Wednesday, November 16, 2011

Unbelievable . . . Stunned beyond words . . .

(This post is a purely of medical academic interest and contains snaps which could be offensive to many. Kindly be careful)

I had written the  previous blog about SD and PD yesterday night but could not post it as there was no internet connection.

PD's relatives brought the 2 pints of blood requested by us by early morning today and Dr Nandamani  called me to help with the surgery.

We were definite that we would be in for few surprises.

This was what we saw as we opened the abdomen. Instead of a smooth ending slope of the uterus what we got was a beveled lower segment which was quite undermined. We decided that there must be a tumour somewhere nearby and opened the uterus where we could visualize as low as possible and delivered the baby.

Then we found out that the uterus was refusing to contract and it looked more like one of those olden days' wineskins.

Dr. Nandamani then started to search for the apparent cervical fibroid which we had found out during the ultrasound. The uterus was quite large and he had to really work hard to mobilize the uterus outside. It was then we noticed where the bleeding was from. One of the ovaries looked ruptured – must have been a large ovarian cyst.

We found out the ‘tumour’ which we were looking for – but it looked quite unusual. It was then that we realized something funny. There was one more ovary on the same side. Well, it did not take long for Nandu to realize that the uterus had got twisted in its axis 180 degrees and he had opened the posterior wall rather than the anterior wall.

And as shown in the snap, the 'tumour' was the left horn of a bicornuate uterus.

We confirmed it after few more examinations. It was quite a relief to realise that we were not dealing with any malignancy.

The rest of the surgery was uneventful. However, we realised that we've just witnessed something which was quite rare.

The best part of the surgery was that although we had to remove the flaccid right horn of the bicornuate uterus, we could leave behind the left horn intact. And maybe, she may concieve. After 4 pregnancies where she ultimately lost all the babies, we pray that she would be able to concieve.

I remember a similiar case of rupture uterus during my previous stinct at NJH, where we found out that it was a bicornuate uterus and the lady concieved in the other horn after one year and delivered a baby by elective Cesarian section.