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Medicine and Health Sciences
Oncology

Perforated+Uterus

Profile image of Juliet OfforJuliet Offor
https://doi.org/10.1186/S12957022-02623-0
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Abstract

Background: Uterine rupture following choriocarcinoma is rare and this can increase morbidity and mortality in a condition that has over 90% curative rate. This was the first case of uterine rupture and intestinal metastasis resulting from choriocarcinoma that was managed in our facility. Case Presentation: A 29-yearold P 0 + 1 lady who presented at our facility on 21/3/2019, with abdominal pain, distension and ultrasound report suggestive of molar pregnancy. Her last menstrual period was on 18/2/2019. She had a history of spontaneous miscarriage about four months prior to presentation. Quantitative beta-human chorionic gonadotropin (B-HCG) was 131,106.17miu/ml and chest x-ray revealed multiple intrapulmonary masses most probably metastatic lung disease. She was scheduled for suction evacuation, but further evaluation revealed signs of haemoperitonium necessitating exploratory laparotomy with finding of extensive molar uterine invasion, ragged uterine rupture and dilated 180 0 twisted small intestinal loops containing blood with areas of mesenteric ischaemia and friable seedlings on the ileum serosa that adhered to the uterus. A total abdominal hysterectomy and mesenteric untwisting were done. She received 6 courses of chemotherapy with Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Oncovin (EMACO) regimen due to high-risk prognostic score of 8. The qB-hCG normalized after the 3 rd course of chemotherapy. She had been followed up with monthly qB-hCG for one year with no recurrence. Conclusions: This is to emphasize the need for histology of products of conception following miscarriages. It is also pertinent for any woman within the reproductive age presenting with bleeding to have at least one B-hCG assay to ensure that metastatic gestational trophoblastic neoplasia is excluded.

Figures (4)
Figure 1: Chest X-ray Further review of the patient with the result of the investigations while on admission by the gynaecologist revealed her to be in respiratory distress, moderately
Figure 1: Chest X-ray Further review of the patient with the result of the investigations while on admission by the gynaecologist revealed her to be in respiratory distress, moderately
Figure 2: dilated intestinal loops containing blood with areas of ischaemia Haemoperitoneum about 2.0 litres, multiple ragged looking defects on the uterine fundus; multiple moles on the serosal surfaces of the uterus extending from the fundus to the posterior surface of the uterus with friable muscle layer; and dilated 180° twisted small intestinal loops containing blood with areas of mesenteric ischaemia. They were friable seedlings on the part of ileum serosa that adhered to the uterus.
Figure 2: dilated intestinal loops containing blood with areas of ischaemia Haemoperitoneum about 2.0 litres, multiple ragged looking defects on the uterine fundus; multiple moles on the serosal surfaces of the uterus extending from the fundus to the posterior surface of the uterus with friable muscle layer; and dilated 180° twisted small intestinal loops containing blood with areas of mesenteric ischaemia. They were friable seedlings on the part of ileum serosa that adhered to the uterus.
Figure 3: multiple ragged uterine invasion and perforation
Figure 3: multiple ragged uterine invasion and perforation
options were discussed with her, and she opted for surrogacy.
options were discussed with her, and she opted for surrogacy.

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