Giant penoscrotal filariasis.

A 42 year old male individual having a hugely distended scrotum and barely perceptible penis, unable to maintain his livelihood on account of his handicap and socially withdrawn for the fear of humiliation, got admitted into the Surgery department of Mymensingh Medical College Hospital in August 5, 2007. The person had been carrying the so called curse for the last four years. On the basis of clinical, serological and haematological examinations, diagnosis was established as lymphatic filariasis causing elephantiasis of the scrotum. After assessment for operative feasibility, the patient underwent an operation in August 20, 2007 during which, ligation of both the spermatic cords, excision of the scrotum along with the testicles and reposition of the penile shaft into the anterior pelvic wall in the subcutaneous plane (Fleying procedure) was performed. The scrotum measured about 36 inches in diameter and weighed 40 kgs after excision. Histopathological examination of the scrotal skin confirmed the diagnosis. The patient was released without any complication, on the 11th post operative day after removal of stitches, with indwelling urethral catheter. He was prescribed Doxicycline for the next 8 weeks, a drug which has been found to be effective in treating filariasis in a number of studies, and acts by killing a symbiotic bacteria necessary for the survival of the worm. Follow up after 3 months was uneventful.

Choledochal cyst.

Choledochal cyst, a congenital anomaly, is a premalignant condition. Progressive damage to the bile ducts and to the liver parenchyma may also have association with the condition. Subsequent risk of developing cholangiocarcinoma may be lessen by early diagnosis and prompt definitive surgical treatment, that may even permanently correct the condition. A young lady was admitted into Mymensingh Medical College Hospital and was presented with pain in the upper abdomen associated with intermittent vomiting for several months. Her per abdominal examination revealed an ill defined mass in the epigastrium and right hypogastrium with diffuse tenderness. Patients may also present with attacks of jaundice of obstructive type, but this was absent in this particular case. Diagnosis of choledochal cyst was confirmed by the ultrasound. On exploration, the cyst was excised and Hepatico-jejunostomy and jejuno-jejunostomy was done by Roux-en-Y method. Her post operative period was uneventful and followed up till to date. Purpose of this presentation is to emphasize early diagnosis and definitive treatment of this developmental anomaly that may predispose to malignancy.

Urinary incontinence due to duplication of ureter--a case report.

A seventeen years old female student from Nakla, Sherpur was admitted in the surgical unit I of Mymensingh Medical College Hospital (MMCH) on 28th October 2000 with the one and only complain of continuous dribbling of urine since her birth. Besides her urinary incontinence she used to have urge for micturition and normal voiding pattern as well. She has a good physique but a very depressed mental state. IVU suggested about the duplication of the right ureter but not clearly. Voiding cystourethrogram excluded any degree of vesicoureteral reflux. During examination under anesthesia (EUA) a tiny orifice was noted in the urethro-vaginal septum just below the external urethral orifice through the orifice delineated whole of the ecotopic ureter. Right heminephrectomy was done including excision of the pelvis and proximal part of the upper ureter that was draining directly to the exterior. Postoperative recovery was uneventful and the patient got rid of the ever-disgusting problem.

Tuberculous prostatitis--a case report.

Tuberculous prostatitis is a rare condition. A 55 years-old man admitted into a surgery unit of Mymensingh Medical College Hospital with features of prostatism. After clinical examination and investigations, it was diagnosed as a case of benign enlargement of prostate (BEP) and surgery was decided to do. During exploration a large cystic cavitation found in prostate and the intact median lobe taken out for histopathological examination, which revealed tuberculous granuloma. The patient had no evidence of past or present pulmonary tuberculosis. He was treated with anti-tubercular chemotherapy and responded well. No such case is found reported in Bangladesh yet in through medline search database. So, the case is reported here.