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Kyejo W, Ismail A, Kitua A, Moshi B, Ntiyakunze G, Kaguta M, Mwanga A. Incidental actinomycosis in a 44-year-old female during total abdominal hysterectomy for abnormal uterine bleeding: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241248389. [PMID: 38655125 PMCID: PMC11036907 DOI: 10.1177/2050313x241248389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Actinomycosis, a rare chronic bacterial infection caused by Actinomyces species, presents diagnostic challenges due to diverse clinical presentations. This report presents a case of peritoneal actinomycosis incidentally discovered during a total abdominal hysterectomy in a 44-year-old female with refractory abnormal uterine bleeding and a history of long-term intrauterine contraceptive device use. The patient presented with persistent abnormal uterine bleeding despite conservative management. Intraoperative findings during total abdominal hysterectomy revealed peritoneal involvement, prompting histopathological evaluation confirming actinomycosis. This case highlights diagnostic complexities associated with actinomycosis, emphasizing the significance of histopathological confirmation. Postoperative management with antibiotics demonstrated favorable outcomes, supporting their efficacy in treating actinomycosis. The case underscores the importance of considering uncommon infections in pelvic pathology, particularly in patients with prolonged intrauterine contraceptive device usage. It prompts further exploration of actinomycosis in relation to intrauterine contraceptive device use and highlights the need for timely intervention and histopathological confirmation for optimal patient care.
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Affiliation(s)
- Willbroad Kyejo
- Department of Family Medicine, Aga Khan University, Dar Es Salaam, Tanzania
| | - Allyzain Ismail
- Department of Surgery, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Abduel Kitua
- Department of Surgery, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Brenda Moshi
- Department of Obstetrics and Gynecology, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Gregory Ntiyakunze
- Department of Obstetrics and Gynecology, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Munawar Kaguta
- Department of Obstetrics and Gynecology, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Ally Mwanga
- Department of Surgery, Aga Khan Hospital, Dar Es Salaam, Tanzania
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Kyejo W, Moshi B, Massanga E, Ntiyakunze G, Mgonja M, Kaguta M, Mdachi E. Abdominal wall endometriosis in cesarean scar: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241237333. [PMID: 38463448 PMCID: PMC10921851 DOI: 10.1177/2050313x241237333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/16/2024] [Indexed: 03/12/2024] Open
Abstract
Abdominal wall endometriosis refers to the presence of endometrial tissue within surgical scars, most commonly occurring following gynecological procedures such as cesarean sections. This case report presents a rare case of abdominal wall endometriosis in a cesarean scar. The patient, a 32-year-old woman with a history of two previous cesarean sections, presented with cyclic pain and swelling in the lower abdominal region. Physical examination revealed a tender, well-defined mass within the cesarean scar. Surgical excision of the mass was performed, and histopathological examination confirmed the presence of endometrial tissue. This case highlights the importance of considering abdominal wall endometriosis in the differential diagnosis of patients presenting with cyclic pain or swelling in previous surgical scars. Prompt diagnosis and appropriate management can help alleviate symptoms and prevent complications.
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Affiliation(s)
- Willbroad Kyejo
- Department of Family Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Brenda Moshi
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Euphraim Massanga
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Gregory Ntiyakunze
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Miriam Mgonja
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Munawar Kaguta
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Ernest Mdachi
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
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Kyejo W, Ntiyakunze G, Moshi B, Lubuva N, Kaguta M, Jaiswal S. Total abdominal hysterectomy in a patient with immune thrombocytopenic Purpura: A case report. Int J Surg Case Rep 2024; 114:109102. [PMID: 38061090 PMCID: PMC10755033 DOI: 10.1016/j.ijscr.2023.109102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/19/2023] [Accepted: 12/01/2023] [Indexed: 01/01/2024] Open
Abstract
INTRODUCTION Immune Thrombocytopenic Purpura poses unique challenges in surgical settings due to an increased risk of bleeding. This report details the perioperative management of a patient with Immune Thrombocytopenic Purpura undergoing Total Abdominal Hysterectomy, emphasizing the importance of tailored approaches for such cases. CASE PRESENTATION A 41-year-old female with Immune Thrombocytopenic Purpura and symptomatic uterine fibroids, despite medical management, opted for Total Abdominal Hysterectomy. Prednisolone therapy and platelet transfusion were used preoperatively to optimize platelet counts. DISCUSSION Effective management was achieved through meticulous surgery, continued prednisolone therapy, and vigilant postoperative monitoring. This case highlights the value of a multidisciplinary approach in ensuring positive surgical outcomes for Immune Thrombocytopenic Purpura patients. CONCLUSION AND RECOMMENDATION This case underscores the significance of individualized perioperative care for Immune Thrombocytopenic Purpura patients undergoing major surgery. By optimizing medical therapy and maintaining close monitoring, favorable results can be achieved, enhancing the quality of life for such patients. It is recommended that such comprehensive approaches are considered in similar cases.
