Vagino-cutaneous fistula: unreported, under-reported or unheralded?

Fistulas are communicating tracts between two surfaces, linking structures and planes that should, under normal circumstances, not be in dialogue. They may be congenital or acquired and are most commonly associated with the gastrointestinal and ano-rectal territories, where they link two different organ systems internally, or track outwards, creating a communicating channel between the internal viscera and the skin surface. Vaginal fistulas on occasion result from perineal tears due to traumatic delivery, or less commonly, infection or non-healing of the episiotomy wound, and are of the rectovaginal or vesicovaginal variety. Very rarely, the channel from the vagina tracks to an opening in the skin. This is the report of a patient who developed the rare vagino-cutaneous fistula following a normal vaginal delivery with episiotomy, and review of the limited literature available about the peculiar entity, so rare that no previous reports of vagino-cutaneous fistulas developing after vaginal delivery with episiotomy could be found.

Irritable bowel syndrome, endometriosis and polycystic ovary syndrome: is there a link?

Chronic pelvic pain is a common yet difficult problem to manage, plaguing the gynecologist as well as the gastroenterologist and general surgeon. Highlighted by increased visceral hypersensitivity, endometriosis and irritable bowel syndrome (IBS) are the most common causes or chronic unrelenting pelvic pain. Recently, the similarities between the two conditions has begged the question as to whether there is any common denominator between the two conditions and their likely co-existence and mismanagement. Further, the association of polycystic ovary syndrome (PCOS) in this cohort remains definitively uncharacterized. This report details a young female patient with the triad of POCS, IBS and endometriosis presenting with chronic pelvic pain.

Anthropology of Inguinal Hernia

Introduction: Inguinal hernias are among the most commonsurgical problems worldwide. Hernias, defined as theprotrusion of a whole or part of an organ through the containingwall, along with difficult childbirth and problematic bowelevacuation are thought to be the price we pay for adopting thebipedal gait from previously crawling on all fours. The aim ofthis study was to analyse the anthropological characteristics ofpatients with inguinal hernias, so as to determine the influenceof behavior, evolutionary development and flawed physiologyof their pathogenesis, and thereby identify potential domainsfor risk reduction.Material and Methods: This was a non-interventional,retrospective study. 100 consecutive patients electivelyoperated for inguinal hernias were included and theirclinical profiles studied. The details of their demography andpresentation were tabulated and analyzed.Results: Inguinal hernia had an overwhelmingly malepreponderance, with 99% of patients being male. The meanage of patients at presentation was 56.5±13.27 years. In 93% ofpatients the condition was unilateral, where as it was bilateralin 7%. Right sided hernia was more common with 49% ofcases, left side was involved in 44%. 49% were found to bedirect hernias, 36% were indirect and 8% were pantaloonshernias, with the remainder being bilateral hernias. Rightsided direct hernias were the most commonly encountered,accounting for 28% of the cases, followed by left indirecthernias which were seen in 24%.Conclusions: The epidemiological profile of inguinal herniasin the study population translate to statistically significantfindings with respect to demographic features and risk factorsfor inguinal hernias, well elucidating the anthropology ofthe condition. This study showed statistically significantassociation between inguinal hernia and high BMI, olderage and positive family history, rather than the conventionalsuggestion that increased intra-abdominal pressure is the majorrisk factor. Thus, the role of anthropology and physiographyin the development of inguinal hernias cannot be overlooked.

Unusual Presentation Of Mesenteric Cyst In A 3-Year-Old Child - A Case Report

Mesenteric lymphatic cysts are rare congenital benign malformations of the lymphatic system. Rarely, the wall of the lymphatic cyst can undergo calcification mimicking other conditions. In the literature, about six cases of calcified lymphatic cyst have been reported. Here, we present the case of a 3-year-old child who presented with vague abdominal pain and diagnosed to have an intra-abdominal calcified cyst. On exploration, the cyst was arising from the mesentery and the child required excision of the cyst with the involved intestine. The biopsy was suggestive of a mesenteric lymphatic cyst.