RADICAL HYSTERECTOMY

1. EHBSO
MUKESH SAH, MD
POST GRADUATE MEDICAL INTERN

2. CASE 1
SN
46yo/ Single
Roman Catholic
CAB CITY
Unemployed
Admitted 09/24/2018

3. Chief complaint
 Vaginal bleeding

4. History of Present Illness
 2yrs PTA, patient has palpable mass at lower
abdomen, no consult was done, no meds taken.
 3 months PTA, patient experienced hypogastric
pain with associated vaginal bleeding consuming
5 pads/day, difficulty of urination and enlarging
hypogastric mass. Patient sought consult in a
private clinic in Bugallon and was advised to have
an ultrasound, but was not done, hence Px was
advised to go to Region 1 Medical Center and
was admitted.
 One month prior to admission, symptoms persisted
which prompted consult to R1MC hence, workup
done and scheduled for elective OR.

5. Past medical History
June 26,2018 admitted at R1MC due to
hypotension and Anemia s/p 2 PRBC
transfusion
Family History
(+) CA (urinary system)
(-) HPN (-) DM (-) heart disease
Personal & Social History
Unremarkable

6. Gynecological Hx
Menarche- 15 y/o
Interval- Irregular
Duration- 4-5 days
Amount- 2-3 pads/day
Symptoms- (+) dysmenorrhea
Sexual history
First coitus: 24y/o
No. of partner- 1
Family Planning Method: Condom

7. OB Hx
 LMP- sep24,2018
 G2P2(2002)

8. Physical Examination
Patient is conscious, coherent not in cardio respiratory
distress
BP:100/60mmHg CR:83 bpm RR:19 T:36.5C
Skin: (+) pallor (-) jaundice (-) cyanosis
HEENT: Pink palpebral conjuntiva, Anicteric Sclerae
Chest and Lungs: Symmetrical chest expansion, no
retractions, clear breath sounds
Cardiovascular: Adynamic precordium, normal rate
regular rhythm, no murmur

9. Physical Examination
Abdomen is flabby, soft, non-tender
+palpable mass 12x10cm, firm, mobile,
nontender
IE- Cervix admits tip, midline
Uterus enlarged to 3 months size
Adnexa free
With scanty vaginal bleeding

10. Admitting Diagnosis
G2P2(2002) Endometrial
Adenocarcinoma

11. Day 1 of Admission
 9-21-2018
 Admitted at Gyne ward
 GL then NPO postmidnight
 Secure 2 units of PRBC properly typed and
crossmatched
 For EHBSO, PFC, BLND

15. Operative Findings
There was 50cc straw colored peritoneal fluid.
The liver, gallbladder, spleen, subdiaphragmatic
surface, kidneys, stomach and peritoneum were all smooth.
The uterus measured 9.5 x 7 x 3.5 cm with smooth
serosal surface, cervix measured 4x3x2cm.
On cut section, the endometrial depth measured 8cm,
4cm of which is the endocervical canal.
Endometrium 0.4cm thick. Myometrium is 2cm at the
fundus. It showed a necrotic tissue more than 50% of the
myometrium.
All harvested nodes were suspicious for malignancy.
Estimated Blood Loss: <200 ml

17. Final Diagnosis
G2P2 (2002) Endometrial
Adenocarcinoma
Stage I vs Stage IIIC

30. Operation Done
 TAHRSO

31. Operative Findings
There was 50cc straw colored peritoneal fluid.
The liver, gallbladder, spleen, subdiaphragmatic
surface, kidneys, stomach and peritoneum were all smooth.
The uterus measured 9.5 x 7 x 3.5 cm with smooth
serosal surface, cervix measured 4x3x2cm.
On cut section, the endometrial depth measured 8cm,
4cm of which is the endocervical canal.
Endometrium 0.4cm thick. Myometrium is 2cm at the
fundus. It showed a necrotic tissue more than 50% of the
myometrium.
All harvested nodes were suspicious for malignancy.
Estimated Blood Loss: <200 ml