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Affiliation(s)
- Willbroad Kyejo
- Department of Family Medicine, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania.
| | - Gregory Ntiyakunze
- Department of Obstetrics and Gynecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Brenda Moshi
- Department of Obstetrics and Gynecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Neema Lubuva
- Department of Hematology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Munawar Kaguta
- Department of Obstetrics and Gynecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Shweta Jaiswal
- Department of Obstetrics and Gynecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
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Kyejo W, Moshi B, Gidion D, Abeid M, Somji S, Kaguta M, Mgonja M. A rare case report of tuberculosis endometritis in a private hospital Dar es salaam, Tanzania. SAGE Open Med Case Rep 2023; 11:2050313X221150054. [PMID: 36686206 PMCID: PMC9850118 DOI: 10.1177/2050313x221150054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
Tuberculosis endometritis is a pathological diagnosis and has been always over shadowed by pelvic tuberculosis. It is usually asymptomatic, but patients could complain of menstrual irregularity and per vaginal discharge. We report a case of a 37-year-old female who presented with per vaginal discharge for 2 years. Histopathology showed numerous caseating and non-caseating granulomas with plasma cells, Ziehl-Neelsen stain for acid fast bacillus is positive, and she was initiated on anti-tuberculosis treatment. On subsequent follow-up visits, patient was doing well with complete resolution of symptoms. Genital tuberculosis is usually caused by reactivation of organism from systemic distribution during primary infection. It is estimated that approximately 8 million cases of tuberculosis occur worldwide every year, 95% of which are from developing countries. Tuberculosis usually affects the lung but about one-third of patients have extra pulmonary involvement which include female genitals organs and other organs. Genital tuberculosis is an indolent infection: its common symptoms include pelvic pain, vaginal bleeding, amenorrhea, vaginal discharge, and infertility. Most of the patients respond quickly after initiating anti-tuberculosis medications. We recommend that all patients with a positive Ziehl-Neelsen stain and menstrual abnormalities undergo aggressive evaluation for genital tuberculosis.
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Affiliation(s)
- Willbroad Kyejo
- Department of Family Medicine, Aga Khan
University, Dar Es Salaam, Tanzania,Willbroad Kyejo, Department of Family
Medicine, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania.
| | - Brenda Moshi
- Department of Obstetrics and
Gynecology, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Daudi Gidion
- Department of Obstetrics and
Gynecology, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Muzdalifat Abeid
- Department of Obstetrics and
Gynecology, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Samina Somji
- Department of Internal Medicine, Aga
Khan Hospital, Dar Es Salaam, Tanzania
| | - Munawar Kaguta
- Department of Obstetrics and
Gynecology, Aga Khan Hospital, Dar Es Salaam, Tanzania
| | - Miriam Mgonja
- Department of Obstetrics and
Gynecology, Aga Khan Hospital, Dar Es Salaam, Tanzania
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Kapesi V, Moshi B, Kyejo W, Jusabani A, Mgonja M, Kaguta M. Couvelaire uterus in a previable pregnancy: Complication in abruptio placenta, case series from Tanzanian tertiary hospital. Int J Surg Case Rep 2022; 102:107862. [PMID: 36621218 PMCID: PMC9850026 DOI: 10.1016/j.ijscr.2022.107862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Couvelaire uterus, also previously known as uteroplacental apoplexy. This is a life-threatening condition resulting from bleeding into the myometrium that may extend to the parametrium and peritoneum. Couvelaire uterus is typically associated with abruptio placentae, the premature separation of the placenta. This syndrome can only be diagnosed by direct visualization during caesarean section or biopsy (or both). For this reason, its prevalence is under-reported and underestimated in the literature. CASES FINDINGS We present a rare case series of two patients with Couvelaire uterus in previable pregnancy at Aga Khan Hospital, Dar es salaam. This combination is a rare occurrence and there are no cases reported in sub-Saharan Africa to the best of our knowledge. CLINICAL DISCUSSION AND CONCLUSION Couvelaire uterus is a rare manifestation to find in a previable pregnancy. The incidence of Couvelaire uterus is difficult to estimate since the diagnosis can only be reached intra-operatively. In most cases it occurs with abruptio placentae which develops due to a disruption in the vessels within the placenta allowing for blood to seep into the decidua basalis leading to premature separation of the placenta and bleeding into the myometrium which may extend to the parametrium and peritoneum. Clinicians should be vigilant when dealing with vaginal bleeding in a pre-viable pregnancy and placental separation is considered as an important differential to avoid the maternal morbidity and mortality that may ensue.
