Protracted Chemical Peritonitis Following Laparoscopy for Dermoid Cyst: A management dilemma.

Dermoid cysts are common benign ovarian tumours arising from totipotent germ cells. We report a rare case of chemical peritonitis and prolonged fever following laparoscopic salpingo-oophorectomy for torsion of a large ovarian dermoid and discuss the management of this patient with prolonged hospital stay, antibiotics and anti-inflammatory use, repeated drainage of the collection as well as re-laparotomy. The occurrence of this rare condition can be extremely distressing for the patient and treating surgeon alike, as the recommendations for management are limited. The management of chemical peritonitis may require one or more surgical procedures along with prolonged anti-inflammatory therapy.

Bilateral abdominopelvic lymphoceles secondary to huge uterine leiomyomas: A case report.

Pelvic lymphocele secondary to uterine leiomyoma has not been previously reported. We report a case of abdominopelvic lymphocele associated with huge uterine fibroids which was managed conservatively. A 39-year-old unmarried lady presented with pressure symptoms in pelvis was diagnosed to have a huge uterine leiomyomas occupying the entire abdomen. Magnetic resonance imaging of pelvis and abdomen demonstrated multiple uterine fibroids. In addition, bilateral cystic structures were seen in the pelvis with extension to the para-colic gutters. During myomectomy, bilateral abdominopelvic lymphoceles were noted which required only fine-needle aspiration. Follow up abdominal ultrasound at 6 weeks, demonstrated spontaneous resolution of these lesions. The pressure exerted by these huge uterine leiomyomas might have possibly obstructed the lymphatic drainage leading to bilateral abdominopelvic lymphoceles. These secondary lymphoceles resolve spontaneously and does not need any further diagnostic procedures or surgical interventions.

Foreign body in the liver: Case report and review of literature.

Foreign bodies in the liver, although rare, have been described previously in the literature. While more common in children, adults may also swallow foreign bodies that can reach the liver by penetrating the stomach, duodenum or colon. We describe the case of a young lady who accidentally swallowed a needle, which was later found in the liver by abdominal X-ray and computed tomography (CT). It was removed intact by laparoscopy. A foreign body in the liver is a rare occurrence. Radiology is important in diagnosis through modalities including plain X-ray, ultrasonography and abdominal CT. Removal can be achieved by laparotomy or laparoscopy.

Asymptomatic Ileal Schwannoma presenting as a Mesenteric Tumour: Case report and review of literature.

A schwannoma is a benign tumour which arises from the schwann cells of the central or peripheral nervous system. Common sites include the head and limbs; it is rare that this tumour arises from the gastrointestinal tract's neural plexus. It is even rarer to find the ileum as the site of origin. We report a patient who presented with a central abdominal mass which was preoperatively diagnosed as a mesenteric tumour. However, immunohistochemistry of the surgically-removed specimen proved it to be a benign ileal schwannoma.

Adrenal oncocytic neoplasm with uncertain malignant potential.

Adrenal oncocytic neoplasms (AONs) are a rare group of tumours with a somewhat uncertain natural history and clinical behaviour. Out of 46 cases of AON reported to date, 6 cases were histologically classified as neoplasms with uncertain malignant potential. We report the case of a 35-year-old male with an incidentally-detected large AON with mostly benign morphology and some characteristics which would make its behaviour uncertain.

Successful term pregnancies after laparoscopic excision of poorly differentiated Sertoli-Leydig cell tumor of the ovary.

Ovarian Sertoli-Leydig cell tumors are rare sex cord-stromal tumors, accounting for less than 1% of ovarian tumors. Majority of these tumors are benign and unilateral, only 3-5% are bilateral. These patients present with clinical features of virilization due to excessive secretion of testosterone from the tumor, however 50% may have no endocrine symptoms. We report a case of poorly differentiated Sertoli-Leydig cell tumour in a woman diagnosed during routine investigation of infertility. She had two spontaneous successful pregnancies after tumor excision laparoscopically.

Surface marking of the deep inguinal ring.

The surface marking of the deep inguinal ring (DIR) is commonly described as being located at either the middle of the inguinal ligament (MIL) or at the mid-inguinal point (MIP); there seems to be no consensus in previous studies in patients with inguinal hernias. The present study was carried out to determine a more accurate location of the DIR in individuals without inguinal hernias. Fifty-two cadavers without inguinal hernias were dissected and the positions of the DIR, MIL, MIP and femoral artery (FA) were determined. The mean distance from the anterior superior iliac spine (ASIS) to the DIR was 62 mm, where as the mean distance from the ASIS to the MIL, MIP, and FA were 55, 66, and 65 mm, respectively. The study showed that in individuals without inguinal hernias the DIR did not correspond to the MIL or MIP, but rather to an area between these two landmarks. The surface marking of the DIR may be best described as at the mid-inguinal region.