Perforated Uterus and Intestinal Metastasis Resulting from Choriocarcinoma In A 29-Year-Old Nullipara, A Case Report

Abstract

Background: Uterine rupture following choriocarcinoma is rare and this can increase morbidity and mortality in a condition that has over 90% curative rate. This was the first case of uterine rupture and intestinal metastasis resulting from choriocarcinoma that was managed in our facility.  

Case presentation: A 29 year old P^{0 + 1} lady who presented at our facility on 21/3/2019, with abdominal pain, distention and ultrasound report suggestive of molar pregnancy. Her last menstrual period was on 18/2/2019. She had a history of spontaneous miscarriage about four months prior to presentation. Quantitative beta-human chorionic gonadotropin (B-HCG) was 131,106.17miu/ml and chest x-ray revealed multiple intrapulmonary masses most probably metastatic lung disease. She was scheduled for suction evacuation but further evaluation revealed signs of haemoperitonium necessitating exploratory laparotomy with finding of extensive molar uterine invasion, ragged uterine rupture and dilated 180⁰ twisted small intestinal loops containing blood with areas of mesenteric ischaemia. A total abdominal hysterectomy and mesenteric untwisting were done. She received 6 courses of chemotherapy with Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Oncovin (EMACO) regimen due to high risk prognostic score of 8. The qB-hCG normalized after the 3^rd course of chemotherapy. She had been followed up for two years with no recurrence.

Conclusions: This is to emphasize the need for histology of products of conception and appropriate follow up for early detection of choriocarcinoma and its management. It is also pertinent for any woman presenting with bleeding to have at least one B-hCG assay to ensure that metastatic gestational trophoblastic neoplasia is excluded