Case Conference January 2th 2013

02-Jan-2013, Divisi Ginekologi Onkologi RSCM

Mrs. S / 37 yo / P4A1 / 353 69 27 / Jamkesmas

(ER RSCM, 26/12/2012)

•      Chief complain : Vaginal bleeding since 1 hour before admission

History :

          she complain vaginal bleeding since 1 hour, 5-6 pads. Lower abdominal pain +. Already diagnosed with cervical cancer st. IIB. And already did chemotherapy 4x, and radiotherapy 31x. History of blood transfusion (6-7 x).

          Eat and drink was normal, vomit, nause and dispneu was nothing.

•      First she came to RSCM at 25/1/2012, R/ Pasar Rebo hospital à wd/ G5P3A1 15 wga, singleton life, cervical cancer susp. St IIIB. à in RSCM, was given cisplatin 4x when she still pregnant and did the CS after 34 wga à baby boy, 2700 gr, good condition until now. Theres no history of CS before last pregnancy.

•      13/12/2012 àDid emergency embolization for stop the vaginal bleeding. (by Dr. Sahat, SpRad)

•      Menarche in 16 yo, regular cycle, no menstrual pain. She has been married 2 times , when she was 25 YO, and 31 YO. The first husband was divorced since 3 years,  multiple sexual partners -.

Physical examination

General states : BP 120/80 mmHg, HR 105x/min, RR 20x/min

•      Eye : conjugtiva pale +/+, sclera icteric -/-

Gynecological state :

•      Inspeculo : Exophitic mass, fragile and easy to bleed.

•      RVT : Exophitic mass was  palpable with measure 3 x 2 x 3 cm. until one third vaginal wall at distal part. anteflexion uterus, normal in size and shape, Both parametrium are Hard, and rectal mucosa smooth.

Laboratory result (27-12-2012)

•      CBC: 6.7/15.1/14000/196000/87.9/29.6/33.7

•      PT/APTT : 1.05/1.08 x control

•      Ureum/creatinin: 34.3/1.8

•      AST/ALT : 9/8

•      RBG : 150

•      Diagnosis : anemia due to vaginal bleeding due to cervical cancer st. IIB (complete radiation and on chemotherapy)

•      Therapy :

•      Transfusion PRC

•      arteriography

 

27/12/2012

Arteriography result :

•      Theres no sign of bleeding from both hypogastric a. At this time.

•      Non visualized eksternal illiac a.