20/03/2021
Good morning everyone
This case is admitted under Dr.Prof. Hemlata jharbade madam, Dr.Monica verma madam(associate professor),Dr vaishali jain madam(assistant professor)
and team!
26 Year old , G8P3L3A4 , all vaginal births, last delivery 8 months back. Patient was in had 2 month amenorrhoea. She went to CHC sardarpur with complaint of bleeding per vaginum .
There she was subjected to suction and evacuation for the same with diagnosis of incomplete abortion.
During suction the operator ( she was a doctor) evacuated something and sent it in a histopath box to nearby dh Dhar along with the diagnosis of? Molar pregnancy.
Our previous senior resident Dr Neeraj bagde there saw the box and immediately sent the patient here because it was not molar content but OMENTUM.
Now I'm going to tell you the best most interesting part of the story.
The patient was received here at around 1am. Her pulse bp were stable. There was very little bleeding per vaginum.
An X-ray ultrasound higher antibiotics surgery reference other investigations were done.
The reports are as follows
X-ray gas under diagphram
Usg minimal ascitis with echoes
Now comes the fun part
UPT negative
Beta hcg < 2.0
😬😬😬
We tried transferring the patient to surgery but they refused.
We opened the patient today morning and the intraop findings were
Hemoperitoneum 200ml
Small 2cm rent on fundus of uterus
Uterus 6cm in size ( lactation uterus)
Mesentric injury from ic junction to 20 CM of small bowel
Gangrenous bowel
After repair of the rent by 2 0 vicryl
Resection of gangrenous bowel with double barreled ileostomy done.
Now the patient is going to stay in MYH with a colostomy bag for a long long time.... 😁😁
So the moral is every patient coming with amenorrhea followed by bleeding is not incomplete abortion.... Especially in lactating woman.
Small surgery like a suction evacuation can also become life threatening and if not diagnosed and attended at the right time, Can cost a mother's life..... 😊