36. Final Diagnosis
G2P2(2002) Endometrial
Adenocarcinoma stage IB vs III C

37. CASE 3
BR
43y/o/Married
Roman Catholic
CAB CITY
Unemployed
Admitted 7-28-18

38. Chief complaint
Vaginal Bleeding with pain
 Pelvoabdominal mass

39. History of Present Illness
 1 year PTA, patient noticed an enlarging
abdomen, no consult was done.
 1 month PTA, (+) Vaginal bleeding with pain
associated with enlarging abdomen
consult at R1MC and was scheduled for
elective
 5 days PTA, persistence of bleeding
consuming 3 diaper pads/day associated
with hypogastric pain, consulted at R1MC
and was admitted.

40. Past medical History
Unremarkable
Family History
(+) HPN mother, No other
heredofamlial diseases noted
Personal & Social History
Unremarkable
Immunization- none

41. OB Hx
Menarche-15y/o
Interval- Regular
Duration- 3 days
Amount- 2 pads/day
Symptoms- (-) dysmenorrhea
Coitus- 18yo
No. of partner- 1

42. LMP: June last week 2018
G1P1 (1001)
G1- 1994, term, NSD, hospital delivery, female, Alive

43. Physical Examination
Patient is conscious, coherent not in cardio
respiratory distress
BP:140/80mmHg CR:83bpm RR:19 T:36.6C
Skin: (-)pallor (-) jaundice (-) cyanosis
Head EENT: Anicteric sclerae, pale palpebral
conjuntiva
Chest and Lungs: Symmetrical chest expansion, no
retractions, clear breath sounds
Cardiovascular: Adynamic precordium, normal
rate regular rhythm, no murmur

44. Physical Examination
Globular abdomen, soft, normoactive bowel sounds,
soft, non-tender with 2 palpable masses at
hypogastric area measuring about 12x10cm, firm,
irregular in shape, slightly mobile, nontender and 12 x
15cm cystic mass, mobile,nontender.
IE- Normal external genitalia,
Cervix admits tip, midline
Uterus enlarged about 12x10cm, firm, irregular in
shape, slightly mobile, nontender, right adnexa with
cystic mass about 12 x 15cm, mobile, nontender, left
Adnexa free, with minimal vaginal bleeding.

45. Admitting Diagnosis
G1P1 (1001) AUB-L; Anemia
severe secondary to chronic
blood loss; ONG, right

46. Day 1 of Admission
 DAT
 Secure 3 units PRBC then to transfuse
 Tranexamic acid 1g IV q 8
On 3rd HD
 For emergency TAHBSO

50. Operative Findings
On laparotomy, no hemoperitoneum nor ascites noted, smooth,
pinkish uterus seen about 3 months size, irregular in shape,
adherent to right ovary, omentum and rectosigmoid area,
enterolysis was done. The right ovary was cystically enlarged
adherent to the omentum and posterior wall of uterus, Adhesiolysis
was done, then proceeded to TAHBSO.
Grossly, the uterus measures 12 x 10 x 10cms,
asymmetrically enlarged, left fallopian tube 7 x 0.5 cm and right
fallopian tube 10 x 0.5 cm and were grossly normal. The right ovary
measures 11x 15cm, cystic with chocolate-like fluid, left ovary
measures 2x2cm, grossly normal. Cervix is whitish smooth
measuring 4x3x3 cm.
On cut section, uterus has thick myometrium having
interspered blot hemorrhages.Anterior myometrium is 3 cm thick
with endometrial canal 7 cm. The right ovary was cystic, thin
walled with chocolate like fluid.

52. Final Diagnosis
G1P1 (1001) Adenomyosis , Pelvic
Endometriosis, endometrioma right
ruptured

54.  3 months PTA patient experienced heavy menstruation
and she was consult at R1MC stage was dx: AUB-0 and
due to hypotension and anemia patient was admitted
was given blood transfusion 2 unit and patient was do
endometrial biopsy and was dx: Endometrial Adeno
carcinoma he