Vaginal Cuff Dehiscence Following Remote Hysterectomy: An Unusual Case of Bowel Evisceration.

Hysterectomy is one of the most common gynecologic procedures performed worldwide. Vaginal cuff dehiscence with resultant bowel evisceration, while rare, is one of the most serious complications of the procedure. We present the case of a 79-year-old female with vaginal cuff dehiscence several decades after hysterectomy. The patient had no significant antecedent symptoms until she experienced bowel evisceration during Valsalva. She underwent a successful reduction of bowel contents with limited resection and transvaginal cuff repair. This case highlights the risk of vaginal cuff dehiscence even decades following the procedure.

Delayed Diagnosis of Blunt Ureteral Injury following Motor Vehicle Collision.

Background: A 19-year-old male requiring emergency surgery after presenting to the emergency department (ED) as a trauma activation status post-motor vehicle collision. Summary. The patient presented to the ED after a motor vehicle collision. He was taken emergently to the operating room after finding hemoperitoneum on computerized tomography scan without evidence of solid organ injury. Significant small and large bowel injuries were discovered requiring resection and anastomosis. The patient had an uneventful post-operative recovery and was discharged home. He was later re-admitted to the hospital with a large pelvic abscess and a left mid-ureteral stricture causing hydronephrosis. The abscess was treated with antibiotics, and the left ureteral injury was treated with a nephrostomy tube and stent placement. He made a full recovery after hospital re-admission and a delay in diagnosis of blunt ureteral injury. Conclusion: Patients involved in motor vehicle collisions are at risk of multi-system trauma including genito-urinary injuries. A small percentage of these patients may present with blunt ureteral injuries. A high index of suspicion is required to make an early diagnosis. Earlier diagnosis may help to prevent morbidity.

Bladder perforation as a rare complication of urethra sounding with a blunt marking pen.

Urethral sounding is the insertion of an object or liquid into the urethra for sexual gratification. It is associated with a substantial risk of loss of the foreign body in the bladder, urethral strictures or infection. Bladder perforation is a rare complication of urethral sounding which is usually associated with a sharp object. Here, we present the case of a young adult female presenting with abdominal pain after practicing urethral sounding with a blunt marking pen. She was found to have an intraperitoneal bladder perforation, requiring exploratory laparotomy and bladder repair.

Medical and Surgical Management of Postpartum Hemorrhage in a Woman with Factor XIII Deficiency.

Factor XIII deficiency is a rare inherited coagulopathy. Factor XIII is the last clotting factor in the coagulation cascade to insure strength and stability to fibrin clots. Without this enzyme, the fibrous clot is unstable and nonresistant to fibrinolysis. Gravid women with this congenital disease are especially at risk for complications including miscarriages and hemorrhage without appropriate interventions. We present a case of a woman in her 20s with Factor XIII deficiency who was treated with cryoprecipitate and had a successful normal spontaneous vaginal delivery; subsequently, patient suffered from postpartum hemorrhage and consumptive coagulopathy due to consumption of Factor XIII, requiring emergency surgical intervention. Intraoperative management was challenged by an ethical dilemma involving the patient's religious beliefs about not receiving blood. This paper will discuss the mechanism of Factor XIII and the medical and surgical management involved with this patient.