CASE OF THE WEEK – “Fibrous Dysplasia of the Clivus skull bone” by Dr Shekhar Shikare, HOD & Consultant, Nuclear Medicine, NMC Royal Hospital Sharjah

CASE OF THE WEEK – “Fibrous Dysplasia of the Clivus skull bone” by Dr Shekhar Shikare, HOD & Consultant, Nuclear Medicine, NMC Royal Hospital Sharjah

Rare case of removal of 21 intramural fibroids in a 43 year old Emirati woman

An Emirati woman visited for consultation with complaints of severe bleeding with irregular periods and severe pelvic pain for more than a year. Her hemoglobin level was noted at 6.5 g/dl and she was not responding to medications as per her symptoms.

The patient was hypothyroid with TSH recorded at 27. She was advised for Ultrasound followed by MRI of abdomen. The investigations revealed multiple intramural fibroids along with multiple sub-mucosal fibroids.

To prepare the patient for pre-operation, the patient was advised for undergoing transfusion of 3 blood units followed by consultation with an endocrinologist and was given 75 mcg of thyroxin.

Dr. Ayman Hassan, Consultant Anaesthesiology consulted the patient and consented for the surgery. The patient underwent hysteroscopy under general anaesthesia. The procedure revealed 4 big fibroids (each one was about 4-5 cm).

The patient was prepared for Laparotomy and was injected diluted vasopressin in myometrium to reduce bleeding & control blood loss during the operation. The patient underwent Laparotomy and 21 intramural fibroids (largest fibroid measuring 9 cm) & 4 sub-mucosal fibroids from intra-cavity of uterus (largest fibroid measuring 6 cm).

The duration of the operation was recorded at 1 hour & 40 minutes and the patient lost 1000 ml of blood and withstood the operation well. The patient was observed in post-operative care and it was noted that the patient has no bleeding after operation followed which she was shifted to the ward.

The patient was recovering well but the hemoglobin level was 6.7 g/dl and underwent 3 blood unit transfusion. After observing the patient for further 5 days, she was discharged.

Dr. Mohammad Alhasoun, Specialist Obstetrics & Gynaecology is grateful to the team comprising of Dr. Israa Ali, Consultant Obstetrics & Gynaecology, Dr. Ayman Hassan, Consultant Anaesthesiology and nursing team of Mr. Asif, Ms. Jessicca & Mr. Aazabllow.

Fibrous Dysplasia of the Clivus skull bone