Unsuspected uterine choriocarcinoma in a case of uterine perforation

INTRODUCTION . CHORIOCARCINOMA IS A HIGHLY MALIGNANT INSTITUTE OF OBSTETRICS AND GYNECOLOGY TUMOR OF TROPHOBLASTIC ORIGIN. GESTATIONAL CHORIOCARCINOMA USUALLY OCCURS WITHIN ONE YEAR OF ANTECEDENT PREGNANCY , USUALLY MOLAR ,MISCARRIAGE PREGNANCIES.NON GESTATIONAL CHORIOCARCINOMAS ARE RARE AND ARISE FROM GERM CELL RESTS. RARE CASES OF UTERINE PERFORATION ARE REPORTED IN LITERATURE. MATERIALS AND METHODS- WE REPORT A CASE OF UTERINE CHORICARCINOMA IN A WOMAN WHO PRESENTED WITH ACUTE CATASTROPHE AT THE CASUALTY IN IOG IN MAY 2013.CASE REPORT- 26 YRS NULLIPARA, PREVIOUS HO MISCARIAGES PRESENTED WITH ACUTE ABDOMINAL PAIN , VAGINAL BLEEDING . BULKY UTERUS,URINE GRAVINDEX POSITIVE, USG HEMOPERITONEUM, PREPARED FOR LAPAROTOMY WITH PRVISIONAL DIAGNOSIS OF RUPTURE ECTOPIC. INTRAOPERATIVELY ADNEXA FOUND NORMAL, UTERINE RENT IN FUNDUS , ITH ABNORMAL VASCULAR PROJECTIONS, EVACUATION WITH RENT REPAIR DONE . POST OPERATIVE b HCG- 5,00,000C XR-MULTIPLE LUNG METASTSIS. PATIENT RESPONDED WWELL TO EMA-CO REGIMEN.CURRENTLY UNDER FOLLWUP WITH ONCOLOGY.COCLUSIONS-THIS CASE IS PRESENTED FOR ITS RARE OCCURRENCE AND EMPHASISES HIGH INDEX OF SUSPICION IN ALL CASES OF ABNORMAL VAGINAL BLEEDING IRRESPECTIVE OF THE OUTCOME AND DURATION OF ANTECEDENT PREGNANCY .FEASIBILITY OF DIAGNOSTIC MODALITIES AND AVAILABILITY OF HIGLY EFFICACIOUS CHEMOTHERAPY CALLS THE IMPORTANCE OF PROMPT DIAGNOSIS.