ABSTRACT
INTRODUCTION: Persistent Mullerian duct syndrome is a rare form of male pseudo-hermaphroditism characterized by the presence of Mullerian duct structures in an otherwise phenotypically, as well as genotypically, normal man; only a few cases have been reported in the worldwide literature. A great variety of organs have been found in indirect inguinal hernial sacs. PRESENTATION OF CASE: We report a case of 70 year old man, father of 4 children with unilateral cryptorchidism on the right side and left-sided obstructed inguinal hernia containing uterus and fallopian tube (that is, hernia uteri inguinalis; type I male form of persistent Mullerian duct syndrome) coincidentally detected during an operation for an obstructed left inguinal hernia. DISCUSSION: PMDS is usually coincidently detected during surgical operation, as was in our case. However pre-operative ultrasonography, computerized tomography and MRI allow possible pre-operative diagnosis.(3) CONCLUSION: In cases of unilateral or bilateral cryptorchidism associated with hernia, as in our patient's case, the possibility of PMDS should be kept in mind.
ABSTRACT
Training in minimal access surgery has always been difficult in developing countries with limited resources, non availability of formal animal labs, inaffordability of conventional endotrainers and lack of trained endosurgeons to help the amateurs. It is always difficult to start a new procedure in such places where not only the patients but the orthodox surgical fraternity are reluctant to accept new ideas and newer trends in surgery. After thorough discussions with senior surgeons, the author (who was the only trained endosurgeon to begin with) developed a training policy to train the surgeons over a period of time through various exercises before allowing them to assist him in the actual surgeries. A homemade, inexpensive endotrainer was designed for these exercises. Audio-visual seminars were held in between the training sessions. This training module can be employed by other rural hospitals to improve the skills of surgeons who are new to the art of endosurgery.