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Affiliation(s)
- Vicky Kapesi
- Department of Obstetrics and Gynaecology, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania,Corresponding author.
| | - Brenda Moshi
- Department of Obstetrics and Gynaecology, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania
| | - Willbroad Kyejo
- Department of Family Medicine, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania
| | - Ahmed Jusabani
- Department of Radiology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Miriam Mgonja
- Department of Obstetrics and Gynaecology, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania
| | - Munawar Kaguta
- Department of Obstetrics and Gynaecology, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania
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Kyejo W, Ismail A, Moshi B, Ntiyakunze G, Matillya N, Kaguta M. Pregnancy following robot-assisted laparoscopic bilateral endometriotic cystectomy rare case report of endometriosis stage IV. Int J Surg Case Rep 2022; 98:107508. [PMID: 35985118 PMCID: PMC9418437 DOI: 10.1016/j.ijscr.2022.107508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 10/31/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion Successful pregnancy after laparoscopic endometriotic cystectomy Lady with infertility and chronic lower abdomen pain Multidisciplinary approach
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Kyejo W, Moshi B, Kapesi V, Ntiyakunze G, Gidion D, Kaguta M. Cervical vasovagal shock: A rare complication of incomplete abortion case report. Int J Surg Case Rep 2022; 97:107455. [PMID: 35907297 PMCID: PMC9403285 DOI: 10.1016/j.ijscr.2022.107455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/21/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Cervical vasovagal shock is termed as stimulation either by instruments or products of conception at cervical os results into bradycardia and hypotension. In primary care settings cervical vasovagal shock can occur during insertion of an intrauterine device (IUD) or any cervical stimulation during physical examination. This case we highlight an uncommon complication of incomplete abortion which is the rare cause of cervical vasovagal shock. CASE PRESENTATION A 42-year-old Gravida 3 Para 2 Living 2 with Gestational age of 12 weeks presented with vaginal spotting for 2 days. Initial examination she was conscious with normal vital signs. However, after initiation of medical management of incomplete abortion, she had increased per vaginal bleeding with hypotension and bradycardia. Speculum examination was done; this revealed products of conceptus in cervical os and a diagnosis of cervical vasovagal shock was made. Patient was then counselled for evacuation and informed consent was sought. She was taken for evacuation; suction and gentle curettage was done. Post evacuation patients' vitals returned to normal ranges, and patient taken to the ward to continue with post procedure management. CLINICAL DISCUSSION Bleeding in the first trimester is a common presentation in up to 30 % in early pregnancies and more than 50 % of those will go on to have a normal pregnancy. Most patients with incomplete abortion present at emergence department with shock, this will commonly be due to sepsis, hypovolemia, or haemorrhage. In this case report with discuss a rare cause of shock in women with incomplete abortion. CONCLUSION Cervical vasovagal effect of the products of conception passing through the cervix causes a reflex bradycardia. It is crucial as physician attending women with incomplete abortion to make sure all the product of conception are passed out and in situation if there is remaining products of conception in the cervix should be removed using a sponge-holding forceps to prevent vasovagal stimulation in the cervix.
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Affiliation(s)
- Willbroad Kyejo
- Department of Family Medicine, Aga Khan University, P.O. Box 38129, Dar Es Salaam, Tanzania,Corresponding author.
| | - Brenda Moshi
- Department of Obstetrics and Gynaecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Vicky Kapesi
- Department of Obstetrics and Gynaecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Gregory Ntiyakunze
- Department of Obstetrics and Gynaecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Daud Gidion
- Department of Obstetrics and Gynaecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
| | - Munawar Kaguta
- Department of Obstetrics and Gynaecology, Aga Khan Hospital, P.O. Box 2289, Dar Es Salaam, Tanzania
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