarcerado recidivante

We describe the case of a woman in her first pregnancy with acute urinary retention associated with a retroverted gravid uterus. In her second pregnancy, the process of incarceration of a gravid uterus recurred. On both occasions, the patient was successfully treated by manual repositioning of the gravid uterus. In the tenth week of the patient's third pregnancy, a pessary was placed in the vagina, which prevented uterine incarceration. Several aspects of the frequency, etiology, treatment and possibility of recurrent incarcerated retroverted uterus are discussed.     

Atrapamiento de cabeza fetal en útero septo

Septate uterus, which occurs in approximately 1% of fertile women, is considered the most common uterine anomaly but is associated with the poorest reproductive results. Uterine anomalies are especially associated with difficulty in maintaining a pregnancy to full term, often leading to late miscarriage or preterm delivery. We present a case of fetal microcephaly in a woman with septate uterus as a consequence of trapping of the fetal head between the septum and one of the uterine walls.     

Adenocarcinoma de endometrio en útero septo: utilidad de la histeroscopia en el diagnóstico

We present a case of adenocarcinoma in the left horn of a septate uterus. Correct diagnosis is often difficult. Hysteroscopy is one of the diagnostic methods of choice.     

Útero didelfo,bicollis y tabique vaginal longitudinal,causa de aborto habitual

We present a case of didelphic uterus, bicollis, and high partial longitudinal vaginal septum in a 27-year-old woman with three consecutive abortions.     

Abordaje histeroscópico del endometrio residual en muñón cervical

The main difference between subtotal and total hysterectomy lies in the persistence of the cervical stump and the possible associated problems. One of these problems is cyclical bleeding after a subtotal hysterectomy, which, depending on the series, occurs in 0% to 25% of cases. We describe resolution of cyclical bleeding after a subtotal hysterectomy by means of hysteroscopic treatment. To our knowledge, this is the first published case in which ablation of the remnant tissue was performed with a monopolar loop in order to treat cyclical bleeding. We believe this surgical treatment could be a valid alternative to resolve cyclical bleeding associated with persistence of endometrial tissue in the cervical stump.     

Útero unicorne con cuerno rudimentario no comunicante en la adolescencia

Unicornuate uterus is a rare uterine anomaly resulting from the abnormal development of one of the Müllerian ducts. This abnormality usually manifests with dysmenorrhea, dyspareunia and pelvic pain appearing a few months after menarche, although there are late or even asymptomatic presentations. Clinicians should be aware of the importance of this rare congenital anomaly of the female genital tract, especially when symptoms occur shortly after menarche, because without early diagnosis and treatment, patients carrying this anomaly may develop endometriosis, infertility, and severe complications.     

Útero didelfo y hemivagina ciega. Una causa de dolor abdominal en la adolescencia

Objective

To evaluate didelphic uterus as a cause of abdominal pain.

Material and method

We reviewed 2 cases in adolescents managed by our service from 2002 to 2006.

Results

In both patients, we confirmed the existence of didelphic uterus and septate vagina associated with renal agenesis. Outcome was favorable in both patients after surgery.

Conclusions

The 2 cases described illustrate the need to include congenital abnormalities in the differential diagnosis of lower abdominal pain and vaginal mass in adolescents.     

Abordaje conservador del embarazo ectópico cervical

Cervical pregnancy is a rare form of ectopic pregnancy with a high risk of hemorrhage. Early diagnosis is an important prognostic factor for survival and preserved fertility in these patients. We present the case of a patient diagnosed with cervical ectopic pregnancy in her seventh week of gestation. The therapeutic management was conservative and involved the combination of systemic and intra-amniotic methotrexate Because of the lower associated morbidity and mortality and the possibility of maintaining the patient’s fertility, conservative treatment is a viable therapeutic approach in cases such as that presented herein.     

Evisceración vaginal. Abordaje abdominal y reparación con malla sintética

Spontaneous vaginal evisceration is a rare phenomenon in daily clinical practice. Since McGregor reported the first case at the beginning of the past century, more than 70 cases have been reported to date. Spontaneous vaginal evisceration usually occurs in patients with postmenopausal hypoestrogenism associated with previous gynecologic surgery. This entity has recently been described in non-gynecological conditions after perineal proctectomy. We present a new case of spontaneous vaginal evisceration in a postmenopausal woman with previous gynecological surgery. Surgical mesh repair was performed through conventional laparotomy.     

Rotura uterina por placenta percreta. Un caso clínico en útero bicorne unicollis

A woman in the 27th week of gestation, with a prior diagnosis of uterus bicornis unicollis and a cervical cerclage in situ, presented to the emergency department with severe abdominal pain. No uterine dynamics were observed. The patient rapidly deteriorated shortly after admission, warranting removal of the cervical cerclage and emergency cesarean section delivery with the working diagnoses of hypovolemic shock and abruptio placentae. Laparotomy showed free blood in the peritoneum (2 liters) as well as a placenta accreta with a 3-cm perforation in the uterine fundus. A female infant, weighing 1030 g, was delivered and progressed satisfactorily.     

Tratamiento del embarazo ectópico cervical con metotrexato y rescate con leucovorina

Objective

To present two cases of cervical ectopic pregnancy successfully treated with systemic methotrexate.

