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This blog is built to present our opinion of our variety of cases. The cases presented here are not always difficult or special or unique or wierd. Some of them are just ordinary cases, because we want always to review gynecologic oncology cases for our students, residents, trainees, all of our Indonesian colleagues, also all of gynecologist, gynecologic oncologist all over the world
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Mrs T, 46 yo , P4 (last child age is 17 years old), is reffered by POLRI hosp with information of Chorio Carcinoma
About 2 months ago she underwent currtage due to hydatyde mole. Hystopatological result is not available.
Postcurretage she has irreguler bleeding until this time, Loss of body weight 8 kg within 2 months
Gen st : BP 130/90 HR 112x/m RR 36 x/m
Gyn st : VT: enlarge until 2 finger below umbilicus
USG: Uterus 73,4x111,4 mm , honeycomb appearance, discontinuitas (-)
Chest Xray : lung metastasis
bhCG : 548.012
No sign acute abdomen and heavy bleeding per vagina
Hemoglobine level (Hb): 7.6 g/dl, transfusion was given and Hb level increase to 9.6, but then after next 375 cc PRC transfusion, suddenly Hb level decreased til 5 ???
Problem : GTD with lung metastasis, anemi due to???
Suggestion : USG, blood smear
The clinical conference decide to look for the cause of the bleeding by USG, (The USG result above was done about 3 days before the conference) and if there is no bleeding than searching for another possible causes, like hemolytic anemia due to transfussion or due to cancer itself.
USG result: There is hemoperitoneum
Laparatomy was performed: Blood intraperitoneally about 2000 ml, the patient seemed even felt no pain or acute abdomen.. The blue circle in the picture below was the perforated hole, in the left cornual area.
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