Surgical challenges in unusual fibroids - a case series

Uterine leiomyoma are benign monoclonal tumours arising from smooth muscle tissue. There are different types of fibroids depending on the location of fibroid. There are various operative challenges in long standing huge fibroids on abnormal location. Surgical difficulties associated with these cases are due to poor access to the operative field, distorted anatomy, difficulty in suturing the repairs, increased blood loss. It is an art and skill to surgically remove these difficult fibroids and do difficult hysterectomies. Here we present case series of 7 cases, we have described variety of fibroid at different ages, presentations, precautions and also surgical challenges and the steps to overcome them successfully. Case 1- cervical fibroid, case 2- submucosal fibroid polyp, case 3- Bulky uterus with fundal fibroid during vaginal hysterectomy, case 4- broad ligament fibroid, case 5- multiple fibroids, case 6- multiple subserosal fibroids during caesarean section, and case 7- giant fibroid. Different types of fibroids are tackled in different ways. So, fibroid mapping by imaging studies and also ureteric stenting preoperatively whenever needed, helps to prevent untoward injuries. Following principles of surgery in any difficult fibroids leads to successful management and also helps to prevent injuries to the urinary tract and avoiding intra operative blood loss

Incidental adnexal masses during caesarean section: a case series

Adnexal masses originate in the ovaries, fallopian tubes or surrounding tissue. Adnexal masses can be found in women of any age and pregnancy is no exception. Reasons for adnexal masses going undiagnosed in antenatal period are asymptomatic and small (≤5 cm) mass size; the pregnant patients refused a pelvic examination and a transvaginal USG examination for the fear of abortion during early pregnancy. In 3rd trimester ultrasound, a gravid uterus may obscure the correct visualization and detection of an adnexal mass or it is often missed when we keep our focus on the baby and placenta. As there is also increase in caesarean section rate, the incidence has also increased. Here we presented a case series of 4 different cases, we had described variety of adnexal masses which were diagnosed accidentally during caesarean section and also about their management. Case 1-dermoid cyst, case 2-para ovarian cyst, case 3-complex cyst, case 4-includes 3 cases of simple cyst. Adnexal masses arising in pregnancy are functional, asymptomatic and resolve spontaneously. The risk of malignancy in persistent adnexal masses is low and ultrasonography is the preferred method to assess this risk. If the pathology is incidental finding in caesarean section, it is to be removed in the same setting to avoid surgery later