CASE PRESENTATION

• Name – Mrs X
• Husband’s name – Mr Y
• Aged – 60 years
• Residing at jaraganahalli , bangalore
• Occupation - housewife
• DOE – 25/5/20
CHIEF COMPLAINTS – mass per vagina since 1
year
c/o back pain since 2 months
• Attained menopause 8 years back
• History of presenting complaint –
Complaints of mass per vagina since 1 year , gradual
in onset initially size of lemon progressed to
present size , reduces on lying down , protrudes on
standing
c/o backpain since 2 months , dull aching type of pain
radiating to both lower limbs till knee, relieved on
rest aggravates on doing household work
• No c/o white discharge per vagina
• No c/o burning micturition , difficulty in
passing urine
• No c/o pain abdomen, mass per abdomen
• No c/o cough, difficulty in passing stools
• Menstrual history
Age of menarche 15 years
Attained menopause 8 years back
Previous cycle – regular
3-4 days /27 – 28 days
No c/o post menopausal bleeding
• Obstetric history
• P4L4
1st pregnancy – female 40 yrs old FTVD at home BW -?, A & H
2nd pregnancy – female 38 yrs , FTVD at home BW-? A & H
3rd pregnancy – male 35 yrs , FTVD at GOVT hospital BW –
3kg A and H
4th pregnancy – male 34 yrs , FTVD at Govt hosp
BW – 3 kg A & H
Tubectomised – 32 yrs back
• Medical history – no h/o HTN, DM
• Past history – no h/o tuberculosis, asthma,
thyroid disorders, blood transfusion
• Family history – no h/o HTN, DM, cancers ,
prolapse
• Personal history
Diet – mixed
Appetite - good
Sleep – sound
Bowel and bladder - normal
 On examination –
• Moderately built and nourished
• Height – 158cm weight – 58kg
• BMI – 23.2
• no pallor, icterus , clubbing , cyanosis and
lymphadenopathy
• Thyroid , breast and spine – normal
• Temp – afebrile , PR - 84 bpm regular , normal volume
• BP- 150 /90mmhg
• Cardiovasular system – normal , no murmurs
• Respiratory system – normal vesicular breath
sounds , no added sounds
• Per abdomen
• Inspection – all quadrants move equally with
respiration
umbilicus central, inverted
hernial orifice intact
tubectomy scar +
no engorged veins / sinuses
Palpation – soft nontender
No organomegaly

Auscultation – bowel sounds +

• L/E – vulva – normal
• labia – atrophic
• Gaping introitus
• Cervix seen protuding through the introitus,
hypertrophied. No growth or ulcer or discharge
• Cystocele +
• No urinary incontinence
• Prolapse is reducible
• Bimanual examination – uterus retroverted , atophic
bilateral fornices shallow non tender
• Summary
• 60 year old, Mrs X, with mass per vagina
since 1 year and low backpain since 2 months,
P4L4 tubectomised , attained menopause 8
years back, o/e 3 degree UV prolapse with
cystocele for further management
• Diagnosis
P4L4 with 3 degree UV prolapse with cystocele