Gossypiboma: a surgical menace

Gossypiboma is a rare yet devastating complication. It may be a sequela to any kind of surgical procedure, however intra-abdominal surgeries are commonly implicated as the cause for this entity. In chronic cases, it may even lead to severe morbidity. We report a case of gossypiboma post vaginal hysterectomy, diagnosed and treated successfully by laparoscopy.

Autoamputation of the ovary: a rare consequence of torsion in a mature cystic teratoma

Autoamputation of the ovary may be a result of longstanding infarction resulting from torsion of the ovarian pedicle. This entity may be confused with an ectopic or supernumerary ovary.  A proper detailed history taking is important to provide clues for diagnosis. We report a case of a young female patient diagnosed with autoamputation of unilateral ovary on laparoscopy, with histopathology confirmation of ovary with dermoid cyst.

Pelvic tuberculosis: from millets to masses

An adnexal mass is a common entity in the reproductive age group. Ovarian masses form a majority of this condition. Tuberculosis is a disease commonly encountered in the Tropics and is endemic to India. Abdominopelvic affliction of this disease is common in women especially in the reproductive age groups. It may present with variety of non-specific clinical features and often poses an enormous diagnostic dilemma Author report one such case, presenting with a clinical impression of ovarian malignancy, however, was diagnosed to be a case of extensive pelvic tuberculosis on laparoscopy. Tissue biopsy was consistent with the finding of tuberculosis.

Footprint lesion: a mirror image of an endometrial polyp

Endometrial polyps may present with a variety of symptomatology. They are mostly benign and commonly encountered in the reproductive age group. Hysteroscopy is an emerging tool for diagnostic as well as a therapeutic purposes. We report a case of endometrial polyp diagnosed on hysteroscopy, with a “footprint”, that is contact lesion visible. This is a relatively rare phenomenon, and there is sparse information and literature regarding this entity. Hence the true nature of its effects is yet unknown.

Cesarean scar pregnancy: scope for hysteroscopy

Scar ectopic pregnancy also known as cesarean scar pregnancy is a rare form of an extrauterine pregnancy. The blastocyst is implanted at the site of the previous cesarean scar. Most patients remain asymptomatic and are detected on routine ultrasonography imaging. The diagnosis and management of this condition is hence challenging and difficult. A timely ultrasonography in the early weeks of gestation is the key to preventing catastrophic events like uterine perforation and excessive hemorrhage. There is a wide armamentarium of treatment modalities to choose from, however each case must be individualised. Medical management has its own limitations and often patients are required to have a long-term follow-up. We present a case of a cesarean scar pregnancy managed conservatively with systemic methotrexate but subsequently requiring surgical intervention done successfully via hysteroscopy. A repeat ultrasonography done a fortnight later revealed no retained products of conception.

Hotdog in bun: a recent technique for oophoropexy

Ovarian torsion is an acute gynaecological emergency. It may present at any age group, however it is more common in the reproductive years. The patient may present with a myriad of clinical features which are often non-specific posing a diagnostic dilemma. Ultrasonography is the best initial modality of imaging. Once diagnosed a surgical approach is the mainstay of treatment. Preservation of ovaries and preventing recurrence in young patients is crucial. We present a case of a young adolescent girl diagnosed with an ovarian torsion who was managed laparoscopically. Oophoropexy was done to avoid future recurrence by an emerging method called the “Hotdog in bun” technique.

Endoscopy in the management of a rudimentary non-communicating functional horn

Mullerian anomalies are developmental malformations of the female reproductive tract, often diagnosed late. They are classified into numerous types like a septate uterus, bicornuate or unicornuate uterus etc. A rudimentary non-communicating functional horn is a rare variant of a unicornuate uterus. It may present with a wide spectrum of symptoms like severe dysmenorrhea, infertility, lump in abdomen or rarely maybe diagnosed with a ruptured ectopic in the horn. The diagnosis of this entity is a difficult and challenging. Authors present a case of a young adolescent diagnosed with this Mullerian anomaly, the role of hysteroscopy in confirmation of diagnosis and the management of the patient by laparoscopy successfully. The patient was completely relieved of her symptoms post-surgery.

A novel approach for laparoscopic retrieval of dermoid cyst

A dermoid cyst is a germ cell tumour, benign in nature and common in young women under the age of 30. They are usually asymptomatic and often detected incidentally on imaging. Resection of the cyst is important owing to complications like torsion or malignancy. Laparoscopic surgery is the modality of choice in today’s era. However, rupture of the cyst during laparoscopic retrieval is any surgeon’s nightmare. Hence, good surgical skill and a reliable method of retrieval are of prime importance here. Authors present a novel method of dermoid extraction done laparoscopically with a sterile urine collection (urobag) bag. This is an easy and simple method which decreases the rate of spillage owing to the strength of the bag.

Evaluation of Cardiac Iron Load by Cardiac Magnetic Resonance in Thalassemia.

Objective: To quantify myocardial iron stores by Cardiac Magnetic Resonance (CMR) . Design: Prospective cohort study. Setting: Thalassemia center in a teaching hospital. Participants: 60 transfusion dependant thalassemia major patients and 10 controls during 2008-2009. Methods: MRI T2* for cardiac iron load and cardiac functions was performed on a 1.5 Tesla Siemens Sonata machine using the thalassemia tools software. Ejection fraction (EF) was measured using standard CMR sequence and EF <56% considered as cardiac dysfunction. Quantification of iron deposition was categorized as T2* <10 milliseconds (ms) as high risk, 10-20 ms as intermediate risk and >20 ms as low risk. Simultaneous liver iron T2* values were categorized into normal i.e. >6.3 ms, mild iron overload 6.3 - 2.7 ms , moderate iron overload 2.7- 1.4 ms and severe iron overload <1.4 ms. Pretransfusion serum ferritin levels were simultaneously determined. Data was analyzed by paired and unpaired t test of mean. Results: Of 60 patients, 50% had no cardiac siderosis; 33.3% had mild to moderate and while 16.7% had severe cardiac siderosis . In contrast, only 8.3% had normal liver iron values, 55.7% had mild to moderate and 36% had severe iron stores. The mean serum ferritin of all 60 cases was 3528.6 ± 1958.6 ng/mL. There was a statistically significant difference in the mean cardiac T2* of patients (23.45 ± 13.4 ms) as compared to controls (32.67 ± 2.68 ms) (P<0.01). Conclusions: Thalassemia patients had significantly higher cardiac iron stores as compared to controls. Serum ferritin and liver iron values did not correlate with cardiac iron values. Three of 10 patients <10 years showed evidence of myocardial siderosis.