•43 yearls old obese lady with heavy menstrual bleeding and severe pain during bleeding
•Ultrasound revealed chocolate cysts in both ovaries
•Injection Leuprolide was advised to relieve her symptoms
•After 3 months of injection, the symptoms recurred and she opted for operation (Removal of the uterus and the ovaries) after explaining all the risks and benefits
•The operation was EXTREMELY DIFFICULT, because of severe ADHESION (uterus, ovaries, bladder, ureters, intestines, rectum all were attached together)
•Careful dissection was performed, removing the uterus first. Because of severe adhesion, subtotal hysterectomy was done (Leaving behind the cervix (lower part of the uterus), which has been explained to the patient
•Then both ovaries containing chocolate cysts were removed •Patient was transfused blood and her condition was closely monitored •She was discharged in stable condition
•She is absolutely OK in follow up period
•Biopsy revealed ENDOMETRIOSIS
Dermoid Cysts in Both Ovaries
•34 years old lady from Burdwan
•Presented with HUGE TUMOURS in both OVARIES, confirmed by ultrasound and CT scan
•CA-125 was normal and our presumption was Benign “Dermoid Cysts” of the ovaries
•We removed cysts from both sides, preserving her ovaries and tubes in both sides and the uterus, as per her request.
•Right sided cyst- 9 cm x 8 cm x 5.5 cm
•Left sided cyst- 10 cm x 9 cm x 7 cm
•Biopsy confirmed DERMOID CYSTS
•Despite major surgery, she went home within 3 days!!!
•She is now doing well and her normal menstruation again started after the operation •
Challenging Case of Hysterectomy
•55 years old lady presented with post-menopausal bleeding
•She was found to have multiple FIBROIDS in the UTERUS, confirmed by ultrasound
•IVP was done to ensure that the tumours had not affected urinary tract
•She was having Diabetes and Hypertension, with Haemoglobin 7.2 g/dl- so at HIGH RISK from ANAESTHETIC and SURGICAL point of view
•After discussion and obtaining patient’s informed CONSENT, we proceeded for this CHALLENGING SURGERY
•10 KG TUMOUR was removed along with the uterus and the ovaries.
•3 units of BLOOD was TRANSFUSED
•Post-operative period was alright and SHE WENT HOME WITHIN 3 DAYS, despite major surgery!!! •
Fallopian Tube Block, Successful Laparoscopy-Hysteroscopy
•5 years long Infertility
•HyCoSy showed BOTH THE FALLOPIAN TUBES were BLOCKED
•All other Fertility Factors normal
•Was offered 2 options 1.Directly IVF 2.Laparoscopy and Hysteroscopic guided Proximal tubal Cannulation (Attempt to open the tube surgically), failing which IVF would be required
•Patient opted for option 2
•We managed to open one tube during the operation
•Conceived naturally within 3 months of the operation
•Pregnancy was uncomplicated, except mild hypertension
•Delivered a healthy baby at 37 weeks •
Ruptured Ectopic Pregnancy
•ECTOPIC PREGNANCY (Pregnancy outside the uterus, usually in the tubes or ovaries), is uncommon but LIFE-THREATENING condition, because of severe INTERNAL BLEEDING
•Patient presented with severe pain abdomen and bleeding per vagina, after a missed period
•Her pregnancy test was positive and so the diagnosis of ECTOPIC PREGNANCY was considered
•She came to us without any tests, so we advised URGENT ULTRASOUND SCAN, which confirmed RUPTURED ECTOPIC PREGNANCY
•After arranging BLOOD, starting intravenous SALINE, we decided for IMMEDIATE SURGERY to save her LIFE to stop the INTERNAL BLEEDING
•In Surgery abdominal BLEEDING (Around 1 Litre !!!) Was found with Left FALLOPIAN TUBE RUPTURED, which contained the ECTOPIC PREGNANCY
•Patient’s condition IMPROVED DRAMATICALLY after the surgery and she returned back to home within 3 DAYS !!!!!
Dermoid Cyst Surgery in a Very High Risk Patient
•57 years old lady, having high blood pressure and heart disease (Angina), who was on multiple medicines for BP and angina, presented with swollen abdomen
•She had Angiography 2 times before
•Ultrasound scan and MRI revealed a large Tumour (17 x 12 cm) from Right Ovary, with normal CA 125 level
•The diagnosis was Dermoid cyst
•She opted for removal of both the ovaries (bilateral oophorectomy) and the uterus (hysterectomy)
•After proper arrangement, Anaesthetic check up and Cardiologist review, the operation was done with ICU back up (though she did not require it)- removing the large tumour with the uterus and part of omentum (abdominal fat)
•Despite Major Operation, she recovered well and was discharged from the hospital 4th day after the operation !!!
•Biopsy came as DERMOID CYST (benign disease, NOT cancer) and she is now doing well •
Removal Of Hydrosalpinx before IVF
If the Fallopian tube us swollen and filled by the fluid/ pus/ blood, the tube is not functioning. The tube can even damage the Embryo which is implanted after IVF.
Thus, the affected tube must be removed before IVF to improve the success rate of IVF. It can be done by Laparoscopy.
The picture shows Laparoscopic Tube Removal (Salpingectomy) in a patient who is planning for IVF.
Please pray for her.
Dermoid Cyst Removal, Laparoscopy, Natural Pregnancy
•Dermoid Cyst Removal and Preserving the healthy Ovary by Laparoscopy in a lady with Infertility.
It was 5 cm dermoid cyst in left ovary. After taking consent and explaining the risk, we proceeded for Laparoscopy and removed the cyst with all hair (!!!) and secretion. The right ovary was intact and not disturbed. The left ovary was preserved as much as possible so as not to compromise her Fertility much.
We also performed hysteroscopy to look inside the uterus in the same sitting (with her consent) to avoid the need of second operation.
We also checked whether the tubes are patent or not by inserting blue dye (Methylene blue- shown in the picture).
Dermoid cyst is a benign tumour of the ovary that may contain hair (seen in this picture), oil (like skin secretion), skin, teeth, bones, cartilages etc.
The chance of malignancy is very rare.
But if left untreated, it can undergo TORSION (twisting of the ovary, causing severe pain and may cause gangrene of the ovary if untreated, an ACUTE EMERGENCY) and also hemorrhage inside the cyst.
It was a CHALLENGE to remove the cyst (5 cm size) keeping the ovary (we took consent from the woman that she may require removal of the ovary, fortunately it did not happen).
The operation took long time but finally it was done.
•She got pregnant naturally within 3 months of surgery
Fibroid-Infertility, Lapaparoscopic Myomectomy, Low AMH, Advanced Age, Spontaneous Pregnancy
•40 year-old woman presented with Infertility of 5 years
•AMH was very low and she was advised IVF with Egg-Donation
•She had large fibroid (6 cm) with heavy menstrual bleeding, not relieved by any medicines
•We removed the fibroid by laparoscopy (Myomectomy) and she was discharged from the hospital next day
•Within 3 months after the operation, she conceived spontaneously (Without IVF) and delivered a healthy baby