A clinical case of giant serous cystadenoma is presented in the context of a twin pregnancy complicated by severe preeclampsia. The patient was admitted to the high-risk obstetric hospitalization area and underwent surgery by emergency cesarean section. During the procedure, a large tubo-ovarian tumor was evidenced, which was removed with fertility preservation. Histopathological examination confirmed the diagnosis of ovarian serous cystadenoma. It should be noted that in none of the prenatal ultrasound controls was the presence of an adnexal tumor reported, which underscores the diagnostic difficulty in this type of scenario. Ovarian tumors are pathological structures that can be benign or malignant depending on their histological characteristics. In women of reproductive age, timely diagnosis is essential to preserve fertility and reduce complications. Ultrasound is the initial tool of choice, while magnetic resonance imaging is reserved for more complex cases. The detection of adnexal tumors during a twin pregnancy represents an additional challenge in gynecology, since the potential complications of twisting, rupture or hypovolemic shock can seriously compromise maternal and fetal health. In the present case, giant tubo-ovarian tumor was not diagnosed during prenatal care and was identified as a transsurgical finding. The removal confirmed the diagnosis of serous cystadenoma, with a favorable evolution and a good prognosis for both the mother and the newborns. This case highlights the importance of thorough ultrasound surveillance and appropriate surgical preparation in patients with high-risk pregnancies.
Malformations of the uterus are due to defective fusion of the Müller's ducts. These include the unicornuate uterus, with or without a rudimentary horn. Emergency cesarean section was performed due to alteration of the fetal heart rate diagnosed by fetal monitoring, obtaining a male newborn with a cephalic presentation of flexion with the presence of caput weighing 3360 g, height 51 cm, APGAR 7-8-9, CAPURRO 41 weeks of gestation, posterior fundic placenta, extraction was performed. Due to the percentage of infertility presented by patients with unicornuate uterus with the possibility of the use of assisted reproductive technology, women with congenital uterine anomalies should be informed about the impact on the probabilities of success, as well as on pregnancy-related complications. Women with a unicornuate uterus should undergo a prenatal checkup that includes monitoring of cervical length, growth and fetal presentation. If present, the rudimentary non-communicating horn should be removed to avoid ectopic pregnancy. Despite the pregnancy complications associated with a unicornuate uterus, there is the possibility of a successful pregnancy, as referred to in the present clinical case, however, it is important to recognize that patients who present with Mullerian malformation of the unicornuate uterus tend to infertility and to be habitual abortionists with difficulty in reaching a term and successful pregnancy. Here lies the importance and attention of the present case, the patient despite presenting the condition of unicornuate uterus reaches 41 weeks of gestation and has a successful cesarean delivery.
Determining the current advances in post-mastectomy breast reconstruction is a topic of great interest due to the connotations it carries with it. A structured review was carried out for the research; Two research questions were generated focused on the topic: What are the current advances in post-mastectomy breast reconstruction? What are the surgical techniques used for post-mastectomy breast reconstruction? Search terms consisted of mammoplasty, plastic surgery procedures, breast implants, breast neoplasms, breast diseases. The search in databases such as Pubmed, Mendeley, Wiley, Web of Science, Cochrane, Latindex and Google Scholar, with articles published in the last 5 years, and others of more than 5 years that provided relevant data. We chose observational, randomised studies, systematic reviews, case presentations related to the research topic to assess the number of available studies. The current management of breast cancer includes immediate breast reconstruction, which is performed after the initial mastectomy treatment, and breast reconstruction, by placing a prepectoral or subpectoral breast implant to the pectoralis major muscle or by using the patient's own tissue with autologous reconstruction, accompanied by immediate radiotherapy, constituting an advance whose results are still under discussion. Regarding post-mastectomy breast reconstruction, it is important to first determine if the patient with breast cancer is willing to undergo breast reconstructive treatment because this can influence the results. According to the data obtained, patients with autologous fat transfer obtained greater satisfaction, greater physical well-being and better results.
Ludwig's angina is a rapidly progressive cervicofacial infection involving the submandibular, sublingual, and submental spaces, with a high risk of acute airway obstruction and extension into the deep cervical spaces and mediastinum. It constitutes a medical and surgical emergency associated with high morbidity and mortality when diagnosis and treatment are delayed. We present the case of a 30-year-old man with no significant past medical history who developed fever, odynophagia, dysphagia, neck pain, mucopurulent sputum, and progressively worsening respiratory distress following the extraction of the right mandibular third molar. Neck computed tomography (CT) demonstrated gas within the cervical soft tissues and edema involving the submandibular and parapharyngeal spaces, while chest CT confirmed extension of the infection into the mediastinum, revealing a mediastinal collection consistent with descending necrotizing mediastinitis. During hospitalization, the patient developed acute respiratory failure requiring orotracheal intubation, invasive mechanical ventilation, and admission to the intensive care unit. He underwent emergency thoracotomy with mediastinal abscess drainage, exploratory cervicectomy, and multiple surgical debridement’s. Cultures obtained from the cervical and mediastinal abscesses yielded Streptococcus anginosus. During his clinical course, he developed ventilator-associated pneumonia caused by multidrugresistant Acinetobacter baumannii, prompting adjustment of antimicrobial therapy. After 25 days of intensive care, the patient showed favorable clinical improvement and was discharged in stable condition. This case highlights the importance of early recognition of Ludwig's angina and the timely use of computed tomography to identify cervicomediastinal spread of the infection. Early airway protection, prompt administration of broad-spectrum antibiotics, timely surgical drainage, and multidisciplinary intensive care management were critical in achieving a favorable outcome despite the severity of the disease.
Heterotopic pregnancy is a rare condition in gynecology and obstetrics, characterized by the simultaneous implantation of at least two gestational sacs in different locations, one intrauterine and one extrauterine. We present the case of a 28 year-old female patient, with a gestation of approximately 5 weeks confirmed by previous ultrasound, who presented to the emergency department for pelvic pain of 24 hours of evolution, irradiated to the lumbosacral region, of moderate intensity (7/10), accompanied by slight transvaginal bleeding initiated two days earlier. Transvaginal ultrasound showed the presence of a gestational sac in the left fallopian tube and another in the uterine cavity, confirming the diagnosis of heterotopic pregnancy. Treatment consisted of exploratory laparotomy with salpinguectomy, allowing the continuation of the intrauterine pregnancy with-out subsequent complications. Associated risk factors include a history of cesarean section, tubal surgeries, pelvic inflammatory disease, adenomyosis, and, more importantly today, in vitro fertilization techniques, which have increased the incidence of this clinical entity. Heterotopic pregnancy represents a diagnostic challenge due to its low frequency and high maternal morbidity and mortality, mainly in cases of rupture and hemorrhage that can trigger hypovolemic shock. Transvaginal ultrasound is the initial diagnostic tool, complemented in complex situations with nuclear magnetic resonance imaging. Early and timely diagnosis, together with continuous monitoring, is essential to define therapeutic strategies that guarantee maternal and fetal wellbeing in high-risk conditions.
