JULY CASE

This 37 year old lady with 3 children was diagnosed with a missed abortion. She was planned for Dilatation and Curettage (D&C) but also expressed the desire for tubal ligation (TL) as permanent contraception. Over the years she had developed mild period pain but was otherwise well. Under general anaesthesia, D&C was carried out followed by laparoscopy for the TL. Incidental endometriosis was then discovered on inspection of the pelvis. This picture shows some classical lesions. Firstly, the uterus was mildly enlarged but this could have been due to the pregnancy. There was a left ovarian cyst and the enlarged ovary was stuck to the back of the uterus. At the point of adhesion, a flame shaped endometriotic lesion was observed. This case demonstrates again the discrepancy between symptoms and the extent of the disease in endometriosise, as despite having severe endometriosis, she was relatively well apart from mild dysmenorrhoea.

Wanita berumur 37 tahun dan beranak 3 mengalami keguguran dan bersedia melalui prosedur cuci (D&C). Sambil itu, memandangkan usia meningkat serta ketidakrelaan mengandung lagi, dia juga ingin melalui prosedur ikat tiub (TL) sekali harung. Selain dari mengalami perasaan sakit senggugut sedikit, beliau sihat walafiat. Selepas dibius penuh, kandungan yang gugur telah dicuci dan laparoskop di masukkan melalui pusatnya untuk prosedur TL. Selepas diteliti, pesakit ini didapati mengalami penyakit endometriosis yang agak teruk dengan serba jenis lesi. Rahimnya bengkak sedikit tetapi ini mungkin disebabkan mengandung. Ovari kiri bengkak juga kerana kehadiran sista, dan ovari ini terlekat pula ke bahagian belakang rahim. Ditempat lekatan ini berlaku, terdapat satu lesi "flame". Kes ini memberi pengajaran lagi yang simptom atau tanda penyakit endometriosis tidak semestinya secocok dengan keterukan penyakit itu.