#Wonders #hysteroscopy #Shawki #Asherman #hero
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29 years old infertility patient.
She had history of hysteroscopy for submucous myoma resection.
unfortunately myoma was not removed completely and even more complicated by adhesion and cavity occlusion.
later on, suffered very scanty menses and infertility.
She came for consultation and scheduled for Re do Hysteroscopy.
She was hesitant for surgery and disappeared for a while.
Surprisingly, she got pregnant but was missed abortion at 8 weeks.
Trial for surgical evacuation was unsuccessful and surgeon faced great challenge as pregnancy sac was somewhere above adhesion and remaining myoma.
Two months later she came back for consultation, extremely desperate with tears in eyes.
I reassured her for another trial Hysteroscopy , but deep in myself i was so skeptical that I can find a way or provide any help .
Yesterday, I did the Hysteroscopy fro her and a wonderful surprise scenario occurred;
1) Adhesion at lateral side of internal os making internal OS very stenotic and narrow. Scissors cut and release of adhesion to allow insertion under vision.
2) Access to a deformed cavity, irregular and no obvious anatomy.
3) Apparently , still remaining pat of myoma was there and occlude the central part of cavity.
4) Scissors cut and release of adhesion and also going into myoma substance. Avoiding electro surgery for fear of further damage of poor endometrium
5) Reaching what I thought fundus by extreme difficulty, but while cut more, i realized that there is another healthy compartment above what i thought a fundus. Rt. Osteum was reached and seen nicely.
The left cornue was full of remnants of products of conception that was cut and cleaned out.
Also, scissors cut and remove remaining aprts of myoma.
At end , there was a beautiful cavity with exposure of both cornue and some nice endometrium.
Fooly balloon catheter left inside for keep cavity expansion.
I left the OT full of happiness and content.
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