Prolapse

Particulars of the patient

Name:
Age: 60 years old
Sex:
Religion:
Occupation:
Marital status:
Address : Habiganj, Sylhet
Date of admission:
Date of examination:

Chief complaints :
1. Something coming down per vagina for 5 years.
2. Incomplete voiding for 2 years.
3. Difficulty in defaecation for 2 years

H/O present illness :

According to the statement of the patient, she was reasonably well 5
years back, then she noticed something something coming down per
vaginally. At initial days it remained inside but recently it comes outside
the vagina that’s, it is revealed more nowadays. She also complaints of
incomplete voiding and difficulty in defaecation for last 2 years. She
even repositions the anterior and posterior vaginal wall. She is known
to be hypertensive, diabetic and non asthmatic. With these complaints
she got admitted in this hospital for better management.

H/O past illness :

Nothing significant.

Family history :
Nothing significant.

Drug history :
Insulin
Sidopin
Socio-economic history :
Low socio economic

Menstrual history
Post menopausal for last 10 years.

Obstetric history
Married for : 42 years
Para: 6(NVD)-1(NND)-2(ab)
ALC : 28 years
Contraceptive history : nil
General examination
Appearance: ill looking
Body built: average
Co-operation : co-operative
Decubitus : on choice
Anemia : absent
Jaundice : absent
Edema : absent
Cyanosis : absent
Clubbing: absent
Koilonychia : absent
Leukonychia : absent
Pulse: 70bpm
BP: 140/90 mmHg
Temperature : 98 degree F
Respiratory rate : 15 breaths/min
Lymph node: not palpable
Thyroid gland: not enlarged
Breast examination : normal

Systemic examination

Abdominal examination:

Inspection : abdomen is normal in size, shape.

Umbilicus centrally placed and inverted.

No visible veins, peristalsis or scar mark.

Palpation : no organomegaly. At the level of the introitus, cervix is felt between

and posterior wall.

Percussion : tympanic

Auscultation: bowel sound present.

Per vaginal examination: not done.

Other systemic examination : reveals no abnormality.

Salient feature :
Mrs .X , 60 years old, muslim, housewife, hailing from Habiganj, Sylhet was
admitted in this hospital with the complaints ofsomething coming down per
vagina for last 5 years, incomplete sense of voiding for last 2 years and difficulty in
defaecation for last 2 years. She stated that on her initially days it used to remain
inside and need not reposition it but nowadays it comes outside the vagina on
straining or defaecation and has to reposition the anterior and posterior vagianl
wall manually. She had a history of vaginal delivery at home by untrained birth
attendant. She is known to be hypertensive and diabetic on general examination
she is ill looking and all her vitals were normal except BP which was recorded
140/90mmHg. All other systemic examination reveals normal findings.

Provisional diagnosis :
2nd degree uterovaginal prolapse.

Differential diagnosis :
I. Gartner’s cyst
II. Myomatous polyp
III. Chronic inversion of the uterus
Investigations :
1. CBC with ESR
2. Blood grouping and Rh typing.
3. Blood sugar profile : 2HABF, HbA1c
4. Urine RME
5. Serum creatinine
6. SGPT, PT
7. ECG
8. Echocardiography
9. X-ray chest P/A view

Treatment :
Vaginal hysterectomy with anterior colporrhaphy with posterior
colpoperineorraphy.

Follow up :