Ruptured Left Ovarian Teratoma Presenting as an Irreducible Right Inguinal Hernia.

Teratomas of the ovary rarely present as inguinal hernias. Teratomas most commonly occur in the gonads or along with midline structures. Although the majority are asymptomatic, complications such as spontaneous rupture are known to occur. We present a previously unreported case of a ruptured ovarian teratoma presenting as an irreducible inguinal hernia. The patient underwent an open exploratory laparotomy with left oophorectomy, and the right inguinal hernia was repaired in the same setting with a separate inguinal incision.

Bee sting leading to stroke: a case report and review of the literature.

In India, bee stings are very common, seen mainly in farmers and honey collectors. Usually, it presents with local reactions and anaphylaxis. It rarely requires urgent hospitalisation. Other major complications seen are acute renal failure, intravascular coagulation, rhabdomyolysis and acute pulmonary oedema. Stroke as a presentation is uncommon. We report a case of a 45-year-old man presenting with right-sided hemiplegia and aphasia due to multiple bee stings. Diffusion MRI showed left middle cerebral artery territory hyperacute infarct.

Endometriosis in the tract of transvaginal ovum pick up, a rare and late complication of in vitro fertilisation.

Endometriosis is a common and painful condition. We present a case of a 33-year-old woman who had delivered triplets after in vitro fertilisation (IVF) for male factor infertility. She did not have any clinical features suggestive of endometriosis before the IVF treatment. The patient presented 7 years after conception, with premensural and postmenstrual abdominal pain and intense pain on defecation. The patient was diagnosed to have endometriosis in the tract of transvaginal ovum pick up in the right pouch of Douglas and right distal uterosacral ligament. The patient underwent excision of a nodule of endometriosis. The patient is asymptomatic 1 month after surgery. Histopathology analysis revealed features suggestive of endometriosis. The needle ovum pick up tract must have implanted the endometriotic tissue near the pararectal tissue. This is an unreported and late complication of IVF treatment.

Metastatic anorectal malignant melanoma causing ileocaecal junction obstruction due to contiguous spread.

Malignant melanoma of the anal canal is a rare and aggressive tumour associated with significant mortality. Early diagnosis and early curative surgical resection have shown to offer a survival advantage. We present a case of 53-year-old woman, who was accidentally diagnosed to have a localised lesion of malignant melanoma of the anal canal on histopathology report of the specimen of haemorrhoidectomy done for thrombosed external haemorrhoids. She refused any form of treatment and did not return for follow-up. Two years after the initial diagnosis, she presented with intestinal obstruction. The malignant melanoma had become advanced with multiple metastases to the lungs, the liver, the peritoneum and the spine. The patient underwent a diverting loop ileostomy. At the time of surgery, it was found that the primary malignant melanoma of anal canal had contiguously involved the entire large intestine up to the ileocaecal junction and hence transverse colostomy could not be done.

Superior mesenteric artery syndrome in a patient with celiacomesenteric trunk.

Superior mesenteric artery (SMA) syndrome is an uncommon entity leading to compression of the duodenum between the aorta and the SMA. Normally the coeliac trunk and the superior mesenteric arteries have distinct origins from the abdominal aorta. The celiacomesenteric trunk (CMT) is the least frequently reported anatomic variation of all abdominal vascular anomalies. CMT denotes a common trunk of origin of the coeliac and superior mesenteric arteries. The coexistence of these anomalies has never been reported in the literature. We present a case of a 59-year-old man presenting with duodenal obstruction due to SMA syndrome with CMT. The aortomesenteric angle was 13 degrees and SMA-aorta distance was 8 mm. Patient underwent a gastrojejunostomy. After an uneventful recovery, the patient has been symptom free for 1-year follow-up.

Intra-abdominal small intestinal desmoid tumour mimicking GIST.

Desmoid tumours, also known as aggressive fibromatosis, are fibromuscular neoplasms that arise from mesenchymal cell lines. Desmoid tumours are usually benign and are locally aggressive tumours. We report a case of a 31-year-old man presenting with abdominal mass associated with dyspepsia and early satiety. CT scan demonstrated a large heterogeneous mass adherent to or arising from the jejunum. The patient underwent a successful elective exploratory laparotomy with resection of the tumour arising from the wall of the ileum with a 10 cm margin. The patient had an uneventful recovery and no recurrence at 6-month follow-up. Pathology report and immunohistochemistry analysis revealed the mass to be a primary desmoid tumour of the small bowel, as the tumour was negative for c-kit and Discovered on GIST 1 (DOG-1) and positive for beta-catenin and smooth muscle actin.

Metastasis of carcinoma of buccal mucosa to small intestine causing ileal perforation.

Oral cancers rarely metastasize to the small intestines. In a previously operated case of squamous cell carcinoma of buccal mucosa without any known preoperative distant metastases, we report a case of solitary ileal perforation 3 months after the surgery. The edge of the ileal perforation was positive for squamous cell carcinoma on histopathology. It is important to remember metastases as a cause of acute abdomen in the prior history of oral malignancies.