Case Conference August 3rd 2011

03-Aug-2011, Divisi ginekologi onkologi RSCM

Mrs. Y/40 yo/P2/JAMKESMAS

 

History

Patient first came to RSCM in March 1, 2011 with complaint of bleeding.

Patient was referred by St.Elizabeth Hospital Bekasi with cervical cancer

History of massive bleeding(+), postcoital bleeding (+)

Contraceptive with depo injection.

 

EXAMINATION

USG : malignancy of cerviks

Thorax X-Ray : within normal limit

BNO-IVP :

Ectopic uretero vesical junction kanan. Fungsi sekresi dan eksresi kedua ginjal baik.

Cystoscopy : Normal

Rectoscopy : Normal

 

Staging by consultant (dr. Laila Nuranna,SpOG (K)

Tumor sized was 4 x 5 x 2 cm (LLxAPxCC)

VT,RT : CUT was normal, right fornice was stiff, Right and left parametrium was loose

Assessed as Cervical Cancer stage II A2

Suggested to perform chemotherapy first (Neoadjuvant) by PVB

 

Chemotherapy :

I.                   March 15, 2011.

II.                April 5, 2011.

III.             April 26, 2011.

 

June 24, 2011

Post NAC, With Cervical cancer stage II A2 with partial respon.

Plan to perform radical hysterectomy (acc by dr Haryono SpOG (K)

 

June 30, 2011

patient underwent radical hysterectomy

Operation Report :

During operation, The bladder was checked and two point of leaking were noted, then, it was repaired by safil 2.0 continue and overlapping simple interrupted.

Bladder filled by 200 cc of aqua mixed with methylene blue. No leaking noted.

 

After being in-ward for 5 days, bladder training was performed. Then at day 8, post operation, patient was discharge from hospital

 

July 12, 2011

Patient was controlled at oncology clinic

Wound dehiscense (+) minimal, performed NaCl compress

Residual urin at bladder training 500 cc

 

July 18, 2011

Patient came again with wound dehisense decrease, the dehisense now only 0,5 cm in diameter.

Residual urin at bladder training 300 cc

 

July 26, 2011

Patient came again with wound dehisense already healed.

Residual urin at bladder training was 100 cc. Cystofix was released.

 

July 28, 2011

Came again to Ciptomangunkusumo Hospital because micturition problem

Inspeculo examination : leakage can be seen at at vaginal stump

 

July 29, 2011

Dr. Sigit Purbadi, SpOG (K) round, suggested to perform methylene blue examination

 

Examine by methilen blue : leakage (+) at vagina à suspected vesicovaginal fistulas.

 

August 01, 2011

Prof Dr.dr. Andrijono SpOG (K) round suggested to perform repair of the fistula immediately

Histopathology result revealed with :

• Squamous cell carcinoma, keratinized, good differentiation
• Lymphatic emboli was found. Lymphocyte reaction was found
• Vaginal border was free of tumour
• One of metastases was found on one lymph node of the right pelvic lymph node

 

August 02,2011.

Consult to Urology Department :

Plan to evaluate by cystoscopy first.

Medical record round by dr Laila Nurranna SpOG (K)

Suggested to perform conservative treatment by folley catheter for quite sometime.

Bring this case to CC

 

ANALYSIS :

Cervical cancer stage II A 2  post radical hysterectomy

Vesicovaginal fistulas

 

MANAGEMENT PLAN :

Conservative treatment

Repair fistula by first perform cystoscopy