Vaginal reconstruction for vaginal obliteration secondary to Stevens Johnson syndrome: a case report and review of literature

Stevens-Johnson syndrome [SJS] is a rare and acute life-threatening condition which is almost always precipitated by drugs. Genital mucositis in female patients may also be an important cause of long-term morbidity secondary to mucosal scarring. We present the case of a 33-year-old nulligravid woman with distal vaginal synechiae necessitating a surgical approach, which occurred after an episode of SJS. Also, we aimed to review the literature to reveal cases which required surgical management for long-term genital sequelae as well as discuss preventive measures

Repair of diaphragmatic injury and placement of tube thoracostomy during right upper quadrant peritonectomy / 부인종양

OBJECTIVE: Patients with advanced or recurrent ovarian cancer often have metastatic disease in the upper abdominal region, especially to the right hemidiaphragm, which requires diaphragmatic resection in order to achieve optimal cytoreduction. The aim of this surgical video is to demonstrate repair of a diaphragmatic injury and placement of tube thoracostomy during right upper quadrant peritonectomy in a patient with recurrent ovarian cancer. METHODS: This is the case of a 45-year-old woman presented with platinum sensitive recurrent ovarian cancer. Abdomen computed tomography also confirmed peritoneal carcinomatosis and pelvic recurrent mass. HIPEC was administered after complete cytoreduction including bilateral upper quadrant peritonectomy, during which diaphragmatic injury occurred near the central tendon and pleural cavity was entered. We inserted a chest tube through the 6th intercostal space in the anterior axillary line in order to prevent postoperative massive pleural effusion. Diaphragmatic defect was closed primarily after the tube placement. The chest tube was withdrawn on the third postoperative day and the patient was discharged on postoperative day 25 without any complications. RESULTS: The central tendon of diaphragm is the most vulnerable part for lacerations. Diaphragmatic repairs could be performed by various techniques; interrupted or continuous, locking or non-locking sutures, with either permanent or absorbable materials. In our view, all of the techniques provide similar results and surgeons can choose any of them as long as they are comfortable with the procedure. CONCLUSION: In most cases, these lacerations can be repaired primarily without necessitating tube thoracostomy. However, performance of HIPEC can cause massive pleural effusions which can lead to significant pulmonary morbidity. Therefore, retrograde placement of the chest tube under direct vision is quite straightforward when the diaphragm is opened.

unusual complication of uterine prolapse. Bilateral severe hydronephrosis

Obstructive uropathy with bilateral hydronephrosis may be seen in uterine procidentia cases. Early recognition and treatment can prevent irreversible renal damage. Although this association has been known for a long time, it is clinically under evaluated most of the time. Here, we present a neglected case of total uterine procidentia in a 64-year-old woman who was detected also to have renal dysfunction. After surgical correction of procidentia, renal function tests returned to normal