Team of doctors
- Prof Shashi Bala Arya
Department of Obst & Gynaecology
- Dr Geeta Karki
Associate Professor, Department of Anaesthesia
Date of Operation: 17 April 2019
Patient Sunita, 30 years old, an unmarried female was presented to OPD with a complaint of a large lump in abdomen with large breast swelling. Her menstrual cycle was irregular with metromenorrhagia.
On examination, she was pale, PR -100/ minutes, BP – 98/60 mmHg, Cardiovascular examination reveals murmur huge abdominal swelling of 36X38 cm arising from pelvis, firm in consistency and non-tender, No c/o ascites, Left breast has 8X6 cm, firm mobile, non-tender mass.
She has underwent investigations, Hb- 4 g%, ECHO – DCMP, EF- 25%, MRI showed 2 huge fibroids. Both ovaries were normal. FNAC of breast mass showed fibroadenoma. Having sought cardiology reference, medical treatment started. To improve her EF apart from medication, 3 units of PRBC were transfused. To stop her menses, progesterone was also started.
She was optimized for 3 weeks taking her up for surgery. Meanwhile, she kept on bleeding P/V so her Hb could only be built up to 10 g% As she was bleeding continuously P/V so the decision to do definitive treatment was taken.
Consent for hysterectomy was obtained as she was not fit for prolonged anesthesia but keeping in view her nulliparous state, anesthesia team could manage high risk while obstetrician performed surgery. Two large myomas of 6 Kg were removed and uterine contour was maintained simultaneously, surgeon did the excision of fibroadenoma.