Uterine fibroid or leiomyoma is the most common benign uterine tumor which affects mostly women in reproductive age. However, its occurrence after menopause is very rare as the growth of a fibroid depends on the hormone of estrogen. There are several risk factors including nulliparity, obesity, black race, family history, and hypertension. Therefore, fibroid degeneration is rare after menopause. We are reporting a case of a post-menopausal woman of 60-year-old, menopaused for 10 years, with a history of bleeding for 2 years for whom the gynecological exam revealed a cervical budding lesion hypervascularized for which a previous cervicovaginal smear revealed no suspicious cells .Then a biopsy was performed and also devoid of malignancy signs .The ultrasound has identified two fibroids classified 2-5 for the first corporeal-fundal myoma about 50/55 mm ( myoma or sarcoma ?) and a corporeal posterior myoma type 2 about 40/30 mm repressing the endometrium (8,5mm).The eventual diagnosis of sarcoma was not excluded till then .The RMI has not been realized. A total hysterectomy with bilateral adnexectomy was performed focusing on the two fibroids, and the histopathological, report confirmed the leiomyoma tumor diagnosis. Even if the fibroid degeneration is rare after the menopause, the association in this case with the cervical lesion and bleeding especially at the age of 60 had not absolved the malignancy till the last histopathological confirmation.
Nowadays, the uterine rupture is a situation world widely encountered especially in low-income countries. Postpartum hemorrhage that the uterine rupture leads to is frequently severe and life threatening. The aim of medical and surgical conservative methods is to preserve the uterus and the fertility. However, sometimes, the surgeon has to perform a hysterectomy and even completing with the unilateral or bilateral internal iliac artery ligation to manage the blood loss which may last in some cases after hysterectomy. Here we present a 34 years old pregnant woman with previous cesarean delivery scar for a twin pregnancy, admitted in advanced labor for term pregnancy with a posterior uterine rupture of 12 cm and abdominal expulsion of a dead male fetus with a lesion fusing to the right vaginal angle, with intact lower segment scar. The hemostatic subtotal hysterectomy was performed with the failure of handling the vaginal bleeding. At last, a bilateral internal iliac artery ligation was performed to ensure successful hemostasis and maternal lifesaving.
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