A rare case of immune-related pseudotumor of ovary mimicking ovarian malignancy

IgG4-related disease (IgG4-RD) is a chronic inflammatory condition affecting various body organs. However, genital tract involvement is rarely reported. A 40 years old reproductive-age woman presented with a solid abdominopelvic mass of 20 weeks size. CECT revealed a large multiloculated solid cystic lesion arising from right adnexa with multiple enlarged lymph nodes and omental thickening with gross right-sided hydroureteronephrosis suggestive of ovarian malignancy stage III. Surprisingly, tumor markers were normal. Intraoperatively, we noticed a 15×15 cm right ovarian mass encasing the right ureter all around and constricting it. The mass was densely adherent to recto-sigmoid and right pelvic wall, which mandated extensive surgery. Histopathological examination with immuno-histo-chemistry (IHC) suggested the diagnosis of IgG4-RD of ovary. Awareness about its occurrence in ovary will help in arriving at the diagnosis which may influence the extent of surgery. Lymphoplasmacytic infiltration with fibrosis in histopathological examination warrants IHC analysis for achieving a diagnosis.

A rare case of immune-related pseudotumor of ovary mimicking ovarian malignancy

IgG4-related disease (IgG4-RD) is a chronic inflammatory condition affecting various body organs. However, genital tract involvement is rarely reported. A 40 years old reproductive-age woman presented with a solid abdominopelvic mass of 20 weeks size. CECT revealed a large multiloculated solid cystic lesion arising from right adnexa with multiple enlarged lymph nodes and omental thickening with gross right-sided hydroureteronephrosis suggestive of ovarian malignancy stage III. Surprisingly, tumor markers were normal. Intraoperatively, we noticed a 15×15 cm right ovarian mass encasing the right ureter all around and constricting it. The mass was densely adherent to recto-sigmoid and right pelvic wall, which mandated extensive surgery. Histopathological examination with immuno-histo-chemistry (IHC) suggested the diagnosis of IgG4-RD of ovary. Awareness about its occurrence in ovary will help in arriving at the diagnosis which may influence the extent of surgery. Lymphoplasmacytic infiltration with fibrosis in histopathological examination warrants IHC analysis for achieving a diagnosis.

Single-incision multi-port appendectomy for a patient with situs inversus totalis: first case report

Situs inversus totalis [SIT] is a rare autosomal recessive condition involving the complete lateral transposition of the organs. When individuals with this condition suffer from appendicitis, associated pain and symptoms are usually present on the left side, resulting in diagnostic difficulties. Moreover, the laparoscopic removal of the left-sided appendix may pose practical problems during surgery. Removal of an inflamed appendix is generally performed using a multiple-port laparoscopy. We report a 22-year-old male who presented to the Lifeline Institute of Minimal Access Surgery in Chennai, India, in April 2015 with pain in the left iliac fossa. Chest X-rays and ultrasonography confirmed SIT with an acutely inflamed appendix on the left side. The patient underwent a single-incision multi-port laparoscopic appendectomy with a successful outcome. To the best of the authors' knowledge, this is the first report in the literature of a single-incision multi-port appendectomy in a patient with SIT

Lower limb weakness and paresthesia after combined spinal epidural anesthesia for abdominal hysterectomy: a report of three cases

Neurological deficits are the rare but unacceptable complications of neuraxial blockade. We report three cases of vaginal hysterectomy performed under combined spinal epidural anesthesia [CSE] using 3 mlof 0.5% hyperbaric bupivacaine [15 mg] in subarachnoid space followed by epidural analgesia top up after wearing off of spinal anesthesia. One patient complained of unilateral paresthesia and numbness on left thigh with no motor involvement in the evening postoperatively, two patients developed bilateral paresthesia and numbness over anterior thigh and knees and motor weakness in both lower limbs on next day morning. Epidural catheter was removed immediately and treated with oral tab prednisolone and tab methylcobalamin. All patients had complete recovery and were discharged after a week. Unrecognised mechanical irritation of the nerve roots by epidural catheter is thought to be the cause. We conclude that patients with epidural catheter should be monitored and on appearance of any neurological symptoms the catheter be removed to prevent permanent neurological sequelae

Prolongation of subarachnoid block for prolapsed intervertebral disc surgery by intra-operative subdural injection under direct vision

A 45 yearsold male, weighing 70 kg suffering from prolapsed intervertebral discs [PIVD] and was scheduled for decompression surgery at L3-L4, L4-L5 spinal levels. Spinal anesthesia was administered at L3-L4 interspace in the sitting position using 25gauge spinal needle and 3 ml of 0.5% hyperbaric bupivacaine was injected. The patient was turned prone after 5 min. After about two hours of surgery the patient complained of pain. A decision to administer spinal anesthesia again was undertaken as the dura mater was already exposed at the surgical site. Hyperbaric bupivacaine 1.5 ml was injected in the subarachnoid space under direct vision using 25G spinal needle. Adequate block was achieved and surgery was completed without

Cardiac arrest after simultaneous release of bilateral tourniquets in lower limb orthopaedic surgery: a case report

Surgical tourniquets are commonly used in orthopaedic and trauma surgery, but these have their complications. Reperfusion injury following simultaneous release of bilateral tourniquets is the most likely explanation of cardiac arrest in this case. We describe an unusual complication experienced by a 40 year old, 65 kg healthy male who underwent surgery for trauma to the lower extremity [bilateral fracture tibia]. Bilateral mid-thigh tourniquets [Esmarch bandage] were applied, which were simultaneously released after 90 min. After 5 min of tourniquet release sudden severe hypotension occurred followed by cardiac arrest. Patient was immediately intubated and cardio pulmonary cerebral resuscitation [CPCR] was started. We conclude that bilateral tourniquet application can be hazardous within the safe limit of tourniquet time [<2 hours] and their simultaneous release should be avoided. Moreover, Esmarch tourniquet may generate very high uncontrolled pressures and should be avoided