This document presents two medical case studies: Case 1 is a 40-year-old female who presented with vaginal bleeding and abdominal pain. Examination revealed a large prolapsed mass protruding from her vagina. She was diagnosed with a submucous cervical myoma and underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Case 2 is a 43-year-old female with a history of vaginal bleeding and pelvic mass. Physical examination found two large abdominal masses. She underwent an emergency total abdominal hysterectomy and bilateral salpingo-oophorectomy. Operative findings included an enlarged uterus with endometrial implants and a cystic right ovary. She was

1. MUKESH SAH,MD
POST GRADUATE MEDICAL INTERN
GOODSAM MEDICAL CENTER
TAHRSO
CASES PRESENTATIONS

2. CASE 1
Fernandez, Rita
40yo/Married
Roman Catholic
San Carlos City, Pangasinan
Unemployed
Admitted 09/05/2018

3. CHIEF COMPLAINT
 Vaginal bleeding, hypogastric pain

4. HISTORY OF PRESENT ILLNESS
 2yrs PTA, patient has enlarging abdomen, no consult was
done, no meds taken.
 2 months PTA, patient experienced hypogastric pain with
associated vaginal bleeding consuming 5 pads/day,
difficulty of urination and undocumented fever. Patient
sought consult in a private clinic in San Carlos City and was
advised to have an ultrasound, which showed mass
protruding through the vaginal canal measuring 11.6 cm x
14.1 cm x9.7 cm. Patient went to PPH but was advised to go
to Region 1 Medical Center.
 One month prior to admission, symptoms persisted which
prompted consult to R1MC hence, workup done and
scheduled for elective OR.

5. Past medical History
Appendectomy (February 2018)
Family History
+ HPN - Mother
Personal & Social History
Unremarkable

6. GYNECOLOGICAL HX
Menarche- 12 y/o
Interval- Regular
Duration- 4-5 days
Amount- 5 pads/day
Symptoms- (+) dysmenorrhea
Sexual history
First coitus: 33 y/o
No. of partner- 1
Family Planning Method: OCP

7. OB HX
 LMP- July 2018
 G0

8. PHYSICAL EXAMINATION
Patient is conscious, coherent not in cardio respiratory
distress
BP:120/80mmHg CR:81 bpm RR:20 T:36.7C
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 15x16cm, firm, mobile
IE- (+) prolapsed mass
Measuring 12 x 11 cm, firm, smooth contour,
bleeds to touch
Pedicle cannot be delineated
Uterus enlarged to 4 months size
Adnexa free
With scanty vaginal bleeding

10. ADMITTING DIAGNOSIS
G0 Prolapse Submucous Myoma

11. DAY 1 OF ADMISSION
 9-5-2018
 Admitted at Gyne ward
 GL then NPO postmidnight
 Secure 2 units of PRBC properly typed and
crossmatched
 For TAHBSO

24. OPERATION DONE
 TAHRSO

25. OPERATIVE FINDINGS
On laparotomy, no hemoperitoneum nor ascites noted,
smooth, pinkish uterus seen small in sie, regular in shape. Left ovary
and both fallopian tubes were grossly normal, right ovary was
cystic containing chocolate fluid upon accedental rupture.
Grossly, the uterus measures 9 x 7 x 4cms, symmetrical, tan
in color. The right ovary measures 4.5 x 3cm, Left fallopian tube 7 x
0.5 cm and right fallopian tube 8 x 0.5 cm and were grossly normal.
Cervix is whitish smooth measuring 5x4x3 cm.
On cut section, A 15 x 12 cm mass attached at the
posterior cervical area without pediclem, with whorled like pattern.
Anterior myometrium is 1.5 cm thick and Uterine canal measures
4cm. Cervical canal measures 3M.5cm.

30. FINAL DIAGNOSIS
G0 Cervical Myoma, Pelvic
Endometriosis

31. CASE 3
Bumatay, Rowena
43y/o/Married
Roman Catholic
Urdaneta,Pangasinan
Unemployed
Admitted 7-28-18

32. CHIEF COMPLAINT
Vaginal Bleeding with pain
 Pelvoabdominal mass

33. 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.

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

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

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

37. 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

38. 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.

39. ADMITTING DIAGNOSIS
G1P1 (1001) AUB-L; Anemia
severe secondary to chronic
blood loss; ONG, right

40. DAY 1 OF ADMISSION
 DAT
 Secure 3 units PRBC then to transfuse
 Tranexamic acid 1g IV q 8
On 3rd HD
 For emergency TAHBSO

52. 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.

57. FINAL DIAGNOSIS
G1P1 (1001) Adenomyosis , Pelvic
Endometriosis, endometrioma right
ruptured