Misdiagnosed Roberts Uterus Leading to Surgical Misadventures.

BACKGROUND: Developmental anomalies of the Müllerian duct system are some of the most intriguing and challenging disorders that gynecologists and surgeons encounter in their practice. CASE: We report on a 16-year-old adolescent girl with regular menstrual cycles, who presented with recurrent cyclical abdominal pain for which she had undergone 2 unsuccessful surgeries. When correctly diagnosed with the rare condition of "Robert's uterus," she underwent successful metroplasty and is completely asymptomatic at 2-year follow-up. SUMMARY AND CONCLUSION: To avoid inappropriate management, gynecologists and surgeons should be aware of this rare entity while evaluating cases of severe dysmenorrhoea in previously normal menstruating young girls.

Neonatal osteomyelitis of the first rib causing lung abscess.

Rib osteomyelitis (OM) is a rare disease that occurs in ∼1% or less of all haematogenous OM. Acute OM of the rib has rarely been reported and its treatment is difficult. Prompt recognition and aggressive treatment will reduce mortality and morbidity in a new born.

Neonatal gastric teratoma: a rare entity.

Gastric Teratoma is an extremely rare neoplasm seen in children. It is mostly benign and predominantly seen in males presenting with an abdominal mass. The lung and stomach are very unusual sites for teratoma. Gastric teratoma accounts for less than 1% of all teratomas, less than 100 cases are reported in literature. We report a case in a 20-day-old infant who presented with large abdominal mass; our case is an addition to the few limited known gastric teratomas reported in the world literature.

Avoiding negative appendectomies in rural surgical practice: is C-reactive protein estimation useful as a diagnostic tool?

BACKGROUND: Appendectomy is one of the most frequently performed abdominal operations in rural surgical practice. In spite of various preoperative investigations to aid in the diagnosis, the rate of negative appendectomies is 15%-30%. Qualitative C-reactive protein (CRP) estimation is an inexpensive diagnostic test which can be done in small laboratories using a simple kit. We studied the value of estimating the CRP level in diagnosing acute appendicitis and reducing negative appendectomies. METHODS: Patients who had been clinically diagnosed with acute appendicitis and planned for appendectomy, were selected by purposive sampling. Leucocyte counts, CRP level estimation and ultrasonography of the abdomen were done preoperatively. The sensitivity, specificity, predictive value, diagnostic accuracy, false-positive and false-negative rates, and likelihood ratios were calculated for various components of the diagnosis. RESULTS: Of the 238 patients, 193 had histological evidence of acute appendicitis. When the diagnosis was based on the consultant's decision, the overall negative appendectomy rate was 18.9%. CRP level estimation yielded a sensitivity of 98% (95% CI 95%-100%) and specificity of 87% (95% CI 73%-94%). A positive CRP value was associated with acute appendicitis (p<0.0001). Adding CRP to the diagnostic work-up increased the sensitivity to 100% (95% CI 98%-100%) and diagnostic accuracy to 92% (95% CI 87%- 95%), and would have reduced negative explorations to 3%. CONCLUSION: CRP estimation complements the clinical diagnosis by a consultant surgeon, and should be included in the diagnostic work-up of appendicitis. CRP estimation is inexpensive and does not add an undue burden to the cost of management.