Subjects and methods

Two women with a cervical ectopic pregnancy. Interventions: alternative day regime of methotrexate 1 mg/kg (days 1,3,5 and 7) with folinic acid rescue (days 2, 4, 6, and 8). End points: successful treatment.

Results

Two cases of ectopic cervical pregnancy were successfully treated and preserved their reproductive capability.

Conclusions

Conservative medical treatment of cervical ectopic pregnancy with systemic methotrexate is safe and effective.     

Dismenorrea por útero unicorne con cuerno rudimentario

Dysmenorrhea is highly frequent in adolescents and young women, affecting 40-50% of this population to some degree.     

La malformación arteriovenosa uterina. Una lesión más frecuente y grave de lo sospechado

Introduction

Uterine arteriovenous malformation (AVM) is more common than it is reported to be and is a potentially life-threatening condition often secondary to uterine trauma or pregnancy. Congenital origin is also reported but is less common.

Material and methods

Eight cases are described.

Results and discussion

AVM is characterised by the presence of an intra-myometrial arteriovenous skein. Congenital cases may extend to vascular zones of the minor pelvis and/or other organs. The onset of AVMs is usually severe bleeding. Doppler ultrasound is the first diagnosis approach, but, angiography remains the gold standard for diagnostic evaluation. A previous negative pregnancy test is a “sine qua non” condition. Embolization is the more acceptable form of treatment. The therapeutic advances in their diagnosis and treatment are described, based on 8 personal cases.     

Embarazo ectópico cervical: a propósito de 3 casos. Revisión de la práctica clínica

Three cases of cervical ectopic pregnancy treated medically are described. The first case with selective uterine artery embolization and methotrexate dose single, the second case with selective uterine artery embolization and methotrexate dose multiple, and the third case intraamniotic puncture and instillation of KCl due to persistent embryonic heartbeat was necesary, before selective uterine artery and methotrexate dose unique. A spontaneous evacuation of the cervical pregnancy occurred in all patients treated conservatively. We postulate that the preventive use of uterine artery embolization in combination with standard MTX treatment could contribute to reduce the risk of excessive bleeding and facilitate spontaneous expulsion. The diagnostic and therapeutic methods are discussed and the literature is reviewed.     

Úlcera vulvar aguda

Vulvar ulceration can occur as the primary or secondary event in a wide variety of processes: infections, autoimmune and/or inflammatory diseases and dermatoses, neoplasms and entities of unknown etiology. Diagnosis relies on positive criteria: acute onset of one or several deep, large, necrotizing and extremely painful ulcerations in young women, usually virgins, preceded by fever sometimes associated with tonsillitis. Specific microbiological, histological, immunological, and other investigations are often required to establish a diagnosis.     

Reducción funcional y estética de los labios menores: labioplastia con técnica de resección con colgajos especulares en «S»

Women with hypertrophic or enlarged labia minora usually have functional and psychosocial problems. Labial hypertrophy is defined as labia minora that extend beyond the labia majora when the woman is in a normal position. Many affected women have local irritation, interference with sexual intercourse, difficulty with hygiene, and discomfort during walking, sitting, biking or horse-riding. Several surgical techniques can be used to perform labioplasty. One of most common procedures is a simple and straight amputation of the protuberant segments and oversewing of the edge. To prevent the complications associated with this technique, we perform a specular S-shaped resection with interdigitated suturing of the protuberant labium. This technique results in a natural, softer, and more rounded labial edge, with fewer complications. We present our experience in 7 cases with successful outcomes.     

Incarceración y torsión uterina en gestante

Uterine torsion is a rare event, especially in the absence of pregnancy. This complication is defined as a rotation of more than 45° around the long axis of the uterus and usually occurs along the transition between the body and the cervix. In two thirds of cases, the torsion is toward the right side. This event is usually caused by the presence of an abnormal condition that affects the uterus and/or the adjacent structures. Clinical manifestations may be acute or chronic, or even entirely absent, in which case the torsion is identified as an intraoperative finding. The diagnosis can only be confirmed during laparotomy. Because of vessel congestion in the broad ligament and the anterior position of the ovaries, low hysterotomy, usually performed at cesarean section, cannot be carried out in certain situations. Instead classical hysterotomy on the posterior surface of the uterus is performed.     

Fístulas arteriovenosas uterinas tras legrado. Manejo histeroscópico

Uterine arteriovenous malformations are uncommon entities that may lead to life-threatening genital bleeding. These malformations can be congenital or acquired. In this article, we review uterine arteriovenous malformations occurring after curettage, their incidence, and their hysteroscopic management. To our knowledge, the distinct therapeutic options are limited to expectant management with or without methylergometrine maleate, embolization and hysterectomy, without considering hysteroscopy. We believe that hysteroscopic management could be a new treatment option for uterine arteriovenous malformation occurring after curettage.     

Embarazo ectópico cervical: diagnóstico y tratamiento

We report a case of cervical ectopic pregnancy treated with methotrexate and abdominal hysterectomy.     

Rotura uterina en paciente con feto muerto anteparto y lupus eritematoso sistémico

Systemic lupus erythematosus (SLE) is an autoimmune disease of unknown etiology that can affect any device or system in the body, causing a wide variety of symptoms. This disease is more frequent in women of reproductive age.