It seems like none of my gyn cases here in Tenwek are as they seem.
What I expect, is rarely what I find. This is likely because I am still getting accustomed to the new pathology that I am finding common to East Africa.
For example, my case on Thursday: I saw a 39 yo old multiparous patient in our gyn clinic who presented complaining of abdominal and pelvis mass since March 2010. Her menses were regular. She had an ultrasound from another facility showing bilateral ovarian masses measuring both roughly 8x5cm. The masses were septated and appeared to be within the ovaries. The uterus appeared normal.
When I saw the patient, just two weeks ago, I was able to palpate bilateral adnexal masses. There was no ascites; uterus felt normal. A repeat ultrasound revealed again bilateral ovarian masses; the right larger than the left, measuring about 10x6cm. Again the mass was septated. So, on Thursday, OtherDoc and I took the pt for a TAH/BSO. I didn’t really expect to find cancer; maybe some type of benign process. But I did not expect this:
The entire uterus/bilateral adnexal complex was encased in an what appeared to be a filmy inflammatory tissue. Forgive my lack of a better description. It took a few minutes to dissect and find the plan between the uterus and the right adnexal mass to even decipher what was what. The right adnexa had been replaced by this ugly loculated mass which was adherent to both the sidewall and posterior bowel. Ditto for the left adnexa. Once we dissected away the encapsulating adhesions, we were able to lift the right adnex out of the pelvis and amputate it.
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| Here you can also witness some of our varying OR- head gear! |
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| The Right Adnexa |
Then we were able to proceed with a fairly routine TAH/RSO.
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| Uterus and Left Adnexa |
Afterwards, we examined the specimens. The adexal masses were filled with a straw colored fluid and appeared to be separate from the ovaries.
Final postoperative diagnosis? Bilateral Hydrosalpinx.
Pathology pending.
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