Vaginal vault prolapse occurs in 0.2% to 1.0% of menopausal women with prior hysterectomy. Even rarer is the development of concurrent rectal prolapse seen in 0.03% to 0.1% of cases. This paper aimed to 1) present a rare case of concurrent prolapses of the vaginal vault and rectum in an 87-year old grandmultipara, 2) evaluate factors predisposing to vault prolapse and rectal prolapse and their manifestations, 3) introduce the new quantitative staging system of pelvic organ prolapse by the International Continence Society, 4) discuss the options of management, and 5) emphasize the need for multidisciplinary management approach. An 87-year old grandmultipara presented with two distinct prolapsing masses at the introitus and anus. Implicated factors such as prior hysterectomy, advanced age, multiple vaginal deliveries, menopausal state and history of heavy lifting were identified. Diagnosis was made clinically. The vaginal vault prolapse was categorized quantitatively according to the Pelvic Organ Prolapse Quantification System wherein she was diagnosed to be at stage IV C. Based on such stage, treatment options, both conservative and surgical, were discussed. She underwent perineal surgery for both lesions. Effective therapy for concurrent prolapses of vaginal vault and rectum requires in-depth knowledge of pelvic anatomy and physiology, a thorough physical examination, adequate preoperative planning and prudent selection of surgical procedures that will achieve the most anatomically complete repair that will prevent recurrence.

Human ; Female ; Aged 80 And Over ; Rectal Prolapse ; Anal Canal ; Rectum ; Lifting ; Pelvic Organ Prolapse ; Vagina ; Hysterectomy ; Physical Examination

A 44-year old phenotypic female, married with primary amenorrhea presented with recurrent urinary tract infection and an incidental finding of a pelvo-abdomlnal mass.Ultrasonogram with doppler studies showed a huge pelvo-abdominal mass with rich intratumoral and peripheral color flow and low resistance index. No uterus or cervix was demonstrated. Tumor marker, CA-125 level, was elevated. Exploratory laparotomy confirmed the absence of the uterus and fallopian tubes. The left "ovary" was converted to a 16cm x 15cm x 12cm predominantly solid encapsulated mass. The capsule was smooth with a point of rupture measuring approximately 1 cm in diameter, exuding fresh blood. The right "ovary" was grossly normal measuring 3cm x 2cm x 2cm. Bilateral "oophorectomy", peritoneal fluid cytology, infracolic omentectomy with frozen section, were carried out. Histopathology of the left pelvic mass revealed testicular seminoma, while the right mass was consistent with an atrophic testis. Peritoneal fluid was positlve for malignant cells. Referral to a gynecologic oncologist was done for adjuvant radiation therapy. With the late realization of her being genetically male,psychological therapy and genetic counseling were advised.

Human ; Female ; Adult ; Fallopian Tubes ; Ovary ; Frozen Sections ; Seminoma ; Cervix Uteri ; Ascitic Fluid ; Amenorrhea ; Laparotomy ; Uterus ; Ovariectomy ; Urinary Tract Infections

Objective: This study aims to determine the disease-free survival and overall survival outcome of patients with IB to IIA cervical cancer managed with surgery, chemoradiation, or a combination of both in a tertiary government training hospital. Methodology: This is a retrospective study of patients diagnosed with stage IB-IIA2 cervical cancer from January 2013 to June 2017. Data were encoded using Microsoft Excel. Statistical analyses were computed using SPSS. Cox regression and Kaplan Meier analyses were used to predict survival outcomes. Results: Out of 135 patients were included in the study, 111 received treatment. 61 had no evidence of disease. Median age is 46 years with stage IB1 disease. Majority of patients underwent surgery followed by adjuvant therapy. Tumor recurrence was highest in the surgery alone group, with median time to recurrence of 19 months. Median follow-up time was 10 months. Overall 5-year survival is 51.4%; 5-year disease-free survival is 54.8%. Conclusions Age is a statistically significant factor in survival. Surgery with adjuvant chemotherapy + radiation had the most favorable survival outcome. Neoadjuvant treatment gave the least number of recurrences. Despite a small sample size, this study provides baseline data into the survival outcome of patients with locally advanced cervical cancer in our institution given the different treatment recommendations.
Uterine Cervical Neoplasms ; Disease-Free Survival ; Hysterectomy ; Chemotherapy, Adjuvant ; Neoadjuvant Therapy